TABLE 3.
Implementation of the ABCDEF Bundle and Other Supportive Measures for Patients With Coronavirus Disease 2019 Infection
| Variables | Total Patients (n = 262) | Patients Without Mechanical Ventilation and ECMO (n = 137) | Patients on Mechanical Ventilation (n = 124) | Patients on ECMO (n = 12) |
|---|---|---|---|---|
| Implementation of each element of the ABCDEF bundle | ||||
| Patients receiving element A, n (%)a | 118 (45) | 42 (31) | 75 (60) | 12 (100) |
| The presence of a target goal to control patient’s pain, n (%) | 136 (52) | 49 (36) | 86 (69) | 10 (83) |
| Patients receiving element Ba | ||||
| Spontaneous awakening trial during continuous sedation, n (%)a,b | 29 (28) | 4 (19) | 25 (32) | |
| Spontaneous breathing trial on mechanical ventilation, n (%)a,c | 35 (28) | 35 (28) | ||
| Patients receiving element C, n (%)a | 136 (52) | 45 (33) | 90 (73) | 12 (100) |
| The presence of a target goal to control patient’s sedation, n (%) | 157 (60) | 49 (36) | 107 (86) | 12 (100) |
| Patients receiving element D, n (%)a | 100 (38) | 37 (27) | 62 (50) | 7 (58) |
| Patients diagnosed with delirium, n (%) | 30 (11) | 9 (7) | 21 (17) | 2 (17) |
| Patients receiving element E, n (%)a | 93 (35) | 88 (64) | 5 (4) | 1 (8) |
| The highest mobility level according to the ICU Scale, median (interquartile range)d | 2 (0–6) | 5 (3–8) | 0 (0–1) | 0 [0-2] |
| Patients receiving element F, n (%)a | 42 (16) | 23 (17) | 19 (15) | 1 (8) |
| The implementation of other essential ICU care | ||||
| Patients receiving standardized nutrition support, n (%)e | 259 (99) | 136 (99) | 122 (98) | 12 (100) |
| Feeding tube, n (%) | 149 (57) | 39 (28) | 110 (89) | 10 (83) |
| Oral, n (%) | 113 (43) | 105 (77) | 0 (0) | 1 (8) |
| Total parenteral nutrition, n (%) | 16 (6) | 5 (4) | 12 (10) | 2 (17) |
| Estimated energy in nutrition provided within last 24 hr (kcal/d), n (%) | ||||
| < 1,000 | 24 (9) | 12 (9) | 12 (10) | 2 (17) |
| 1,000 to < 1,500 | 118 (45) | 76 (55) | 42 (34) | 3 (25) |
| 1,500 to < 2,000 | 105 (40) | 45 (33) | 60 (48) | 6 (50) |
| ≥ 2,000 | 15 (6) | 4 (3) | 10 (8) | 1 (8) |
| Estimated protein in nutrition provided within last 24 hr (g/kg/d), n (%) | ||||
| < 1.2 g/kg/d | 157 (60) | 82 (60) | 75 (60) | 7 (58) |
| ≥ 1.2 g/kg/d | 105 (40) | 55 (40) | 49 (40) | 5 (42) |
| Patients receiving a regular standardized sleep assessment, n (%) | 86 (33) | 34 (25) | 51 (41) | 6 (50) |
| Patients receiving ICU diary, n (%) | 65 (25) | 50 (36) | 15 (12) | 1 (8) |
| Patients placed in physical restraints at any time on the survey date, n (%) | 58 (22) | 23 (17) | 35 (28) | 5 (42) |
ECMO = extracorporeal membrane oxygenation.
aOperational definitions of each element of the ABCDEF bundle are shown in Supplemental Table 3 (http://links.lww.com/CCX/A515).
bPercentages were calculated by dividing by the numbers of sedated patients. The total number of sedated patients was 102. Twenty-one patients who were sedated were not receiving mechanical ventilation or extracorporeal membrane oxygenation. Seventy-nine sedated patients were receiving mechanical ventilation and 10 were receiving extracorporeal membrane oxygenation.
cPercentage was calculated by dividing by the number of the patients on mechanical ventilation or 124.
dThe highest exercise/rehabilitation level performed at the survey date was assessed based on the ICU Mobility Scale (26). IMS 0: nothing (lying in bed, passive exercise); 1: sitting in bed, exercises in bed; 2: passively moved to chair (no standing); 3: sitting over edge of bed; 4: standing; 5: transferring bed to chair; 6: marching in place (at bedside); 7: walking with assistance of two or more people; 8: walking with assistance of one person; 9: walking independently with a gait aid; 10: walking independently without a gait aid.
eNineteen patients received nutrition via multiple routes. Of those, 15 received enteral and oral nutrition, two received enteral and total parenteral nutrition, and two received oral and parenteral nutrition.
The ABCDEF bundle is a collection of six elements (A, B, C, D, E, and F) which represents an evidence-based approach for clinicians to optimize patients recovery and outcomes in ICU.