Adapting the ABCDEF Bundle to Meet the Needs of Patients Requiring Prolonged Mechanical Ventilation in the Long-Term Acute Care Hospital Setting: Historical Perspectives and Practical Implications

Seminars in Respiratory and Critical Care Medicine
Michele C BalasE Wesley Ely

Abstract

When robust clinical trials are lacking, clinicians are often forced to extrapolate safe and effective evidence-based interventions from one patient care setting to another. This article is about such an extrapolation from the intensive care unit (ICU) to the long-term acute care hospital (LTACH) setting. Chronic critical illness is an emerging, disabling, costly, and yet relatively silent epidemic that is central to both of these settings. The number of chronically critically ill patients requiring prolonged mechanical ventilation is expected to reach unprecedented levels over the next decade. Despite the prevalence, numerous distressing symptoms, and exceptionally poor outcomes associated with chronic critical illness, to date there is very limited scientific evidence available to guide the care and management of this exceptionally vulnerable population, particularly in LTACHs. Recent studies conducted in the traditional ICU setting suggest interprofessional, multicomponent strategies aimed at effectively assessing, preventing, and managing pain, agitation, delirium, and weakness, such as the ABCDEF bundle, may play an important role in the recovery of the chronically critically ill. This article reviews what is known about t...Continue Reading

Citations

Apr 4, 2017·Clinics in Geriatric Medicine·Erik Garpestad, John W Devlin
Jul 4, 2017·Critical Care Medicine·Regis Goulart RosaUNKNOWN ICU Visits Study Group Investigators
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Jun 10, 2021·BMJ : British Medical Journal·M Elizabeth WilcoxCatherine L Hough
Jun 27, 2021·JTCVS Open·Kirby P MayerUNKNOWN Outcomes and Recovery After COVID-19 Leading to ECMO (ORACLE) Group

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