Outcome of improved care bundle in acute respiratory failure patients

Abstract

Background: Prolonged physical immobilization has negative effects on patients on mechanical ventilation (MV).

Aims: To introduce a quality improvement programme with early mobilization on the outcomes of patients on MV in the intensive care unit (ICU). We particularly studied the impact of the ABCDE (daily Awakening, Breathing trial, drug Co-ordination, Delirium survey and treatment, and Early mobilization) bundle on the outcome of MV patients with acute respiratory failure in the ICU.

Design: This is a retrospective, observational, before-and-after outcome study.

Method: Adult patients on MV (N = 173) admitted to a medical centre ICU with 19 beds in southern Taiwan were enrolled. A multidisciplinary team (critical care nurse, nursing assistant, respiratory therapist, physical therapist, patient's family) performed ABCDE with early mobilization within 72 hours of MV when patients became haemodynamically stable (twice daily [30 minutes each time], 5 days/week during family visits and in co-operation with family members).

Main outcome measures: The main outcome measures were differences of MV duration, ICU and hospital length of stay, medical costs, and intra-hospital mortality before (phase 1) and after (phase 2) bundle care.

Results: Phases 1 and 2 revealed several differences, including Acute Physiology and Chronic Health Evaluation (APACHE) II and blood urea nitrogen and creatinine levels. The patients in phase 2 had a significantly lower mean ICU length of stay (8.0 vs 12.0 days) but a similar MV duration (170.2 vs 188.1 hours), hospital stays (21.1 vs 23.3 days) with reduced costs (22.1 vs 31.7 × 10⁴ NT$), and intra-hospital mortality (8.3 vs. 36.6%).

Conclusions: The ABCDE care bundle improved the outcome of acute renal failure patients with MV, especially shortening ICU stays and lowering medical costs and hospital mortality.

Relevance to clinical practice: An ABCDE care bundle with an inter-professional, evidence-based, multicomponent ICU early mobilization management strategy can reduce ICU stays, hospital expenditure, and mortality among acute respiratory failure patients with MV.

Keywords: ICU; MV; early mobilization; mechanical ventilation; rehabilitation.