Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle

A nurse checks a hospital patient's breathing.

A bundle of interventions reduce the effects of prolonged sedation, mechanical ventilation, and immobility in critically ill intensive care patients.


The Issue:

Adult critically ill patients in an intensive care unit (ICU) can experience functional declines such as muscle weakness or experience delirium as a result of their stay. Patients who can breathe without ventilation are more likely to be mobilized and less likely to experience delirium. A small set of evidence-based practices—called a bundle—can improve those patient outcomes.

Researchers wanted to determine if a bundle of interventions could safely and effectively be applied to all critically ill patients, whether on a ventilator or not. The ABCDE bundle includes Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility.

Compared to “usual care,” the bundle was found to have:

  • Increased by three the number of days of breathing without mechanical assistance.
  • Decreased delirium by half the odds.
  • Increased mobility, doubling the odds of a patient getting out of bed at least once during an ICU stay.


"The ABCDE bundle appears to be a valuable tool in the management of critically ill patients,” the researchers concluded.

About the Study:

This 18-month prospective before–after study (November 2010 to May 2012) followed 286 patients in a 624-bed hospital’s adult critical care units.