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ICU Liberation ABCDEF Bundle

ICU Liberation ABCDEF Bundle: ICU Patient - Daily Bundle Assessment → A: Assess, Prevent, and Manage Pain → B: Both SAT and SBT → C: Choice of Analgesia...

Pathway Overview

11 steps

Algorithm Steps

11 total

  1. 01Start

    ICU Patient - Daily Bundle Assessment

    Apply ABCDEF bundle elements daily

  2. 02Action

    A: Assess, Prevent, and Manage Pain

    Pain assessment is the first priority

    • Use validated pain scale (CPOT, BPS, NRS)
    • Assess q4h and PRN
    • Target: pain score <3 or comfortable
    • Analgesia-first approach before sedation
    • Multimodal analgesia when possible
  3. 03Action

    B: Both SAT and SBT

    Coordinated awakening and breathing trials

    • SAT: Daily sedation interruption
    • SBT: Spontaneous breathing trial
    • COORDINATE: SAT before SBT
    • Pass SAT → proceed to SBT
    • Reduces ventilator days and mortality
  4. 04Action

    C: Choice of Analgesia and Sedation

    Avoid benzodiazepines, target light sedation

    • Analgesia-first (opioids, adjuncts)
    • Sedation: Dexmedetomidine or Propofol
    • AVOID benzodiazepines (increased delirium)
    • Target RASS 0 to -2 (light sedation)
    • Daily sedation goals discussion
  5. 05Action

    D: Delirium - Assess, Prevent, Manage

    Screen every shift, use non-pharm interventions

    • CAM-ICU or ICDSC q8-12h
    • Identify and treat underlying causes
    • Non-pharmacologic interventions FIRST
    • Reorientation, sleep hygiene, early mobility
    • Limit deliriogenic medications
  6. 06Action

    E: Early Mobility and Exercise

    Progressive mobility starting day 1

    • Assess for contraindications daily
    • Start: passive ROM, in-bed exercises
    • Progress: sitting, standing, ambulation
    • PT/OT consultation
    • Safe to mobilize on vasopressors (stable doses)
    • Reduces delirium, weakness, LOS
  7. 07Action

    F: Family Engagement and Empowerment

    Include family in care and decisions

    • Open visitation policies when possible
    • Family participation in rounds
    • Communication and updates
    • Family presence reduces delirium
    • Support for family well-being
    • Goals of care discussions
  8. 08Decision

    Bundle Elements Completed Today?

    Document compliance with each element

  9. 09Action

    Document Completion

    Track bundle compliance

    • Each element performed or contraindicated
    • Document reasons if not done
    • Track delirium-free, ventilator-free days
    • QI metric for bundle compliance
  10. 10Outcome

    Daily Bundle Complete

    Repeat daily throughout ICU stay

  11. 11Action

    Address Barriers

    Identify why elements not completed

    • Clinical contraindication (document)
    • Resource limitation (escalate)
    • Knowledge gap (education)
    • System issue (process improvement)
  12. Path rejoins step 10Shared downstream outcome

Guideline Source

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

DOI: 10.1097/CCM.0000000000002375View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Requires multidisciplinary team coordination
  • Some elements may not apply to all patients
  • Does not replace individualized clinical judgment
  • Implementation requires institutional protocols
  • Family engagement may be limited in pandemic/isolation

Contraindicated Populations

pediatric

Applicable Regions

USEUGlobal

Global: SCCM ICU Liberation Bundle

Version 1Next review: 2028-01-01

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Frequently Asked Questions

What is the ICU Liberation ABCDEF Bundle?

The ICU Liberation ABCDEF Bundle is a management clinical algorithm for Critical Care. It provides a structured decision tree to guide clinical decision-making, based on Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.

What guideline is the ICU Liberation ABCDEF Bundle based on?

This algorithm is based on Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (DOI: 10.1097/CCM.0000000000002375).

What are the limitations of the ICU Liberation ABCDEF Bundle?

Known limitations include: Requires multidisciplinary team coordination; Some elements may not apply to all patients; Does not replace individualized clinical judgment; Implementation requires institutional protocols; Family engagement may be limited in pandemic/isolation. Individual patient factors may require deviation from these recommendations.

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