ABCDEF bundle as a tool for the prevention of Post-Intensive Care Syndrome a systematic literature review

• Autor(a) principal: Lopes, Inês Teixeira
• Data de Publicação: 2023
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.6/13489
• topic: Abcdef Bundle; Cuidados Intensivos; Síndrome Pós-Internamento em Cuidados Intensivos; Unidade de Cuidados Intensivos; Domínio/Área Científica::Ciências Médicas::Ciências da Saúde::Medicina

Background: PICS (Post-Intensive Care Syndrome) refers to cognitive, physical, and psychological deficits that can develop in patients and their families during an intensive care unit (ICU) stay and persist after that. The ABCDEF bundle is a guide for the approach of critically ill patients that, by addressing pain, ventilation, analgesia and sedation, delirium, mobility, and patient’s family engagement can have a role in preventing PICS. The increasing survival rate in intensive care patients, due to the development in medicine through the years, has led to an increasing concern to discover ways to mitigate PICS triggers. Thus, we consider it to be relevant to understand the scientific base that studies the relationship between the use of the ABCDEF bundle in ICUs and the frequency of PICS in its survivors. Methods: This article follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) methodology. Using the PICO (participant, intervention, comparison, outcome) strategy for the literature search, articles were selected from different databases: PubMed/MEDLINE, Cochrane Library, and Science Direct. Results: Six cohort studies meeting the established inclusion criteria were included. Some studies compare different levels of adherence and total/partial performance of the bundle. Others compare the use of the bundle with the usual management of critically ill patients in a given ICU (Intensive Care Unit). The outcomes of interest for this review relate to the development of deficits in the domains involving PICS. Overall, the use of the bundle resulted in a decrease in the need for mechanical ventilation, sedation, the prevalence of delirium, and physical restriction. Conclusion: The implementation of the ABCDEF bundle seems to result in a decrease in the development of PICS triggers. Thus, since these triggers are thought to precede PICS, we could infer from our findings that the use of the bundle on critical care has a role in the prevention of PICS. It would be important to define criteria for PICS assessment to better understand the direct effect of the ABCDEF bundle on the prevention of this syndrome. Besides, it needs to be conducted more studies using the more recent bundle, including the “F” element.