Pain, agitation, and delirium occur frequently in ICU patients. Prompt recognition and treatment help optimize ICU patient outcomes. The Society of Critical Care Medicine (SCCM) published guidelines detailing best practices for managing pain, sedation, and delirium in ICU patients to facilitate ventilator weaning, sleep, and early mobilization of patients. The ICU liberation's ABCDEF bundle was created to help translate these guideline recommendations into clinical practice.
In several large, multicenter trials, improved bundle performance leads to improved ICU patient outcomes and lower healthcare costs. The SCCM's ICU Liberation Collaborative, which included over 15,000 adult ICU patients from 68 U.S. hospitals, showed that bundle implementation is associated with significant improvements in survival, duration of mechanical ventilation (MV), delirium and coma, ICU readmissions, and discharge disposition of ICU survivors. Other studies have similarly shown that bundle implementation is associated with improved survival, more delirium and coma free days, reduced ICU LOS, MV duration, and benzodiazepine use, and a lower prevalence of PICS. Bundle performance also helps to promote interprofessional (IPT) teamwork and collaboration in the ICU, and patient and family-centered care.
In 2022, SCCM surveyed ICU clinicians and leaders to assess current ICU liberation bundle practices, to identify gaps in bundle adoption and sustainability, and best practices for improving bundle compliance. This survey showed significant improvements in bundle adoption and compliance since the Covid-19 pandemic, but significant barriers remain. A lack of leadership engagement and buy-in was the most significant barrier to bundle implementation and compliance across all bundle elements, while executive sponsorship of the bundle and strategic goal alignment significantly facilitated bundle compliance. Other barriers included a lack of ICU staff buy-in, poor staff communication, and a lack of staff education about the bundle. Other facilitators of bundle compliance included ICU provider education, daily IPT rounding, workflow integration using bundle champions, order sets, and rounding checklists/goal sheets.
