The Effect of ABCDEF Bundle in ICU Adults: A Systematic Review

Background: The ABCDEF or ABCDE bundle combines the assessment, prevention, and treatment. In recent years, some studies have positive results, but some achievements may be too ideal and perfect. The effect of Implementation of the ABCDEF bundle (Awakening and Breathing Coordination, Delirium assessment/management, Early mobility, and Family engagement/empowerment) in the ICU patient hasn't been fully evaluated, especially patient safety and working load considerations.

Purpose: The purpose of this systematic review is to summarize what advantages and disadvantages of implementing the ABCDEF or ABCDE bundle more comprehensive. Furthermore to confirm the evidence strength of this combination care model.

Method: We searched the Cochrane library, PubMed, CINAHL and Airiti Library in Chinese. The keywords of "intensive care unit", "ABCDEF or ABCDE bundle" (abbreviations and full text), "days of the mechanical ventilator", "length of stay in ICU", "ICU days", "delirium incident", "costs", "working load", "working time", "patient safety" were used in searching strategy. All RCT, CCT and Cohort studies which implementation of ABCDEF or ABCDE bundle in ICU were included. The Cochrane Risk of Bias assessment tool was used to appraisal the studies quality.

Results: We included 5 studies (3 CCT, 2 Cohort studies) , all including process measures and clinical outcomes. The included studies’ quality were moderate to high. The advantages of applied ABCDEF or ABCDE bundle were reduced days of the mechanical ventilator, length of stay in ICU, delirium incident, and increased the ICU mobilization and marked financial benefits. However, nurse workload burden, perceived safety and confidence adherence to implementation was the major challenge.

Conclusion: A comprehensive understanding of the strengths and weaknesses of the implementation of the ABCDEF or ABCDE bundle will help to improve the effectiveness of the implementation. In the future, we need more large sample, long-term follow-up, and cost-benefit researchs to provide a more objective and fair view of practice.