Episode 105: The ABCDEF Bundle in the CVICU
How does the ABCDEF bundle apply to the CVICU with a variety of diagnoses, acuities, and devices? Anna Dalton, DNP, ACANP, in an “Awake and Walking CVICU” shares with us the evolution their team has experienced in improving their mastery of the ABCDEF bundle.
References:
Anna Dalton’s Publication:
Tonna, et al. (2021). The effect of a quality improvement intervention on sleep and delirium in critically ill patients in a surgical icu. Chest, 160(3). https://pubmed.ncbi.nlm.nih.gov/33773988/
EM is safe in CICU and lowers mortality and increases discharge home rate:
Goldfarb, et al. (2021). Early mobilization in older adults with acute cardiovascular disease. Age Aging, 50(4). https://pubmed.ncbi.nlm.nih.gov/33247593/
Early mobility programs in CVICU are safe and feasible:
Matharsa, et al. (2021). A multidisciplinary early mobility model for cardiac patients in coronary intensive care unit. European Journal of Cardiovascular Nursing, 20(1). https://academic.oup.com/eurjcn/article/20/Supplement_1/zvab060.120/6330382
Over a year, the mean hours required for initiating out-of-bed mobility decreased by 50% in a CTICU. Early mobility program is safe and feasible in CTICU and led to the achievement of functional goals:
Prasobh, et al. (2021). Multidisciplinary, early mobility approach to enhance functional independence in patients admitted to a cardiothoracic intensive care unit: a quality improvement programme. British Medical Journal Open Quality, 10(3). https://bmjopenquality.bmj.com/content/10/3/e001256
ABCDEF bundle SIGNIFICANTLY decreased ICU and hospital length of stay. Hospitalization costs decreased by 45.76% and ICU costs decreased by 53.38%:
Takroni, et al. (2021). The effect of early mobilization on icu and hospital length of stay and its impact on the cost of care in post-open heart surgery patients: a randomized control trial. Journal of Heart Health. https://www.sciforschenonline.org/journals/heart/article-data/JHH157/JHH157.pdf
Delirium in the CICU:
Ibrahim, et al. (2018). Delirium in the cardiac intensive care unit. Journal of American Heart Association, 7(4). https://www.ahajournals.org/doi/10.1161/JAHA.118.008568
Delirium is an independent predictor of mortality in CICU:
Pauley, et al. (2015). Delirium is a robust predictor of morbidity and mortality among critically ill patients treated in the cardiac intensive care unit. American Heart Journal, 170(1). https://www.sciencedirect.com/science/article/abs/pii/S000287031500246X
Predicting, preventing, and identifying delirium after cardiac surgery:
O’Neal., J & Shaw, A. (2016). Predicting, preventing, and identifying delirium after cardiac surgery. Perioperative Medicine, 5(7). https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-016-0032-5
Safety and feasibility of early mobility with femoral intra-aortic balloon pumps:
Chen, et al. (2021) Safety and feasibility of an early mobilization protocol for patients with femoral intra-aortic balloon pumps as bridge to heart transplant. ASAIO Journal, 68(5). https://pubmed.ncbi.nlm.nih.gov/34380951/
Increasing PT staffing in CVICU decreased CVICU by 3.6 days and post-ICU LOS by 2.6 days:
Johnson, et al. (2019). Improving outcomes for critically ill cardiovascular patients through increased physical therapy staffing. Archives of Physical Medicine and Rehabilitation, 100(2). https://www.archives-pmr.org/article/S0003-9993%2818%2931173-0/fulltext
Mobility with impella device is associated with improved survival:
Esposito, etc. (2018). Maximum level of mobility with axillary deployment of the imeplla 5.0 is associated with improved survival. Epub, 41(4). https://pubmed.ncbi.nlm.nih.gov/29637832/
