Critical Care Nurses' Role in Implementing the ''ABCDE Bundle'' Practice

Patients undergoing mechanical ventilation in intensive care units (ICUs) are at risk for delirium and weakness, which may impact physical and cognitive outcomes, and potentially burden caregivers and the health care system. This study explores a novel, interprofessional approach to management of ICU-acquired delirium and weakness. This bundle of evidence-based practices can improve patients’ outcomes when performed collectively and reliably.

The Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle is built on three principles: (1) improving communication among ICU team members, (2) standardizing care processes, and (3) limiting over-sedation and prolonged periods of mechanical ventilation. This article looks at the evidence supporting the ABCDE bundle:

  • nurse-implemented sedation protocols and administration of spontaneous awakening trials (SATs);
  • respiratory therapist-implemented protocols for spontaneous breathing trials (SBTs);
  • coordinating SATs and SBTs;
  • delirium monitoring and management; and
  • early mobility.

The authors recommend health care providers use the ABCDE bundle daily with every patient admitted to the ICU. The article provides steps to coordinate SATs and SBTs, articulates essential elements of delirium monitoring and management, and outlines minimum criteria for early mobility protocol.

The authors note that the ABCDE bundle, while complex, is an important tool for ICUs. Nurses play a particularly significant role in its implementation and execution.