The Sedative And Analgesic Effect Of ABCDE Bundle In Patients With Mechanical Ventilation

Objective:To evaluate the sedative and analgesic effect of ABCDE bundle in patients with mechanical ventilation.Methods:It’s a prospective cohort study. One hundred and eight patients with mechanical ventilation(MV) who were admitted in intensive care unit (ICU) from Jan to Oct2011were divided into2groups. The patients in the control group (n=51)received routine care, including compositive nursing interventions assessment, observation and evaluation of the level of consciousness and analgosedation, monitoring and protection of organ function during the analgosedation treatment,etc. However, the patients in the intervention group (n=57)received the ABCDE bundle nursing, that is, Awakening and Breathing Coordination of daily sedation and ventilator removal trials, Choice of sedative or analgesic exposure, Delirium monitoring and management, and Early mobility and exercise.The dose of sedative and analgesic drugs, the duration of mechanical ventilation, the length of ICU stay(ICU-LOS),the total length of hospital stay(hospital LOS), the incidence of delirium and28-day hospital survival were compared between the two groups.We use statistic software SPSS18.0for statistical analysis, and normal distribution data are presented as mean±standard deviation(χ±s), two samples were compared using the t test, and the rate of the two samples were analyzed using the X2test, P<0.05was considered statistically significant.Results:The dose of Morphine and Midazolam, the duration of mechanical ventilation, ICU-LOS, hospital LOS of the intervention group were significantly lower than that of the control group (P<0.001),and the incidence of delirium was reduced significantly (P<0.05),The details as follows:The total dose of morphine injection in the intervention group (group B) was (210.7±71.3) mg, significantly lower than that of thecontrol group(group A)[(378.3±82.5) mg, P<0.001]. And the average dose of morphine injection of group B was (0.027±0.007) mg/kg/h, significantly lower than that of control group(group A)[(0.051±0.006) mg/kg/h, P<0.001]. The total dose of Midazolam injection of group B was (226.6±96.2) mg, significantly lower than that of group A [(398.7±102.3) mg, P<0.001], And the average dose of Midazolam injection of group B was (0.058±0.025) mg/kg/h, significantly lower than that of group A[(0.081±0.028) mg/kg/h, P<0.001].The duration of mechanical ventilation of group B was(5.52±1.98)d, significantly shorter than that of group A[(7.97±3.43)d, P<0.001], ICU-Length of stay (ICU-LOS) of group B was (6.53±3.04)d, significantly shorter than that of group A [(9.81±4.21)d, P<0.001], hospital Length of stay(hospital LOS) of group B was (13.6±5.03)d, significantly shorter than that of group A [(16.1±4.35)d, P<0.001].And the incidence of delirium was reduced significantly (33.3%VS54.9%,P<0.05) after implementing the intervention of ABCDE Bundle, however, the28-day hospital survival of group B was82.5%, not significantly different from that of group A(74.5%,P>0.05).Conclusion:The sedative and analgesic effect of ABCDE bundle is better than routine nursing care in patients with mechanical ventilation.