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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Abstract

Objective—To assess the knowledge and use of the ABCDEF bundle to implement the Pain, Agitation, Delirium (PAD) guidelines. Design—Worldwide On-line 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 (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.) Measurement and Main Results—There were 1521 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. SATs and SBTs 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 hours/day 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 towards patient- and family-centered ICU care in accordance with the PAD guidelines.