Nurse-Led Implementation of the ABCDEF Bundle: Evidence-Based Strategies for ICU Delirium Management
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 140
- 试验地点
- 2
- 主要终点
- Incidence of ICU Delirium
研究概览
简要总结
This study evaluated the effectiveness of a nurse-led implementation of the ABCDEF bundle, an evidence-based, interprofessional care framework, in the prevention and management of delirium among Intensive Care Unit (ICU) patients. The intervention aimed to reduce the incidence and severity of ICU delirium, decrease agitation, and improve patient outcomes through structured nursing interventions guided by the ABCDEF approach.
详细描述
The study employed a single-center, quasi-experimental clinical design with two parallel groups: an intervention group that received the nurse-led ABCDEF bundle and a control group that received standard ICU care. No randomization was applied, but baseline characteristics were matched where possible to control for confounding variables.
The study was conducted in the adult ICU of a tertiary care hospital. Eligible participants included adult patients (≥18 years) who were admitted to the ICU with an expected stay of at least 48 hours. Patients with pre-existing cognitive impairment, severe neurological damage, or those in a persistent vegetative state were excluded.
The intervention group received structured nursing care guided by the ABCDEF bundle, delivered by trained ICU nurses. The protocol included routine pain assessments and management strategies; daily spontaneous awakening and breathing trials; evidence-based sedation choices minimizing benzodiazepine use; systematic delirium screening using a validated tool (e.g., ICDSC); early mobilization practices appropriate to the patient's clinical status; and inclusion of family members in care planning and education.
The control group received usual ICU care without the formal implementation of the ABCDEF bundle.
The primary outcome was the incidence of delirium during the ICU stay, measured using a validated tool (e.g., ICDSC or CAM-ICU). Secondary outcomes included agitation levels, duration of delirium episodes, ICU length of stay, adherence to individual ABCDEF components, use of physical restraints, and sedative/analgesic dosages.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 60 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Critically ill adult patients aged 18 years or older
- •Admitted to the ICU at Ain Shams University Hospitals within 48 hours of enrollment
- •Clinically stable to undergo assessment and nursing intervention
- •Able to provide informed consent personally or via a legally authorized representative
- •Both male and female patients included
排除标准
- •Documented cognitive impairment or pre-existing psychiatric illness
- •Severe neurological conditions (e.g., advanced stroke, traumatic brain injury)
- •Deep sedation level (Richmond Agitation-Sedation Scale [RASS] score < -4)
- •Terminal illness requiring palliative or end-of-life care
- •Patients who declined participation or did not meet eligibility screening
结局指标
主要结局
Incidence of ICU Delirium
时间窗: From ICU admission to ICU discharge or up to 7 days, whichever occurs first
The presence or absence of delirium will be assessed daily using the Intensive Care Delirium Screening Checklist (ICDSC), a validated tool. Delirium is defined as an ICDSC score ≥4. The outcome will measure the proportion of patients who develop delirium during their ICU stay.
Incidence of ICU Delirium
时间窗: From ICU admission to ICU discharge or up to 7 days, whichever occurs first
The presence or absence of delirium will be assessed daily using the Intensive Care Delirium Screening Checklist (ICDSC), a validated tool. Delirium is defined as an ICDSC score ≥4. The outcome will measure the proportion of patients who develop delirium during their ICU stay.
次要结局
未报告次要终点
研究者
Alaa Eldin Moustafa Hamed
Lecturer of Psychiatric and mental health Nursing
Helwan University