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
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- Simone Piva
- Department of Anesthesia, Critical Care and Emergency, SpedaliCivili University Hospital, Brescia, Italy.
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- E. Wesley Ely
- Division of Pulmonary and Critical Care and Health Services Research, Vanderbilt University and VA Geriatric Research Education Clinical Center (GRECC), Nashville, TN.
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- Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India.
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- Jorge I.F. Salluh
- Department of Critical Care, D’or Institute for Research and Education and Post-Graduate Program Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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- Dawit Amare
- Addis Hiwot General Hospital, Addis Ababa, Ethiopia.
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- Elie Azoulay
- Medical 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.
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- Akos Csomos
- Department of Anaesthesia and Intensive Care, Medical Centre, Hungarian Defence Force, Budapest, Hungary.
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- Nazzareno Fagoni
- Department of Anesthesia, Critical Care and Emergency, SpedaliCivili University Hospital, Brescia, Italy.
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- Timothy D. Girard
- CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh and UPMC Health System, Pittsburgh, PA.
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- Gabriel Heras La Calle
- International Research Project Humanizing Intensive Care (Proyecto HU-CI), Intensive Care Unit, Hospital Universitario de Torrejón, Madrid. Spain.
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- Shigeaki Inoue
- Department of Emergency and Critical Care Medicine, Tokai University, School of Medicine, Kanagawa, Japan.
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- Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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- Rafael Kaps
- General Hospital Novo mesto, Novo mesto, Slovenia.
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- Katarzyna Kotfis
- Department of Anaesthesia, Intensive Care and Acute Poisioning, Pomeranian Medical University, Szczecin, Poland.
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- Younsuck Koh
- Department of Pulmonary and Critical Care Medicine Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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- David Misango
- Aga Khan University Hospital, Nairobi, Kenya.
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- Pratik P. Pandharipande
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine Vanderbilt University Medical Center, Nashville, TN.
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- Chairat Permpikul
- Siriraj Hospital, Bangkok, Thailand.
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- Cheng Cheng Tan
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China.
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- Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China.
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- Tarek Sharshar
- Department of Intensive Care Medicine Raymond Poincaré Hospital, Paris, France.
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- Arjen Slooter
- Department of Intensive Care Medicine, Brain Center Rudolf Magnus, Utrecht University, University Medical Center Utrecht, The Netherlands.
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- Martin Smith
- Department of Neurocritical Care, University College London Hospitals, UCLH/UCL National Institute for Health Research Biomedical Research Centre, London, United Kingdom.
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- Ryosuke Tsuruta
- Acute & General Medicine, Yamaguchi Graduate School of Medicine, Yamaguchi, Japan.
説明
<jats:sec> <jats:title>Objectives:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Design:</jats:title> <jats:p>Worldwide online survey.</jats:p> </jats:sec> <jats:sec> <jats:title>Setting:</jats:title> <jats:p>Intensive care.</jats:p> </jats:sec> <jats:sec> <jats:title>Intervention:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Measurement and Main Results:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>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.</jats:p> </jats:sec>
収録刊行物
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- Critical Care Medicine
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Critical Care Medicine 45 (11), e1111-e1122, 2017-11
Ovid Technologies (Wolters Kluwer Health)