Factors associated with ABCDEF bundle implementation for critically ill patients: An international cross-sectional survey in 54 countries.

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL

SAGE Open Medicine Pub Date : 2025-01-09 eCollection Date: 2025-01-01 DOI:10.1177/20503121241312944

Junpei Haruna, Takeshi Unoki, Keibun Liu, Kensuke Nakamura, Shigeaki Inoue, Osamu Nishida

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Abstract

Objectives: This study investigated the implementation of the ABCDEF bundle and the factors associated with its implementation according to national income levels.

Methods: This study is cross-sectional research. We conducted a secondary analysis of an international 1-day point-prevalence study that investigated the implementation of the ABCDEF bundle in critically ill patients. All patients admitted to the ICU were eligible. This study was conducted across 135 ICUs in 54 countries, including data from 664 patients. Outcomes were categorized according to the income level of the country (high-income, middle-income, and low-income countries) in which each ICU was located. A multilevel generalized linear model was developed to identify the factors associated with ABCDEF bundle implementation for each income level.

Results: We identified 664 patients in 79 high-income countries, 278 in 26 middle-income countries, and 287 in 30 low-income countries ICUs. Implementation rates of the ABCDEF bundle were low for all income levels but varied. Few individuals completed the entire bundle on the survey date. Common factors associated with the implementation among all income levels were a multidisciplinary team approach for Element A (pain) and mechanical ventilation use for Element C (sedation), which were also associated with lower Element E (mobility). The existence of a protocol was frequently identified as a promoting factor associated with ABCDEF bundle implementation. The associated factors varied by income level; for example, dedicated intensivists were only identified in high-income countries, but not in middle-income countries or low-income countries.

Conclusions: The overall low ABCDEF bundle implementation rates necessitate action. As factors associated with its implementation vary according to national income level, tailored strategies are essential for improving ICU care quality.

Trial registration: NA.

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与危重患者实施ABCDEF捆绑相关的因素：54个国家的国际横断面调查

目的：本研究根据国民收入水平调查ABCDEF捆绑的实施情况及其实施相关因素。方法：本研究为横断面研究。我们对一项为期1天的国际点流行研究进行了二次分析，该研究调查了ABCDEF捆绑治疗在危重患者中的实施情况。所有入住ICU的患者均符合条件。这项研究在54个国家的135个icu中进行，包括来自664名患者的数据。结果根据每个ICU所在国家（高收入、中等收入和低收入国家）的收入水平进行分类。开发了一个多层广义线性模型，以确定与每个收入水平的ABCDEF捆绑实施相关的因素。结果：我们在79个高收入国家确定了664名患者，在26个中等收入国家确定了278名患者，在30个低收入国家确定了287名患者。所有收入水平的ABCDEF捆绑包的执行率都很低，但各不相同。很少有人在调查当天完成了整个捆绑包。在所有收入水平中，与实施相关的共同因素是多学科团队方法用于a要素（疼痛）和机械通气用于C要素（镇静），这也与较低的E要素（活动能力）相关。协议的存在经常被认为是与ABCDEF包实现相关的促进因素。相关因素因收入水平而异；例如，专门的重症监护医生只在高收入国家被确定，而在中等收入国家或低收入国家则没有。结论：总体较低的ABCDEF捆绑执行率需要采取行动。由于与实施相关的因素因国家收入水平而异，量身定制的战略对于提高ICU护理质量至关重要。试验注册：NA。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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