ABCDEF Bundle and Supportive ICU Care Practices for patients with COVID-19 infection: An international point prevalence study ~The ISIIC Study~

BackgroundAlthough the number of patients with COVID-19 infection is increasing and concerns for their long-term disabilities are increasing, there is a lack of data about the delivery of the ABCDEF-bundle and supportive care in Intensive Care Units (ICUs). The aim of this study is to investigate the implementation of the ABCDEF-bundle and supportive care provided to patients with COVID-19 infections in ICUs. MethodsThis was a world-wide two-day point prevalence study, on June 3 and July 1, 2020. A total of 212 ICUs in 38 countries (166 ICUs on Day 1 and 212 on Day 2) participated. Clinicians in each participating ICU completed web-based online surveys. The implementation rate for elements of the ABCDEF-bundle, other supportive ICU care measures and implementation associated structures were investigated.RESULTSData for 262 patients was collected during the two-day study. Of patients included, 124 (47.3%) underwent mechanical ventilation (MV) and 12 (4.6%) patients were treated with extracorporeal membrane oxygenation (ECMO). The proportion of patients with implementation of each element was: Element A (regular pain assessment) 45%; B (both spontaneous awakening and breathing trials) 28%; C (regular sedation assessment) 52%; D (regular delirium assessment) 38%; E (early mobility and exercise) 47%; and F (family engagement and empowerment) 16%. The implementation of element E for patients on MV was 16% and ECMO was 17%. Supportive care, such as providing protein throughout the ICU stay (under 1.2g/kg for more than 50% of the patients) and introduction of an ICU diary (25%) was inadequate. A higher implementation rate of elements A and D were recognized in ICUs with specific protocols for ICU care and lower numbers of ICU beds exclusively for patients with COVID-19 infection. Element E was implemented at a higher rate in ICUs with more ICU beds for patients with COVID-19 infection.CONCLUSIONSThis worldwide two-day point prevalence study found low implementation of the ABCDEF-bundle. Specific protocols and the number of ICU beds reserved for patients with COVID-19 infections might be key factors to deliver appropriate supportive care.Trial registration: UMIN, UMIN000040405. Registered 14 May 2020, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000046103

[1]  S. Woolf,et al.  Excess Deaths From COVID-19 and Other Causes in the US, March 1, 2020, to January 2, 2021. , 2021, JAMA.

[2]  D. Hurtado,et al.  A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection , 2020, Critical Care.

[3]  H. Prescott,et al.  Recovery From Severe COVID-19: Leveraging the Lessons of Survival From Sepsis. , 2020, JAMA.

[4]  M. Biehl,et al.  Post-intensive care syndrome and COVID-19 - Implications post pandemic. , 2020, Cleveland Clinic journal of medicine.

[5]  Manoj Sivan,et al.  Postdischarge symptoms and rehabilitation needs in survivors of COVID‐19 infection: A cross‐sectional evaluation , 2020, Journal of medical virology.

[6]  F. Pisano,et al.  Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 rehabilitation unit and proposal of a treatment protocol. A cross-sectional study. , 2020, European journal of physical and rehabilitation medicine.

[7]  D. Needham,et al.  Survivorship after COVID-19 ICU stay , 2020, Nature Reviews Disease Primers.

[8]  Sharon J Peacock,et al.  Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. , 2020, JAMA.

[9]  Angelo Carfì,et al.  Persistent Symptoms in Patients After Acute COVID-19. , 2020, JAMA.

[10]  Arthur S Slutsky,et al.  COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted? , 2020, The Lancet Respiratory Medicine.

[11]  H. Krumholz,et al.  Extrapulmonary manifestations of COVID-19 , 2020, Nature Medicine.

[12]  M. Sivan,et al.  A Proposal for Multidisciplinary Tele-Rehabilitation in the Assessment and Rehabilitation of COVID-19 Survivors , 2020, International journal of environmental research and public health.

[13]  Roy T Sabo,et al.  Excess Deaths From COVID-19 and Other Causes, March-April 2020. , 2020, JAMA.

[14]  P. Matthews,et al.  Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study , 2020, The Lancet Psychiatry.

[15]  Larry Chu,et al.  Managing ICU surge during the COVID-19 crisis: rapid guidelines , 2020, Intensive Care Medicine.

[16]  John C. Lin,et al.  Strategies to Optimize ICU Liberation (A to F) Bundle Performance in Critically Ill Adults With Coronavirus Disease 2019 , 2020, Critical care explorations.

[17]  S. McClave,et al.  Nutrition Therapy in Critically Ill Patients With Coronavirus Disease 2019 , 2020, JPEN. Journal of parenteral and enteral nutrition.

[18]  E. Ely,et al.  COVID-19: ICU delirium management during SARS-CoV-2 pandemic , 2020, Critical Care.

[19]  J. Marini,et al.  Management of COVID-19 Respiratory Distress. , 2020, JAMA.

[20]  D. Pilcher,et al.  Surge capacity of intensive care units in case of acute increase in demand caused by COVID‐19 in Australia , 2020, The Medical journal of Australia.

[21]  L. Camporota,et al.  COVID-19 pneumonia: different respiratory treatments for different phenotypes? , 2020, Intensive Care Medicine.

[22]  M. Nishimura,et al.  Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations , 2020, The Lancet Respiratory Medicine.

[23]  Stephan C. Bischoff,et al.  ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection , 2020, Clinical Nutrition.

[24]  M. Kho,et al.  Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations , 2020, Journal of Physiotherapy.

[25]  J. Thornton.  Covid-19: how coronavirus will change the face of general practice forever , 2020, BMJ.

[26]  Darren P. Mareiniss.  The impending storm: COVID-19, pandemics and our overwhelmed emergency departments , 2020, The American Journal of Emergency Medicine.

[27]  John C. Lin,et al.  Best Practices for Conducting Interprofessional Team Rounds to Facilitate Performance of the ICU Liberation (ABCDEF) Bundle. , 2019, Critical care medicine.

[28]  J. Vincent,et al.  How much centralization of critical care services in the era of telemedicine? , 2019, Critical Care.

[29]  A. Lopes,et al.  The impact of intensive care unit diaries on patients’ and relatives’ outcomes: a systematic review and meta-analysis , 2019, Critical Care.

[30]  H. Gershengorn,et al.  Staged Implementation of Awakening and Breathing, Coordination, Delirium Monitoring and Management, and Early Mobilization Bundle Improves Patient Outcomes and Reduces Hospital Costs. , 2019, Critical care medicine.

[31]  L. Lopes,et al.  ABCDE and ABCDEF care bundles: A systematic review protocol of the implementation process in intensive care units , 2019, Medicine.

[32]  J. Devlin,et al.  Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience. , 2019, Critical care nurse.

[33]  C. Pichard,et al.  ESPEN guideline on clinical nutrition in the intensive care unit. , 2019, Clinical nutrition.

[34]  J. R. Aldrich,et al.  Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults , 2019, Critical care medicine.

[35]  Patricia M Sheean,et al.  American Society for Parenteral and Enteral Nutrition Clinical Guidelines: The Validity of Body Composition Assessment in Clinical Populations. , 2019, JPEN. Journal of parenteral and enteral nutrition.

[36]  D. Needham,et al.  Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU , 2018, Critical care medicine.

[37]  Kunihiko Takahashi,et al.  The safety of a novel early mobilization protocol conducted by ICU physicians: a prospective observational study , 2018, Journal of Intensive Care.

[38]  M. Amato,et al.  Fifty Years of Research in ARDS. Spontaneous Breathing during Mechanical Ventilation. Risks, Mechanisms, and Management , 2017, American journal of respiratory and critical care medicine.

[39]  Mayur B. Patel,et al.  The ABCDEF Bundle in Critical Care. , 2017, Critical care clinics.

[40]  E. Ely,et al.  The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families. , 2017, Critical care medicine.

[41]  Russell R. Miller,et al.  Point Prevalence Study of Mobilization Practices for Acute Respiratory Failure Patients in the United States , 2017, Critical care medicine.

[42]  Christina Jones,et al.  Report on Third International Intensive Aftercare Conference in Norrköping, Sweden. , 2015, Nursing Critical Care.

[43]  Jeong Hoon Yang,et al.  Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. , 2015, Journal of critical care.

[44]  K. Nair,et al.  Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. , 2014, Clinical nutrition.

[45]  Michael Bailey,et al.  Feasibility and inter-rater reliability of the ICU Mobility Scale. , 2014, Heart & lung : the journal of critical care.

[46]  Y. Kanda,et al.  Investigation of the freely available easy-to-use software ‘EZR' for medical statistics , 2012, Bone Marrow Transplantation.

[47]  I. Egerod,et al.  Intensive Care Patient Diaries in Scandinavia: a Comparative Study of Emergence and Evolution , 2010 .