Evaluation and impact of the ABCDEF bundle in a neurocritical patient population: a prospective observational study.

OBJECTIVE

To evaluate the clinical impact of adherence to the ABCDEF bundle in neurocritical patients admitted to an Intensive Care Unit (ICU) in Ecuador.

DESIGN

A retrospective, observational, single-center study conducted between 2022 and 2024.

SETTING

The ICU of a tertiary-level hospital in Guayaquil, Ecuador.

PATIENTS OR

PARTICIPANTS

Sixty adult neurocritical patients with ICU stays longer than 48 h were included. Patients were classified into two groups according to their adherence to the ABCDEF bundle: high adherence (≥4 components) and low adherence (≤3 components).

INTERVENTIONS: Implementation of the ABCDEF bundle, including pain assessment, individualized sedation, delirium screening, early mobilization, and family participation. The main outcome measures were ICU mortality, duration of mechanical ventilation (MV), ICU length of stay, and incidence of delirium.

RESULTS

High adherence was associated with a shorter MV duration (median 11 [IQR 7-15.8] vs. 15 [15-18] days; p = 0.001) and shorter ICU stay (15 [10-20] vs. 20 [18-21.8] days; p =  0.016). Mortality was lower in the high-adherence group (23.3% vs. 46.7%), although this difference was not statistically significant in the bivariate analysis (p = 0.104). In the multivariate analysis, low adherence was independently associated with higher mortality (OR: 4.51; 95%CI: 1.07-19.05; p = 0.040). The incidence of delirium was higher in the high-adherence group (53.3% vs. 0%; p < 0.001), a finding that requires further investigation to clarify its clinical significance.

CONCLUSIONS

Adherence to the ABCDEF bundle was associated with improved clinical outcomes in neurocritical patients, supporting its implementation in ICUs with limited resources.