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      Worldwide ABCDEF (Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium monitoring/management, Early exercise/mobility, and Family Empowerment) Survey

      research-article
      , MD, MPH, , MD, , MD, MPH, , MD, FCCM, FICCM, , MD, PhD, , MD, , MD, PhD, , MD, , MD, , MD, PhD, , MD, , MD, MSCI, , MD, , MD, Ph.D, MSCI, , MD, PhD, FCCM, , MD, , M.D., Ph.D., , MD, , MD, , MD, MSCI, , , , MD, PhD, , MD, PhD, , PhD, FCICM, FANZCA, EMBA, , MD, FRCP(c), MSc., FCCM, , MD, , MD, PhD, , MBBS, FRCA, FFICM, , MD, PhD, , MD
      Critical care medicine
      ABCDEF, Pain evaluation, Spontaneous Awakening and Breathing Trials, sedation, delirium monitoring/management, early exercise/mobility, family empowerment, critical care, intensive care

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          Abstract

          Objective

          To assess the knowledge and use of the ABCDEF bundle to implement the Pain, Agitation, Delirium (PAD) guidelines.

          Design

          Worldwide On-line Survey.

          Setting

          Intensive care.

          Intervention

          A cross-sectional online survey using the Delphi method was administered to intensivists worldwide, to assess the knowledge and use of all aspects of the ABCDEF bundle (Assessment, prevention and management of pain; spontaneous awakening and Breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise and Family engagement and empowerment.)

          Measurement and Main Results

          There were 1521 respondents from 47 countries, 57% had implemented the ABCDEF bundle, with varying degrees of compliance across continents. Most of the respondents (83%) used a scale to evaluate pain. SATs and SBTs are performed in 66% and 67% of the responder ICUs respectively. Sedation scale was used in 89% of ICUs. Delirium monitoring was implemented in 70% of ICUs, but only 42% used a validated delirium tool. Likewise, early mobilization was “prescribed” by most but 69% had no mobility team and 79% used no formal mobility scale. Only 36% of the respondents assessed ICU acquired weakness. Family members were actively involved in 67% of ICUs, however only 33% used dedicated staff to support families and only 35% reported that their unit was open 24 hours/day for family visits.

          Conclusions

          The current implementation of the ABCDEF bundle varies across individual components and regions. We identified specific targets for quality improvement and adoption of the ABCDEF bundle. Our data reflect a significant but incomplete shift towards patient- and family-centered ICU care in accordance with the PAD guidelines.

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          Author and article information

          Contributors
          Journal
          0355501
          3206
          Crit Care Med
          Crit. Care Med.
          Critical care medicine
          0090-3493
          1530-0293
          13 July 2017
          November 2017
          01 November 2018
          : 45
          : 11
          : e1111-e1122
          Affiliations
          Ancelle Hospital, Department of Rehabilitation, Cremona, Italy, Geriatric Research Group, Brescia, Italy
          Department of Anesthesia, Critical Care and Emergency, SpedaliCivili University Hospital, Brescia, Italy
          Professor of Medicine, Division of Pulmonary and Critical Care and Health Services Research, Vanderbilt University and VA Geriatric Research Education Clinical Center (GRECC), Nashville, TN, USA
          Professor of Critical Care Medicine, Department of Anaesthesiology, Critical Care and Pain., Tata Memorial Hospital, Mumbai, India
          Senior Researcher, Department of Critical Care D’or Institute for Research and Education and Post-Graduate Program Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
          Addis Hiwot General Hospital, Head of internal medicine and ICU Physician, Addis Ababa Ethiopia
          Medical Intensive Care Unit, Hôpital Saint-Louis,, ECSTRA team, Biostatistics and clinical epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University
          Associate Professor. School of Medicine and Surgery, University of Milano-Bicocca, Milano Geriatric Clinic, San Gerardo University Hospital, Monza. Geriatric Research Group, Brescia, Italy
          Chief, Department of Anaesthesia and Intensive Care, Medical Centre, Hungarian Defence Force. President Hungarian Society of Anaesthesiology and Intensive Therapy (MAITT). Budapest, Hungary
          Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto; and University Health Network, Toronto, Canada
          Department of Anesthesia, Critical Care and Emergency, SpedaliCivili University Hospital, Brescia, Italy
          Associate Professor of Critical Care Medicine, CRISMA Center, Department of Critical Care Medicine; University of Pittsburgh and UPMC Health System
          International Research Project Humanizing Intensive Care (Proyecto HU-CI) Intensive Care Unit. Hospital Universitario de Torrejón, Madrid. Spain
          Associate Professor & Chief Director, Dept. of Emergency and Critical Care Medicine, Tokai University, School of Medicine., Kanagawa, JAPAN
          Professor of Medicine, Department of Pulmonary and Critical Care Medicine Asan Medical Center,, Univ. of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
          Specialist of internal medicine and specialist of intensive care medicine, Head of Dept., General Hospital Novo mesto, 8000 Novo mesto, Slovenia
          Department of Anaesthesia, Intensive Care and Acute Poisioning, Pomeranian Medical University, Szczecin, Poland
          Professor of Medicine Professor of Medical Humanities and Social Sciences Department of Pulmonary and Critical Care Medicine Asan Medical Center, Univ. of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
          Assistant Professor of Anaesthesiology, Aga Khan University Hospital, Nairobi
          Professor of Anesthesiology and Surgery, Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
          Associate Professor. Siriraj Hospital, Bangkok, Thailand
          Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
          Senior Consultant, Department of Intensive Care Medicine Raymond Poincaré Hospital, Paris, France
          Professor of Intensive Care Medicine, School of Clinical Sciences, Faculty of Medicine Monash University & Medical Center, Melbourne, Australia; University New South Wales, Clinical School of Medicine, NSW 2031
          Department of Medicine, McGill University, Montreal, Canada
          Interdepartmental Division of Critical Care Medicine, University of Toronto; and Krembil Neuroscience Centre, University Health Network, Toronto, Canada
          Professor of Intensive Care Neuropsychiatry and Consultant Neurologist – Intensivist, Department of Intensive Care Medicine; Brain Center Rudolf Magnus, Utrecht University; University Medical Center Utrecht, The Netherlands
          Department of Neurocritical Care, University College London Hospitals, UCL National Institute for Health Research Biomedical Research Centre, London UK
          Acute & General Medicine; Yamaguchi Graduate School of Medicine, Yamaguchi, JAPAN
          Professor of Anesthesia and Critical Care Medicine, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy, Department of Anesthesia, Critical Care and Emergency, SpedaliCivili University Hospital, Brescia, Italy
          Author notes
          All correspondence and reprint requests should be sent to: Alessandro Morandi MD, MPH, Via Aselli 16; Cremona, 26100, morandi.alessandro@ 123456gmail.com
          [*]

          Dr Morandi and DrPiva have equally contributed as first authors to the manuscript.

          Article
          PMC5640479 PMC5640479 5640479 nihpa891431
          10.1097/CCM.0000000000002640
          5640479
          28787293
          76bacb52-8a8f-4f18-bce4-88016e395664
          History
          Categories
          Article

          sedation,ABCDEF,Pain evaluation,Spontaneous Awakening and Breathing Trials,delirium monitoring/management,early exercise/mobility,family empowerment,critical care,intensive care

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