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ABCDEF Bundle Practices for Critically Ill Children: An International Survey of 161 PICUs in 18 Countries.
- Source :
-
Critical care medicine [Crit Care Med] 2022 Jan 01; Vol. 50 (1), pp. 114-125. - Publication Year :
- 2022
-
Abstract
- Objectives: To evaluate current international practice in PICUs regarding components of the "Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Sedation, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Engagement/Empowerment" (ABCDEF) bundle.<br />Design: Online surveys conducted between 2017 and 2019.<br />Setting: One-hundred sixty-one PICUs across the United States (n = 82), Canada (n = 14), Brazil (n = 27), and Europe (n = 38) participating in the Prevalence of Acute Rehabilitation for Kids in the PICU study.<br />Interventions: None.<br />Measurements and Main Results: Of the 161 participating PICUs, 83% were in academic teaching hospitals and 42% were in free-standing children's hospitals. Median size was 16 beds (interquartile range, 10-24 beds). Only 15 PICUs (9%) had incorporated all six ABCDEF bundle components into routine practice. Standardized pain assessment (A) was the most common (91%), followed by family engagement (F, 88%) and routine sedation assessment (C) with validated scales (84%). Protocols for testing extubation readiness or conducting spontaneous breathing trials (B) were reported in 57%, with 34% reporting a ventilator weaning protocol. Routine delirium monitoring with a validated screening tool (D) was reported by 44% of PICUs, and 26% had a guideline, protocol, or policy for early exercise/mobility (E). Practices for spontaneous breathing trials were variable in 29% of Canadian PICUs versus greater than 50% in the other regions. Delirium monitoring was lowest in Brazilian PICUs (18%) versus greater than 40% in other regions, and family engagement was reported in 55% of European PICUs versus greater than 90% in other regions.<br />Conclusions: ABCDEF bundle components have been adopted with substantial variability across regions. Additional research must rigorously evaluate the efficacy of specific elements with a focus on B, D, E, and full ABCDEF bundle implementation. Implementation science is needed to facilitate an understanding of the barriers to ABCDEF implementation and sustainability with a focus on specific cultural and regional differences.<br /> (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
- Subjects :
- Anesthesia standards
Clinical Protocols
Delirium diagnosis
Delirium prevention & control
Delirium therapy
Family
Humans
Intensive Care Units, Pediatric standards
Pain Measurement standards
Pain Measurement statistics & numerical data
Patient Care Bundles standards
Ventilator Weaning standards
Critical Illness therapy
Intensive Care Units, Pediatric statistics & numerical data
Patient Care Bundles statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1530-0293
- Volume :
- 50
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Critical care medicine
- Publication Type :
- Academic Journal
- Accession number :
- 34259659
- Full Text :
- https://doi.org/10.1097/CCM.0000000000005168