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:
Reduce ICU length of stay
It is one of the few things that has been shown to reduce mortality = people LIVE MORE FREQUENTLY
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)
- 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)
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
Patient and family centered care
- Communicate with families effectively
- Engaging the family and empowering them to make appropriate decisions for the loved one
