Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil.
Medicine (Baltimore). 2022 Jun 24;101(25):e29499. doi: 10.1097/MD.0000000000029499.
The ABCDE (Awakening and Breathing Coordination of daily sedation and ventilator removal trials, Delirium monitoring and management, and Early mobility and exercise) and ABCDEF (Assessment, prevent and manage pain, Both spontaneous awakening and spontaneous breathing trials, Choice of analgesia and sedation, assess, prevent and manage Delirium, Early mobility and exercise, Family engagement) care bundles consist of small sets of evidence-based interventions and are part of the science behind Intensive Care Unit (ICU) liberation. This review sought to analyse the process of implementation of ABCDE and ABCDEF care bundles in ICUs, identifying barriers, facilitators and changes in perception and attitudes of healthcare professionals; and to estimate care bundle effectiveness and safety.
We selected qualitative and quantitative studies addressing the implementation of ABCDE and ABCDEF bundles in the ICU, identified on MEDLINE, Embase, CINAHL, The Cochrane Library, Web of Science, Epistemonikos, PsycINFO, Virtual Health Library and Open Grey, without restriction on language or date of publication, up to June 2018. The outcomes measured were ICU and hospital length of stay; mechanical ventilation time; incidence and prevalence of delirium or coma; level of agitation and sedation; early mobilization; mortality in ICU and hospital; change in perception, attitude or behaviour of the stakeholders; and change in knowledge of health professionals. Two reviewers independently selected the studies, performed data extraction, and assessed risk of bias and methodological quality. A meta-analysis of random effects was performed.
Twenty studies were included, 13 of which had a predominantly qualitative and 7 a quantitative design (31,604 participants). The implementation strategies were categorized according to the taxonomy developed by the Cochrane Effective Practice and Organization of Care Group and eighty strategies were identified. The meta-analysis results showed that implementation of the bundles may reduce length of ICU stay, mechanical ventilation time, delirium, ICU and hospital mortality, and promoted early mobilization in critically-ill patients.
: This study can contribute to the planning and execution of the implementation process of ABCDE and ABCDEF care bundles in ICUs. However, the effectiveness and safety of these bundles need to be corroborated by further studies with greater methodological rigor.
PROSPERO CRD42019121307.
ABCDE（日常镇静和呼吸机撤离试验的觉醒和呼吸协调、谵妄监测和管理、早期活动和运动）和 ABCDEF（评估、预防和管理疼痛、自主唤醒和自主呼吸试验、镇痛和镇静选择、评估、预防和管理谵妄、早期活动和运动、家庭参与）护理包由一系列小的基于证据的干预措施组成，是重症监护病房（ICU）解放背后的科学的一部分。本综述旨在分析 ICU 中 ABCDE 和 ABCDEF 护理包的实施过程，确定障碍、促进因素以及医护人员认知和态度的变化；并评估护理包的有效性和安全性。
我们在 MEDLINE、Embase、CINAHL、The Cochrane Library、Web of Science、Epistemonikos、PsycINFO、Virtual Health Library 和 Open Grey 上选择了关于 ICU 中 ABCDE 和 ABCDEF 包实施的定性和定量研究，无语言或出版日期限制，截至 2018 年 6 月。测量的结果是 ICU 和医院的住院时间；机械通气时间；谵妄或昏迷的发生率和患病率；躁动和镇静水平；早期活动；ICU 和医院的死亡率；利益相关者的认知、态度或行为的变化；以及卫生专业人员知识的变化。两名审查员独立选择研究、进行数据提取，并评估偏倚风险和方法学质量。进行了随机效应的荟萃分析。
共纳入 20 项研究，其中 13 项为主要定性设计，7 项为定量设计（31604 名参与者）。实施策略根据 Cochrane 有效实践和护理组织组制定的分类法进行分类，共确定了 80 项策略。荟萃分析结果表明，实施这些护理包可能会降低 ICU 住院时间、机械通气时间、谵妄、ICU 和医院死亡率，并促进危重症患者的早期活动。
这项研究可以为 ICU 中 ABCDE 和 ABCDEF 护理包的实施过程的规划和执行提供参考。然而，这些护理包的有效性和安全性还需要通过更具严谨性的方法学研究加以证实。
PROSPERO CRD42019121307。
