Virginia Research Day 2021

Medical Resident Research Cl inical

03 The Effects of Implementing the ABCDEF Protocol in an ICU Within a Level III Trauma Center

Richard Miller, DO; William Cox, DO Corresponding author: richm2711@gmail.com

LewisGale Hospital-Montgomery

Background: The ABCDEF protocol, which stands for Assess, prevent and manage pain, Both spontaneous awakening trials and spontaneous breathing trials, Choice of analgesia and sedation, Delirium: assess, prevent and manage, Early mobility and exercise, and Family engagement and empowerment, also known as the ICU Liberation Bundle, is an evidence based model that combines the individual components involved in managing a patient on mechanical ventilation, into one interdisciplinary protocol. The Society of Critical Care Medicine provides resources for facilities to implement the protocol within their own Intensive Care Unit (ICU). It is well established that the longer a patient remains on mechanical ventilation, the more complications arise. Recent studies have demonstrated significant improvement in ICU outcomes, when utilizing the protocol in tertiary care centers, including survival, ICU readmission, next-day mechanical ventilation, delirium and restraint use¬¬¬. However, no studies

Results: LGHM had 32.9% of patients receive mechanical ventilation for less than 24 hours pre- implementation of the intervention, which increased to 47.9% post-intervention. Additionally, 33.3% of patients on mechanical ventilation expired pre- intervention, which was reduced to 21.7% post- intervention. Overall, the odds of mortality decreased by 19% after implementation of the protocol. Conclusion: The ABCDEF protocol effectively decreased mortality and duration of mechanical ventilation for mechanically ventilated patients at LewisGale Hospital Montgomery.

have specifically examined the protocol’s impact on mortality and duration of mechanical ventilation in a small, community hospital. Objective: To determine if mortality and duration of mechanical ventilation were impacted by implementation of the ABCDEF protocol, in a 10 bed ICU within a Level III Trauma Center. Design: Retrospective secondary analysis of 546 ICU patients requiring mechanical ventilation within LewisGale Hospital Montgomery (LGHM) from 2014 to 2019. Intervention: Implementation of the ABCDEF Protocol Measurements: Number of patients in each hospital requiring mechanical ventilation greater than or less than 24 hours, as well as the total number of expired patients.

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