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Reducing Iatrogenic Risks : ICU-Acquired Delirium and Weakness – Crossing the Quality Chasm

 

Eduard E. Vasilevskis, E. Wesley Ely, Theodore Speroff, Brenda T. Pun, Leanne Boehm and Robert S. Dittus

 

 

Chest 2010;138

 

 

ICUs are experiencing an epidemic of patients with acute brain dysfunction (delirium) and weakness, both associated with increased mortality and long-term disability. These conditions are commonly acquired in the ICU and are often initiated or exacerbated by sedation and ventilation decisions and management. Despite . 10 years of evidence revealing the hazards of delirium, the quality chasm between current and ideal processes of care continues to exist. Monitoring of delirium and sedation levels remains inconsistent. In addition, sedation, ventilation, and physical therapy practices proven successful at reducing the frequency and severity of adverse outcomes are not routinely practiced. In this article, we advocate for the adoption and implementation of a standard bundle of ICU measures with great potential to reduce the burden of ICU-acquired delirium and weakness. Individual components of this bundle are evidence based and can help standardize communication, improve interdisciplinary care, reduce mortality, and improve cognitive and functional outcomes. We refer to this as the “ABCDE bundle,” for awakening and breathing coordination, delirium monitoring, and exercise/early mobility. This evidence-based bundle of practices will build a bridge across the current quality chasm from the “front end” to the “back end” of critical care and toward improved cognitive and functional outcomes for ICU survivors.

 

Abbreviations: ABCDE = awakening and breathing coordination, delirium monitoring, and exercise/early mobility; CAM-ICU = confusion assessment method for the ICU; LOS = length of stay; SAT = spontaneous awakening trial; SBT= spontaneous breathing trial

 

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A new frontier in critical care: saving the injuried brain.

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Gestire il dolore

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Gestire la sedazione

ico-flowchart-sedaz-agitFlowchart sedaz/agitaz
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Gestire il delirium

ico-flowchart-deliriumFlowchart Delirium
ico-manuale-cam-icuManuale CAM-ICU
ico-schedalavoro-cam-icuScheda di lavoro CAM-ICU
ico-icdscICDSC

 

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