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Effects of the ABCDEF Bundle on Delirium, Function, and Quality of Life in Australian ICU Patients: A Pragmatic
Kellie J Sosnowski1,2, Kristen L Ranse1,3, Marion L Mitchell1
1School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia.
Objectives:
To test whether the ABCDEF bundle, compared with usual care, decreases delirium incidence and duration, improves functional status in the ICU, and enhances 90-day post-ICU discharge quality of life in critically ill Australian adults.
Design:
Single-center, pragmatic, randomized controlled trial.
Setting:
Eight-bed medical/surgical ICU in a metropolitan Australian hospital.
Patients:
Adult patients expected to remain in ICU for at least 48 hours.
Interventions:
ABCDEF bundle or usual care.
Measurements And Main Results:
Complete ABCDEF bundle adherence was achieved in 50% of patients each study day. The primary outcome, cumulative incidence of delirium (measured with the Confusion Assessment Method for ICU), was similar between groups (ABCDEF, 37.9%; usual care, 36.4%; odds ratio, 1.1; 95% CI, 0.5-2.2; p = 0.86), as was median delirium duration (ABCDEF, 2.0 d; interquartile range [IQR], 1.3-3.5 d; usual care, 2.5 d; IQR, 1.0-4.4 d; mean difference, -0.4 d; 95% CI, -1.6 to 0.8 d; p = 0.53). Median functional scores at ICU discharge (measured with the Functional Independence Measure) were 55.0 (IQR, 37.0-67.3) in the ABCDEF group and 53.0 (IQR, 43.8-62.5) in the usual care group (mean difference, 0.0; 95% CI, -7.7 to 7.6; p = 0.83). At 90 days post-ICU discharge, the ABCDEF bundle group reported higher scores in the "usual activities" domain ( p < 0.001) (measured with the EuroQol 5D five-level questionnaire), with no differences in other domains.
Conclusions:
In adult ICU patients, the ABCDEF bundle, compared with usual care, did not reduce the cumulative incidence or duration of delirium. While no effect was observed on the primary outcomes, higher scores in the "usual activities" quality of life domain suggest potential long-term benefits that warrant further investigation.
