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

Critically ill patients, such as those on mechanical ventilation in the intensive care unit (ICU), are at risk of developing ICU delirium and weakness, threatening their survival and long-term functioning. While many patients benefit from interruption of sedation and periodic tests for spontaneous breathing, many ICU providers do not use these protocols daily. 

A set of evidence-based practices—called the ABCDE bundle (for Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility bundle)—performed collectively can improve outcomes for ICU patients. 

The ABCDE bundle relies on three principles:

  1. Improving communication among members of the ICU team
  2. Standardizing care processes
  3. Breaking the cycle of oversedation and prolonged mechanical ventilation

These researchers, supported with a Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative grant, proposed that the ABCDE bundle be used daily. A registered nurse performs spontaneous awakening trials to determine the patient’s need for sedation. A respiratory therapist tests if the patient is ready to breathe on her or his on. Patients are candidates for mobilization when they meet certain criteria. 

With nurses taking a lead role in implementing the protocol, the ABCDE bundle incorporates best-available evidence into everyday practice in the ICU.