Evaluation of the Impact of ABCDEF Bundle Compliance Rates on Postintensive Care Syndrome: A Secondary Analysis Study

Daisuke Kawakami; Shigeki Fujitani; Hidenobu Koga; Hisashi Dote; Mumon Takita; Akihiro Takaba; Masaaki Hino; Michitaka Nakamura; Hiromasa Irie; Tomohiro Adachi; Mami Shibata; Jun Kataoka; Akira Korenaga; Tomoya Yamashita; Tomoya Okazaki; Masatoshi Okumura; Takefumi Tsunemitsu

doi:10.1097/CCM.0000000000005980

Evaluation of the Impact of ABCDEF Bundle Compliance Rates on Postintensive Care Syndrome: A Secondary Analysis Study

Crit Care Med. 2023 Dec 1;51(12):1685-1696. doi: 10.1097/CCM.0000000000005980. Epub 2023 Jun 23.

Authors

Daisuke Kawakami^{1

2

3}, Shigeki Fujitani¹, Hidenobu Koga⁴, Hisashi Dote⁵, Mumon Takita¹, Akihiro Takaba⁶, Masaaki Hino⁷, Michitaka Nakamura⁸, Hiromasa Irie⁹, Tomohiro Adachi^{10

11}, Mami Shibata¹², Jun Kataoka^{13

14}, Akira Korenaga¹⁵, Tomoya Yamashita¹⁶, Tomoya Okazaki^{13

17}, Masatoshi Okumura¹⁸, Takefumi Tsunemitsu¹⁹

Affiliations

¹ Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
² Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Japan.
³ Department of Intensive Care Medicine, Iizuka Hospital, Iizuka City, Japan.
⁴ Clinical Research Support Office, Iizuka Hospital, Iizuka City, Japan.
⁵ Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
⁶ Department of Emergency and Critical Care Medicine, JA Hiroshima General Hospital, Hatsukaichi, Japan.
⁷ Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan.
⁸ Department of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Japan.
⁹ Department of Anesthesiology, Kurashiki Central Hospital, Kurashiki, Japan.
¹⁰ Emergency and Critical Care Center, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan.
¹¹ Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
¹² Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Japan.
¹³ Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.
¹⁴ Department of Critical Care Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan.
¹⁵ Department of Emergency Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
¹⁶ Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan.
¹⁷ Emergency Medical Center, Kagawa University Hospital, Kita, Japan.
¹⁸ Department of Anesthesiology, Aichi Medical University Hospital, Nagakute, Japan.
¹⁹ Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.

PMID: 37971720
DOI: 10.1097/CCM.0000000000005980

Abstract

Objectives: This study aimed to examine the association between ABCDEF bundles and long-term postintensive care syndrome (PICS)-related outcomes.

Design: Secondary analysis of the J-PICS study.

Setting: This study was simultaneously conducted in 14 centers and 16 ICUs in Japan between April 1, 2019, and September 30, 2019.

Patients: Adult ICU patients who were expected to be on a ventilator for at least 48 hours.

Interventions: None.

Measurements and main results: Bundle compliance for the last 24 hours was recorded using a checklist at 8:00 am The bundle compliance rate was defined as the 3-day average of the number of bundles performed each day divided by the total number of bundles. The relationship between the bundle compliance rate and PICS prevalence (defined by the 36-item Short Form Physical Component Scale, Mental Component Scale, and Short Memory Questionnaire) was examined. A total of 191 patients were included in this study. Of these, 33 patients (17.3%) died in-hospital and 48 (25.1%) died within 6 months. Of the 96 patients with 6-month outcome data, 61 patients (63.5%) had PICS and 35 (36.5%) were non-PICS. The total bundle compliance rate was 69.8%; the rate was significantly lower in the 6-month mortality group (66.6% vs 71.6%, p = 0.031). Bundle compliance rates in patients with and without PICS were 71.3% and 69.9%, respectively ( p = 0.61). After adjusting for confounding variables, bundle compliance rates were not significantly different in the context of PICS prevalence ( p = 0.56). A strong negative correlation between the bundle compliance rate and PICS prevalence ( r = -0.84, R 2 = 0.71, p = 0.035) was observed in high-volume centers.

Conclusions: The bundle compliance rate was not associated with PICS prevalence. However, 6-month mortality was lower with a higher bundle compliance rate. A trend toward a lower PICS prevalence was associated with higher bundle compliance in high-volume centers.

MeSH terms

Adult
Critical Illness* / epidemiology
Critical Illness* / therapy
Hospital Mortality
Humans
Intensive Care Units*
Ventilators, Mechanical

Supplementary concepts

postintensive care syndrome