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This #medthread is for those providing critical care in pop-up ICU's right now...
💥 A primer on the ABCDEF ICU liberation bundle 💥
Take home: less delirium = lives saved
#medtwitter #weareallintensivistsrightnow
This #medthread is for those providing critical care in pop-up ICU's right now...
💥 A primer on the ABCDEF ICU liberation bundle 💥
Take home: less delirium = lives saved
#medtwitter #weareallintensivistsrightnow
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In 2013 @SCCM published the ABCDEF bundle to:
💡 Reduce ICU delirium
💡 Deliver high value care
💡 Improve short/longterm critical care outcomes
While individual components can be implemented, best practice uses the whole bundle w/ all patients.
sccm.org/ICULiberation/…
In 2013 @SCCM published the ABCDEF bundle to:
💡 Reduce ICU delirium
💡 Deliver high value care
💡 Improve short/longterm critical care outcomes
While individual components can be implemented, best practice uses the whole bundle w/ all patients.
sccm.org/ICULiberation/…
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A = Assess, prevent, and manage pain
ICU patients are often unable to communicate pain.
The CPOT (Critical-Care Pain Observation Tool) is a validated, non-verbal assessment to ensure pain is controlled (score of >2 = pain that should be treated)
ncbi.nlm.nih.gov/pubmed/16823021
A = Assess, prevent, and manage pain
ICU patients are often unable to communicate pain.
The CPOT (Critical-Care Pain Observation Tool) is a validated, non-verbal assessment to ensure pain is controlled (score of >2 = pain that should be treated)
ncbi.nlm.nih.gov/pubmed/16823021
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B = Both spontaneous awakening and breathing trials (SAT/SBT)
Pairing of SATs and SBTs is associated with decreased:
😀 Time on ventilator
😀 Length of stay
😀 Cumulative sedative dose
😀 1 year mortality (!)
ncbi.nlm.nih.gov/pubmed/18191684
B = Both spontaneous awakening and breathing trials (SAT/SBT)
Pairing of SATs and SBTs is associated with decreased:
😀 Time on ventilator
😀 Length of stay
😀 Cumulative sedative dose
😀 1 year mortality (!)
ncbi.nlm.nih.gov/pubmed/18191684
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C = Choice of analgesia and sedation
This has two components:
✅ Targeting sedation to a specific goal (with a scale such as RASS), employing minimum effective doses
✅ Avoiding deliriogenic medications (eg benzodiazepines) where possible
ncbi.nlm.nih.gov/pubmed/12421743
C = Choice of analgesia and sedation
This has two components:
✅ Targeting sedation to a specific goal (with a scale such as RASS), employing minimum effective doses
✅ Avoiding deliriogenic medications (eg benzodiazepines) where possible
ncbi.nlm.nih.gov/pubmed/12421743
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D = Delirium (assess, prevent, manage)
Delirium = ⬆️ mortality
- Assess with a validated scale (CAM-ICU)
- Minimize sedation, choose less deliriogenic sedatives if needed, normalize sleep/wake cycle
Tip: Open curtains to ensure sunlight exposure
sccm.org/ICULiberation/…
D = Delirium (assess, prevent, manage)
Delirium = ⬆️ mortality
- Assess with a validated scale (CAM-ICU)
- Minimize sedation, choose less deliriogenic sedatives if needed, normalize sleep/wake cycle
Tip: Open curtains to ensure sunlight exposure
sccm.org/ICULiberation/…
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E = Early mobility/exercise
Early mobility in intubated patients is associated with ⬇️ delirium and time on vent, ⬆️ functional status at discharge
Goal = achieve maximum mobility for every patient, every day
ncbi.nlm.nih.gov/pubmed/19446324
E = Early mobility/exercise
Early mobility in intubated patients is associated with ⬇️ delirium and time on vent, ⬆️ functional status at discharge
Goal = achieve maximum mobility for every patient, every day
ncbi.nlm.nih.gov/pubmed/19446324
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F= Family engagement/empowerment
This is especially challenging during COVID-19 as families can't visit the hospital.
Some on-the-fly innovations have included families teleconferencing on rounds or connecting with loved ones on iPads via FaceTime.
wired.com/story/ipads-cr…
F= Family engagement/empowerment
This is especially challenging during COVID-19 as families can't visit the hospital.
Some on-the-fly innovations have included families teleconferencing on rounds or connecting with loved ones on iPads via FaceTime.
wired.com/story/ipads-cr…
