DOI: 10.1097/ccm.0000000000005980 ISSN: 0090-3493

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
  • Critical Care and Intensive Care Medicine
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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, R2 = 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.

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