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Worldwide Survey of the "Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment" (ABCDEF) Bundle.
Morandi, Alessandro MD, MPH 1,2; Piva, Simone MD 3; Ely, E. Wesley MD, MPH 4; Myatra, Sheila Nainan MD, FCCM, FICCM 5; Salluh, Jorge I.F. MD, PhD 6; Amare, Dawit MD 7; Azoulay, Elie MD, PhD 8; Bellelli, Giuseppe MD 2,9; Csomos, Akos MD, PhD 10; Fan, Eddy MD, PhD 11,12; Fagoni, Nazzareno MD,PhD 3; Girard, Timothy D. MD, MSCI 13; Heras La Calle, Gabriel MD 14; Inoue, Shigeaki MD, PhD, MSCI 15; Lim, Chae-Man MD, PhD, FCCM 16; Kaps, Rafael MD 17; Kotfis, Katarzyna MD, PhD 18; Koh, Younsuck MD 16; Misango, David MD 19; Pandharipande, Pratik P. MD, MSCI 20; Permpikul, Chairat MD 21; Cheng Tan, Cheng MD, PhD 22; Wang, Dong-Xin MD, PhD 22; Sharshar, Tarek MD, PhD 23; Shehabi, Yahya PhD, FCICM, FANZCA, EMBA 24,25; Skrobik, Yoanna MD, FRCP(c) MSc, FCCM 26,27; Singh, Jeffrey M. MD 28,29; Slooter, Arjen MD, PhD 30; Smith, Martin MBBS, FRCA, FFICM 31; Tsuruta, Ryosuke MD, PhD 32; Latronico, Nicola MD 33,34
[Article] Critical Care Medicine. 45(11):e1111-e1122, November 2017.

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

Design: Worldwide online 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.

Measurement and Main Results: There were 1,521 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. Spontaneous awakening trials and spontaneous breathing trials 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 hr/d 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 toward patient- and family-centered ICU care in accordance with the Pain, Agitation, Delirium guidelines.