Effect Of ABCDEF Bundle Implementation In Mechanically Ventilated Intensive Care Unit Patients To Prevent Delirium

Objectives:To implement ABCDEF bundle of care in ICU patients with mechanical ventilation and measure the effects on prevalence of delirium.Additional outcomes included dosage of sedatives and analgesics,duration of mechanical ventilation,ICU length of stay,incidence of unplanned extubation and mortality.To compare the efficacy,safety and economic benefits of ABCDEF care bundle with a regular routine,and to develop a safe,practical,economical and feasible care bundle.Method:Prospective,randomized trail was conducted in a tertiary hospital intensive care unit(ICU)between December 2017 and March 2019 among 72 ICU patients with mechanical ventilation.Patients that meeting inclusion criteria were randomly divided into the observation group and the control group.Both group were receiving conventional treatment.ABCDEF bundle was implemented in the observation group within 24 hrs after admission.Total intervention durations lasted 10 days.Outcomes included the incidence of delirium,duration of mechanical ventilation,the dosage of sedatives and analgesics,unplanned extubation rate,mortality,satisfaction,length of ICU stay,and expenses,APACHE II scores on the 5th day and 10 th day.Data collection and statistical analysis: Spss20.0 was used for statistical analysis,the measurement data were described by mean plus minus standard deviation()and two independent samples t-test;the counting data were represented by frequency(percentage)[ N(%)],the data were analyzed by chi-square test or Fisher exact probability method.Test level 0.05.Results:1.General Information 72 cases were included in the study,1 case died in the observation group,1 case withdrew midway and 2 case transferred out in the control group,therefore there were 68 effective cases,35 cases in the observation group and 33 cases in the control group.There was no significant difference between the two groups in general data(demographics,disease-related information)(P>0.05).2.Observation Index2.1 Incidence of delirium,mortality,unplanned extubation delirium: 5 cases(14.28%)in observation group and 15 cases(45.45%)in control group There were significant differences between the two groups(P < 0.05).1 patient died in the observation group(2.86%),2 patient died in the control group(6.06%).unplanned extubation: 1 patient in the observation group(2.86%)and 2 patient in the control group(6.06%).2.2 The duration of mechanical ventilation and the dosage of sedative and analgesic The dose of Propofol in the observation group was less than that in the control group [(388.92±70.41)ml vs(458.79±81.77)ml ],The dosage of remifentanil was less than that of the control group [(7.032.18)mg vs(8.653.93)mg ].The duration of mechanical ventilation in the observation group was lower than those in the control group [(5.12±1.21)d vs(8.17±2.30)d ].The difference between two group was statistically significant(P < 0.05)2.3 APACHE II scores Before intervention and on the 5th and 10 th day after intervention,there was significant difference in APACHE II score between two groups(P <0.05),but there was no significant difference before intervention comparison within the group: The scores of the observation group before intervention compared with the 5th and 10 th day,the difference was statistically significant(P < 0.05);the scores of the control group before intervention compared with the 5th day,the difference was not statistically significant(P > 0.05),compared with the 10 th day the difference was statistically significant((P < 0.05).3.Economic benefit indicators There were significant differences of length of stay in ICU and satisfaction between the observation group and the control group(P< 0.05).The difference of ICU cost was not statistically significant(P>0.05).Conclusion:1.The early implementation of ABCDEF bundle of care can effectively prevent or reduce the occurrence of delirium in patients with mechanical ventilation in ICU,shorten the time of mechanical ventilation,reduce the dosage of sedative and analgesic and the cost of ICU stay,improve the outcome of patients and raise the degree of satisfaction It achieves the anticipated curative effect and specific social,economic benefit.2.It provides a safe,effective,economical and feasible strategy for ICU patients with mechanical ventilation,and provides a new theoretical basis for evaluation and prevention of Delirium.