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First: Take a listen to the podcast!

What is the difference between PAD and the A-F bundle?

  • The A-F bundle is a bundle developed by Vanderbilt of care designed to operationalize the SCCM PAD guidelines. It is a new way to think about and organize the guidelines

Why is it important?

  • It has been shown to:
    1. Reduce ICU length of stay
    2. It is one of the few things that has been shown to reduce mortality = people LIVE MORE FREQUENTLY
    3. Reduces incidence of post-intensive care syndrome (PICS)

History of sedatives in the ICU

  • Early vents: not capable of synchronizing breaths with patient, deeper sedation needed to be compliant
  • Newer short acting agents and analgesics have hit the market making deeper sedation unnecessary

So, what does A-F bundle stand for?

 - Majority of ICU patients experience pain which causes significant stress  - Treat pain FIRST; do not reach for sedatives. Intermittent analgesia > continuous gtts (click here for study)  - Assessing for pain: use CPOT (not vital signs)

- Majority of ICU patients experience pain which causes significant stress

- Treat pain FIRST; do not reach for sedatives. Intermittent analgesia > continuous gtts (click here for study)

- Assessing for pain: use CPOT (not vital signs)

 - Stop continuous sedation --> prevent build up of drug, reduced LOS

- Stop continuous sedation --> prevent build up of drug, reduced LOS

  Choose wisely.  RASS score - target 0, free from agitation but not heavily sedated   Sedation choice : Sedatives should only be used if patient is anxious or agitated  Avoid benzo gtts; try to use propofol (no analgesic properties), some SE but has rapid on, rapid off capabilities  Another choice: dexmedetomidine (only approved for short term sedation)

Choose wisely. RASS score - target 0, free from agitation but not heavily sedated

Sedation choice: Sedatives should only be used if patient is anxious or agitated

Avoid benzo gtts; try to use propofol (no analgesic properties), some SE but has rapid on, rapid off capabilities

Another choice: dexmedetomidine (only approved for short term sedation)

 Acute onset of cerebral dysfunction or essentially a change in level of consciousness  - Hypoactive --> calm/lethargic confused patients (majority)  - Hyperactive --> hallucinations and delusions (only ~2%)  Assess once a shift; CAM-ICU

Acute onset of cerebral dysfunction or essentially a change in level of consciousness

- Hypoactive --> calm/lethargic confused patients (majority)

- Hyperactive --> hallucinations and delusions (only ~2%)

Assess once a shift; CAM-ICU

 - Early mobility has the only data for prevention of delirium and best data for reducing days with delirium  - Passive ROM for RASS -2 to -3, active ROM for RASS -1 to 1

- Early mobility has the only data for prevention of delirium and best data for reducing days with delirium

- Passive ROM for RASS -2 to -3, active ROM for RASS -1 to 1

  P  atient and family centered care   - Communicate with families effectively  - Engaging the family and empowering them to make appropriate decisions for the loved one

Patient and family centered care

- Communicate with families effectively

- Engaging the family and empowering them to make appropriate decisions for the loved one

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So why should we do this?

Because they are the best care for our patients and families and that's what's most important.