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ABCDE 方案实施情况调查。

A Survey of Implementation of ABCDE Protocols.

机构信息

Section of Pulmonary, Critical Care, Allergy and Immunology, Department of Internal Medicine, 12280Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.

Department of Biostatistics and Epidemiology, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.

出版信息

J Intensive Care Med. 2023 Jan;38(1):86-94. doi: 10.1177/08850666221109157. Epub 2022 Jun 22.

DOI:10.1177/08850666221109157

PMID:35731642

Abstract

BACKGROUND

Spontaneous awakening trials (SATs), spontaneous breathing trials (SBTs), delirium assessment/management, early mobility have been termed the ABCDE bundle. The ABCDE bundle has been proven to improve patient outcomes. However, there is often a long gap in dissemination and implementation of evidence-based medicine.

OBJECTIVES

To determine the prevalent implementation of and determinants for ABCDE protocol adoption in Pennsylvania.

METHODS

We developed a survey of ABCDE bundle protocols. We surveyed factors around implementation including written protocol presence, standardized assessments to guide protocols, timing of creation of protocols, and estimated adherence to protocols. We also collected data on factors that might be determinants for protocol adoption including ICU staffing models, hospital and ICU level factors. We validated the survey tool using the Michigan Health and Hospital Association Keystone ICU collaborative. We then administered the validated survey to a leader of the medical ICU or mixed medical-surgical ICU of all Pennsylvania Hospitals. Multivariable logistic and ordinal regression were used to determine associations between ICU staffing models and hospital and ICU level factors with the presence of ABCDE bundle protocols.

RESULTS

In the study cohort of Pennsylvania ICUs (n = 144), we had 100 respondents (69% response). The median number of hospital beds among the respondents was 185 (IQR 111-355) with a median of 14 ICU beds (IQR 10-20). 86% reported spontaneous awakening trial protocols, 60% reported spontaneous breathing trial protocols, 43% reported delirium assessment/management protocols, and 27% reported early mobility protocols. Being a medical ICU compared to a mixed medical-surgical ICU (OR 3.48, 95% CI 1.19-10.21, = .02) and presence of multidisciplinary rounds (OR 4.97, 95% CI 2.07-11.94, < .001) were associated with increasing number of ABCDE bundle protocol components.

CONCLUSIONS

Variable implementation of ABCDE bundle protocols was present across Pennsylvania. Team communication is important to implementation of these protocols.

摘要

背景

自主唤醒试验（SATs）、自主呼吸试验（SBTs）、谵妄评估/管理、早期活动被称为 ABCDE 捆绑包。ABCDE 捆绑包已被证明可改善患者预后。然而，基于证据的医学的传播和实施往往存在很长的时间差。

目的

确定宾夕法尼亚州 ABCDE 方案采用的普遍实施情况和决定因素。

方法

我们制定了 ABCDE 捆绑包方案的调查。我们调查了实施情况的相关因素，包括书面方案的存在、指导方案的标准化评估、方案制定的时间以及对方案的估计依从性。我们还收集了可能影响方案采用的因素的数据，包括 ICU 人员配备模式、医院和 ICU 级别因素。我们使用密歇根健康和医院协会基石 ICU 合作组织对调查工具进行了验证。然后，我们向宾夕法尼亚州所有医院的医疗 ICU 或混合内科-外科 ICU 的负责人发放了经过验证的调查。多变量逻辑和有序回归用于确定 ICU 人员配备模式和医院及 ICU 级别因素与 ABCDE 捆绑包方案的存在之间的关联。

结果

在我们的宾夕法尼亚州 ICU 研究队列（n=144）中，有 100 名受访者（69%的回应率）。受访者所在医院的平均病床数为 185 张（IQR 111-355），平均 ICU 床位数为 14 张（IQR 10-20）。86%的人报告了自主唤醒试验方案，60%的人报告了自主呼吸试验方案，43%的人报告了谵妄评估/管理方案，27%的人报告了早期活动方案。与混合内科-外科 ICU 相比，医疗 ICU（比值比 3.48，95%置信区间 1.19-10.21， = .02）和多学科查房的存在（比值比 4.97，95%置信区间 2.07-11.94， < .001）与 ABCDE 捆绑包方案组件数量的增加相关。