“Bundle” of Practices Reduces Risks of Delirium and Immobility, INQRI Study Shows

Patients in hospital intensive care units (ICUs) are often put on ventilators, sedated, and/or immobilized for part of their stays. Unfortunately, all of these procedures can also put them at risk for delirium, which can be debilitating and have long-term negative effects. A new study funded by INQRI and published in Critical Care Medicine, finds that implementing a set of practices to encourage patients’ mobility and reduce sedation effectively reduces delirium and the need for a ventilator, and increases patients’ mobility during hospitalization, which decreases weakness.

The study tested the effectiveness and safety of implementing a bundled set of evidence-based practices into everyday practice in the ICU. It is called the ABCDE bundle, for Awakening and Breathing Coordination, Delirium monitoring and management, and Early mobility.

The research team, led by Michele Balas and William Burke, examined the results of having a nurse-led interdisciplinary team use the bundle with roughly 150 patients in five adult ICUs, one step-down unit, and an oncology/special care unit in a medical center and compared their outcomes with those of a similar group of patients in the same setting prior to implementation of the bundle.

Patients in the study who were managed with the ABCDE bundle spent more days breathing without a ventilator (a median of 24 days compared with a median of 21 days). Fewer of those patients experienced delirium, compared with the other group (48.7% compared with 62.3%), and delirium duration was reduced by one day. Patients treated with the bundle had twice the odds of getting out of bed at least once during their hospital stays, and lower hospital mortality (11.3% compared with 19.9%).

ABCDE is a bundle of interventions tested in clinical trials that have been adapted for everyday use in the ICU. The bundle is founded on three primary principles: improving communication among members of the ICU team; standardizing care processes; and breaking the cycle of oversedation and prolonged attachment to a ventilator that can lead to delirium and weakness.