Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle

Michele C. Balas, Eduard E. Vasilevskis, Keith M. Olsen, Kendra K Schmid, Valerie Shostrom, Marlene Z. Cohen, Gregory Peitz, David E Gannon, Joseph Harold Sisson, James N Sullivan, Joseph Clarke Stothert Jr, Julie Lazure, Suzanne Nuss, Randeep S. Jawa, Frank Freihaut, E. Wesley Ely, William J. Burke

Research output: Contribution to journalArticle

209 Citations (Scopus)

Abstract

Objective: The debilitating and persistent effects of ICU-acquired delirium and weakness warrant testing of prevention strategies. The purpose of this study was to evaluate the effectiveness and safety of implementing the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle into everyday practice. Design: Eighteen-month, prospective, cohort, before-after study conducted between November 2010 and May 2012. Setting: Five adult ICUs, one step-down unit, and one oncology/hematology special care unit located in a 624-bed tertiary medical center. PATIENTS: Two hundred ninety-six patients (146 prebundle and 150 postbundle implementation), who are 19 years old or older, managed by the institutions' medical or surgical critical care service. Interventions: Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle. Measurements and Main Results: For mechanically ventilated patients (n = 187), we examined the association between bundle implementation and ventilator-free days. For all patients, we used regression models to quantify the relationship between Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle implementation and the prevalence/duration of delirium and coma, early mobilization, mortality, time to discharge, and change in residence. Safety outcomes and bundle adherence were monitored. Patients in the postimplementation period spent three more days breathing without mechanical assistance than did those in the preimplementation period (median [interquartile range], 24 [7-26] vs 21 [0-25]; p = 0.04). After adjusting for age, sex, severity of illness, comorbidity, and mechanical ventilation status, patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle experienced a near halving of the odds of delirium (odds ratio, 0.55; 95% CI, 0.33-0.93; p = 0.03) and increased odds of mobilizing out of bed at least once during an ICU stay (odds ratio, 2.11; 95% CI, 1.29-3.45; p = 0.003). No significant differences were noted in self-extubation or reintubation rates. Conclusions: Critically ill patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle spent three more days breathing without assistance, experienced less delirium, and were more likely to be mobilized during their ICU stay than patients treated with usual care.

Original languageEnglish (US)
Pages (from-to)1024-1036
Number of pages13
JournalCritical care medicine
Volume42
Issue number5
DOIs
StatePublished - May 2014

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Delirium
Respiration
Exercise
Safety
Odds Ratio
Early Ambulation
Hematology
Mechanical Ventilators
Critical Care
Coma
Artificial Respiration
Critical Illness
Comorbidity
Mortality

Keywords

  • Awakening and Breathing Coordination
  • Delirium monitoring/management
  • and Early exercise/mobility bundle
  • delirium
  • intensive care unit
  • ventilator-free days

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. / Balas, Michele C.; Vasilevskis, Eduard E.; Olsen, Keith M.; Schmid, Kendra K; Shostrom, Valerie; Cohen, Marlene Z.; Peitz, Gregory; Gannon, David E; Sisson, Joseph Harold; Sullivan, James N; Stothert Jr, Joseph Clarke; Lazure, Julie; Nuss, Suzanne; Jawa, Randeep S.; Freihaut, Frank; Ely, E. Wesley; Burke, William J.

In: Critical care medicine, Vol. 42, No. 5, 05.2014, p. 1024-1036.

Research output: Contribution to journalArticle

Balas, Michele C. ; Vasilevskis, Eduard E. ; Olsen, Keith M. ; Schmid, Kendra K ; Shostrom, Valerie ; Cohen, Marlene Z. ; Peitz, Gregory ; Gannon, David E ; Sisson, Joseph Harold ; Sullivan, James N ; Stothert Jr, Joseph Clarke ; Lazure, Julie ; Nuss, Suzanne ; Jawa, Randeep S. ; Freihaut, Frank ; Ely, E. Wesley ; Burke, William J. / Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. In: Critical care medicine. 2014 ; Vol. 42, No. 5. pp. 1024-1036.
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T1 - Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle

AU - Balas, Michele C.

AU - Vasilevskis, Eduard E.

AU - Olsen, Keith M.

AU - Schmid, Kendra K

AU - Shostrom, Valerie

AU - Cohen, Marlene Z.

AU - Peitz, Gregory

AU - Gannon, David E

AU - Sisson, Joseph Harold

AU - Sullivan, James N

AU - Stothert Jr, Joseph Clarke

AU - Lazure, Julie

AU - Nuss, Suzanne

AU - Jawa, Randeep S.

AU - Freihaut, Frank

AU - Ely, E. Wesley

AU - Burke, William J.

PY - 2014/5

Y1 - 2014/5

N2 - Objective: The debilitating and persistent effects of ICU-acquired delirium and weakness warrant testing of prevention strategies. The purpose of this study was to evaluate the effectiveness and safety of implementing the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle into everyday practice. Design: Eighteen-month, prospective, cohort, before-after study conducted between November 2010 and May 2012. Setting: Five adult ICUs, one step-down unit, and one oncology/hematology special care unit located in a 624-bed tertiary medical center. PATIENTS: Two hundred ninety-six patients (146 prebundle and 150 postbundle implementation), who are 19 years old or older, managed by the institutions' medical or surgical critical care service. Interventions: Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle. Measurements and Main Results: For mechanically ventilated patients (n = 187), we examined the association between bundle implementation and ventilator-free days. For all patients, we used regression models to quantify the relationship between Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle implementation and the prevalence/duration of delirium and coma, early mobilization, mortality, time to discharge, and change in residence. Safety outcomes and bundle adherence were monitored. Patients in the postimplementation period spent three more days breathing without mechanical assistance than did those in the preimplementation period (median [interquartile range], 24 [7-26] vs 21 [0-25]; p = 0.04). After adjusting for age, sex, severity of illness, comorbidity, and mechanical ventilation status, patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle experienced a near halving of the odds of delirium (odds ratio, 0.55; 95% CI, 0.33-0.93; p = 0.03) and increased odds of mobilizing out of bed at least once during an ICU stay (odds ratio, 2.11; 95% CI, 1.29-3.45; p = 0.003). No significant differences were noted in self-extubation or reintubation rates. Conclusions: Critically ill patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle spent three more days breathing without assistance, experienced less delirium, and were more likely to be mobilized during their ICU stay than patients treated with usual care.

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KW - Delirium monitoring/management

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KW - intensive care unit

KW - ventilator-free days

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