危重症患者实施ABCDEF集束化治疗的相关因素：一项在54个国家开展的国际横断面调查
Factors associated with ABCDEF bundle implementation for critically ill patients: An international cross-sectional survey in 54 countries.
作者信息
Haruna Junpei, Unoki Takeshi, Liu Keibun, Nakamura Kensuke, Inoue Shigeaki, Nishida Osamu
机构信息
Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan.
Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan.
出版信息
SAGE Open Med. 2025 Jan 9;13:20503121241312944. doi: 10.1177/20503121241312944. eCollection 2025.
OBJECTIVES
This study investigated the implementation of the ABCDEF bundle and the factors associated with its implementation according to national income levels.
METHODS
This study is cross-sectional research. We conducted a secondary analysis of an international 1-day point-prevalence study that investigated the implementation of the ABCDEF bundle in critically ill patients. All patients admitted to the ICU were eligible. This study was conducted across 135 ICUs in 54 countries, including data from 664 patients. Outcomes were categorized according to the income level of the country (high-income, middle-income, and low-income countries) in which each ICU was located. A multilevel generalized linear model was developed to identify the factors associated with ABCDEF bundle implementation for each income level.
RESULTS
We identified 664 patients in 79 high-income countries, 278 in 26 middle-income countries, and 287 in 30 low-income countries ICUs. Implementation rates of the ABCDEF bundle were low for all income levels but varied. Few individuals completed the entire bundle on the survey date. Common factors associated with the implementation among all income levels were a multidisciplinary team approach for Element A (pain) and mechanical ventilation use for Element C (sedation), which were also associated with lower Element E (mobility). The existence of a protocol was frequently identified as a promoting factor associated with ABCDEF bundle implementation. The associated factors varied by income level; for example, dedicated intensivists were only identified in high-income countries, but not in middle-income countries or low-income countries.
CONCLUSIONS
The overall low ABCDEF bundle implementation rates necessitate action. As factors associated with its implementation vary according to national income level, tailored strategies are essential for improving ICU care quality.
TRIAL REGISTRATION
NA.
目的
本研究根据国民收入水平调查了ABCDEF集束化治疗方案的实施情况及其相关因素。
方法
本研究为横断面研究。我们对一项国际1日时点患病率研究进行了二次分析，该研究调查了重症患者中ABCDEF集束化治疗方案的实施情况。所有入住重症监护病房（ICU）的患者均符合条件。本研究在54个国家的135个ICU中开展，纳入了664例患者的数据。结果根据各ICU所在国家的收入水平（高收入、中等收入和低收入国家）进行分类。建立了一个多水平广义线性模型，以确定每个收入水平下与ABCDEF集束化治疗方案实施相关的因素。
结果
我们在79个高收入国家的ICU中识别出664例患者，在26个中等收入国家的ICU中识别出278例患者，在30个低收入国家的ICU中识别出287例患者。ABCDEF集束化治疗方案在所有收入水平下的实施率都较低，但存在差异。在调查当日，很少有人完成了整个集束化治疗方案。所有收入水平下与实施相关的常见因素包括，对于A要素（疼痛）采用多学科团队方法，对于C要素（镇静）采用机械通气，这也与较低的E要素（活动能力）相关。方案的存在经常被确定为与ABCDEF集束化治疗方案实施相关的促进因素。相关因素因收入水平而异；例如，专职重症医学专家仅在高收入国家被识别出，而在中等收入国家或低收入国家未被识别出。
结论
ABCDEF集束化治疗方案总体实施率较低，需要采取行动。由于与其实施相关的因素因国民收入水平而异，因此量身定制的策略对于提高ICU护理质量至关重要。
试验注册
无。
Zotero 插件