Effectiveness of Bundle Interventions on ICU Delirium: A Meta-Analysis
Critical Care Medicine
Zhang, S., Han, Y., et al. (2021).
Critical Care Medicine, 49(2), 335-346.
<div>This systematic review with meta-analysis investigates the effects of the ABCDEF bundled intervention on delirium in adult intensive care unit (ICU) patients. While the ABCDEF bundled intervention includes components outside the scope of speech-language pathology (e.g., pharmacological), all studies in this review included a delirium monitoring and management component (e.g., reorientation, sleep hygiene) within the bundled intervention.</div>
National Natural Science Foundation of China
<div>The data in this systematic review are included in another document which can be found in the Associated Article section below.</div>
January 2000 to July 2020
<div>Randomized controlled trials and cohort studies with control groups</div>
11
<div>For adult ICU patients, the ABCDEF bundled intervention that included a delirium monitoring and management component significantly reduced:</div>
<div>
<ul>
<li>patient days with coma (risk ratio [RR]=0.47);</li>
<li>length of hospital stay (MD=-1.47); and</li>
<li>the 28-day mortality rate (18% decrease; RR-0.82).</li>
</ul>
<div>The meta-analysis found no significant effects for delirium incidence or duration, days on mechanical ventilation, ICU length of stay, in-hospital mortality, or ventilator-free days.</div>
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<div>Limitations of this review include heterogeneity in the included studies, insufficient power to assess ICU mortality, the inability to pool coma-related outcomes data, and the failure of the studies to include all components of the ABCDEF bundle. Additional research is needed to investigate the full implementation of the ABCDEF bundled intervention.</div>
