“评估疼痛、自主唤醒与呼吸试验、药物选择、谵妄监测/管理、早期运动/活动能力及家庭赋权”（ABCDEF）集束方案的全球调查
Worldwide Survey of the "Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment" (ABCDEF) Bundle.
作者信息
Morandi Alessandro, Piva Simone, Ely E Wesley, Myatra Sheila Nainan, Salluh Jorge I F, Amare Dawit, Azoulay Elie, Bellelli Giuseppe, Csomos Akos, Fan Eddy, Fagoni Nazzareno, Girard Timothy D, Heras La Calle Gabriel, Inoue Shigeaki, Lim Chae-Man, Kaps Rafael, Kotfis Katarzyna, Koh Younsuck, Misango David, Pandharipande Pratik P, Permpikul Chairat, Cheng Tan Cheng, Wang Dong-Xin, Sharshar Tarek, Shehabi Yahya, Skrobik Yoanna, Singh Jeffrey M, Slooter Arjen, Smith Martin, Tsuruta Ryosuke, Latronico Nicola
机构信息
1Department of Rehabilitation, Ancelle Hospital, Cremona, Italy. 2Geriatric Research Group, Brescia, Italy. 3Department of Anesthesia, Critical Care and Emergency, SpedaliCivili University Hospital, Brescia, Italy. 4Division of Pulmonary and Critical Care and Health Services Research, Vanderbilt University and VA Geriatric Research Education Clinical Center (GRECC), Nashville, TN. 5Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India. 6Department of Critical Care, D'or Institute for Research and Education and Post-Graduate Program Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. 7Addis Hiwot General Hospital, Addis Ababa, Ethiopia. 8Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA team, Biostatistics and clinical epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France. 9School of Medicine and Surgery, University of Milano-Bicocca, Milano Geriatric Clinic, San Gerardo University Hospital, Monza, Italy. 10Department of Anaesthesia and Intensive Care, Medical Centre, Hungarian Defence Force, Budapest, Hungary. 11Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 12University Health Network, Toronto, ON, Canada. 13CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh and UPMC Health System, Pittsburgh, PA. 14International Research Project Humanizing Intensive Care (Proyecto HU-CI), Intensive Care Unit, Hospital Universitario de Torrejón, Madrid. Spain. 15Department of Emergency and Critical Care Medicine, Tokai University, School of Medicine, Kanagawa, Japan. 16Department of Pulmonary and Critical Care Medicine Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 17General Hospital Novo mesto, Novo mesto, Slovenia. 18Department of Anaesthesia, Intensive Care and Acute Poisioning, Pomeranian Medical University, Szczecin, Poland. 19Aga Khan University Hospital, Nairobi, Kenya. 20Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine Vanderbilt University Medical Center, Nashville, TN. 21Siriraj Hospital, Bangkok, Thailand. 22Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China. 23Department of Intensive Care Medicine Raymond Poincaré Hospital, Paris, France. 24School of Clinical Sciences, Faculty of Medicine, Monash University & Medical Center, Melbourne, VIC, Australia. 25University New South Wales, Clinical School of Medicine, NSW, Australia. 26Department of Medicine, McGill University, Montreal, QC, Canada. 27Regroupement de Soins Critiques Respiratoires, Réseau de Santé Respiratoire FRQS, Montreal, QC, Canada. 28Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 29Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada. 30Department of Intensive Care Medicine, Brain Center Rudolf Magnus, Utrecht University, University Medical Center Utrecht, The Netherlands. 31Department of Neurocritical Care, University College London Hospitals, UCLH/UCL National Institute for Health Research Biomedical Research Centre, London, United Kingdom. 32Acute & General Medicine, Yamaguchi Graduate School of Medicine, Yamaguchi, Japan. 33Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. 34Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.
出版信息
Crit Care Med. 2017 Nov;45(11):e1111-e1122. doi: 10.1097/CCM.0000000000002640.
OBJECTIVES
To assess the knowledge and use of the Assessment, prevention, and management of pain; spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle to implement the Pain, Agitation, Delirium guidelines.
DESIGN
Worldwide online survey.
SETTING
Intensive care.
INTERVENTION
A cross-sectional online survey using the Delphi method was administered to intensivists worldwide, to assess the knowledge and use of all aspects of the ABCDEF bundle.
MEASUREMENT AND MAIN RESULTS
There were 1,521 respondents from 47 countries, 57% had implemented the ABCDEF bundle, with varying degrees of compliance across continents. Most of the respondents (83%) used a scale to evaluate pain. Spontaneous awakening trials and spontaneous breathing trials are performed in 66% and 67% of the responder ICUs, respectively. Sedation scale was used in 89% of ICUs. Delirium monitoring was implemented in 70% of ICUs, but only 42% used a validated delirium tool. Likewise, early mobilization was "prescribed" by most, but 69% had no mobility team and 79% used no formal mobility scale. Only 36% of the respondents assessed ICU-acquired weakness. Family members were actively involved in 67% of ICUs; however, only 33% used dedicated staff to support families and only 35% reported that their unit was open 24 hr/d for family visits.
CONCLUSIONS
The current implementation of the ABCDEF bundle varies across individual components and regions. We identified specific targets for quality improvement and adoption of the ABCDEF bundle. Our data reflect a significant but incomplete shift toward patient- and family-centered ICU care in accordance with the Pain, Agitation, Delirium guidelines.
目的
评估疼痛评估、预防与管理；自主唤醒与呼吸试验；镇痛与镇静的选择；谵妄评估；早期活动与锻炼；以及家属参与和赋权（ABCDEF）集束化治疗措施的知识掌握情况与应用情况，以实施疼痛、躁动、谵妄指南。
设计
全球在线调查。
背景
重症监护。
干预措施
采用德尔菲法对全球范围内的重症监护医生进行横断面在线调查，以评估ABCDEF集束化治疗措施各方面的知识掌握情况与应用情况。
测量指标与主要结果
来自47个国家的1521名受访者参与了调查，57%的人实施了ABCDEF集束化治疗措施，各洲的依从程度各不相同。大多数受访者（83%）使用量表评估疼痛。分别有66%和67%的受访重症监护病房进行了自主唤醒试验和自主呼吸试验。89%的重症监护病房使用了镇静量表。70%的重症监护病房实施了谵妄监测，但只有42%的病房使用了经过验证的谵妄评估工具。同样，大多数病房都“规定”了早期活动，但69%的病房没有活动团队，79%的病房未使用正式的活动量表。只有36%的受访者评估了重症监护病房获得性肌无力。67%的重症监护病房有家属积极参与；然而，只有33%的病房安排了专门人员支持家属，只有35%的病房报告其科室每天24小时对家属开放探视。
结论
ABCDEF集束化治疗措施目前在各个组成部分和地区的实施情况各不相同。我们确定了质量改进和采用ABCDEF集束化治疗措施的具体目标。我们的数据反映出，根据疼痛、躁动、谵妄指南，向以患者和家属为中心的重症监护转变取得了显著但并不完全的进展。
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