TY - JOUR
T1 - Caring for Critically Ill Children With the ICU Liberation Bundle (ABCDEF)
T2 - Results of the Pediatric Collaborative∗
AU - Lin, John C.
AU - Srivastava, Avantika
AU - Malone, Sara
AU - Jennison, Susan
AU - Simino, Megan
AU - Traube, Chani
AU - Larose, Kimberly
AU - Kawai, Yu
AU - Neu, Lori
AU - Kudchadkar, Sapna
AU - Wieczorek, Beth
AU - Hajnik, Krista
AU - Kordik, Christina M.
AU - Kumar, Vishakha K.
AU - Aghamohammadi, Sara
AU - Arteaga, Grace M.
AU - Smith, Heidi A.B.
AU - Spentzas, Thomas
AU - Orman, Andrea
AU - Landman, Becky Mc Gee
AU - Valdivia, Hector
AU - Browne, Heather
AU - Fang, Timothy
AU - Zimmerman, Jerry J.
N1 - Publisher Copyright:
© 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - OBJECTIVES: Assess clinical outcomes following PICU Liberation ABCDEF Bundle utilization. DESIGN: Prospective, multicenter, cohort study. SETTING: Eight academic PICUs. PATIENTS: Children greater than 2 months with expected PICU stay greater than 2 days and need for mechanical ventilation (MV). INTERVENTIONS: ABCDEF Bundle implementation. MEASUREMENT AND MAIN RESULTS: Over an 11-month period (3-mo baseline, 8-mo implementation), Bundle utilization was measured for 622 patients totaling 5,017 PICU days. Risk of mortality was quantified for 532 patients (4,275 PICU days) for correlation between Bundle utilization and MV duration, PICU length of stay (LOS), delirium incidence, and mortality. Utilization was analyzed as subject-specific (entire PICU stay) and day-specific (single PICU day). Median overall subject-specific utilization increased from 50% during the 3-month baseline to 63.9% during the last four implementation months (p < 0.001). Subject-specific utilization for elements A and C did not change; utilization improved for B (0-12.5%; p = 0.007), D (22.2-61.1%; p < 0.001), E (17.7-50%; p = 0.003), and F (50-79.2%; p = 0.001). We observed no association between Bundle utilization and MV duration, PICU LOS, or delirium incidence. In contrast, on adjusted analysis, every 10% increase in subject-specific utilization correlated with mortality odds ratio (OR) reduction of 34%, p < 0.001; every 10% increase in day-specific utilization correlated with a mortality OR reduction of 1.4% (p = 0.006). CONCLUSIONS: ABCDEF Bundle is applicable to children. Although enhanced Bundle utilization correlated with decreased mortality, increased utilization did not correlate with duration of MV, PICU LOS, or delirium incidence. Additional research in the domains of comparative effectiveness, implementation science, and human factors engineering is required to understand this clinical inconsistency and optimize PICU Liberation concept integration into clinical practice.
AB - OBJECTIVES: Assess clinical outcomes following PICU Liberation ABCDEF Bundle utilization. DESIGN: Prospective, multicenter, cohort study. SETTING: Eight academic PICUs. PATIENTS: Children greater than 2 months with expected PICU stay greater than 2 days and need for mechanical ventilation (MV). INTERVENTIONS: ABCDEF Bundle implementation. MEASUREMENT AND MAIN RESULTS: Over an 11-month period (3-mo baseline, 8-mo implementation), Bundle utilization was measured for 622 patients totaling 5,017 PICU days. Risk of mortality was quantified for 532 patients (4,275 PICU days) for correlation between Bundle utilization and MV duration, PICU length of stay (LOS), delirium incidence, and mortality. Utilization was analyzed as subject-specific (entire PICU stay) and day-specific (single PICU day). Median overall subject-specific utilization increased from 50% during the 3-month baseline to 63.9% during the last four implementation months (p < 0.001). Subject-specific utilization for elements A and C did not change; utilization improved for B (0-12.5%; p = 0.007), D (22.2-61.1%; p < 0.001), E (17.7-50%; p = 0.003), and F (50-79.2%; p = 0.001). We observed no association between Bundle utilization and MV duration, PICU LOS, or delirium incidence. In contrast, on adjusted analysis, every 10% increase in subject-specific utilization correlated with mortality odds ratio (OR) reduction of 34%, p < 0.001; every 10% increase in day-specific utilization correlated with a mortality OR reduction of 1.4% (p = 0.006). CONCLUSIONS: ABCDEF Bundle is applicable to children. Although enhanced Bundle utilization correlated with decreased mortality, increased utilization did not correlate with duration of MV, PICU LOS, or delirium incidence. Additional research in the domains of comparative effectiveness, implementation science, and human factors engineering is required to understand this clinical inconsistency and optimize PICU Liberation concept integration into clinical practice.
KW - ABCDEF
KW - Bundle
KW - delirium
KW - intensive care unit liberation
KW - pediatric critical care
UR - http://www.scopus.com/inward/record.url?scp=85166442743&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000003262
DO - 10.1097/PCC.0000000000003262
M3 - Article
C2 - 37125798
AN - SCOPUS:85166442743
SN - 1529-7535
VL - 24
SP - 636
EP - 651
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 8
ER -