ArticleCritical care medicine2019
Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults.
Article in Critical care medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 5 registered trials, which are not on this map. Cited by 404 papers, 8 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
PICU Up!:A Pilot Stepped-wedge Trial of a Multicomponent Early Mobility Intervention for Critically Ill Children
Determinants of Implementation Success Coordinating Ventilator, Early Ambulation and Rehabilitation Efforts in the Intensive Care Unit
Pediatric Hypertension and the Renin-Angiotensin SystEm (PHRASE): The Role of Angiotensin-(1-7) in Hypertension and Hypertension-Induced Heart and Kidney Damage
Potentially MOdifiable Factors To ImproVe Outcomes of Mechanically Ventilated Patients in ICUs in a Low-income Country: Rationale and Protocol for a Registry-embedded Prospective Observational Study
A Three-phase Pilot Study of the Feasibility of the Measurement and Promotion of Sleep and the Circadian Rhythm in a Pediatric Intensive Care Unit
Who cites it
404 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Psychosocial coping with intensive care delirium: a mixed-methods systematic review of patient and family perspectives.Critical care (London, England) · 2026Pooled it
- [Frailty in intensive care medicine].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2026Pooled it
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- A systematic meta-review of interventions to prevent and manage delirium in the Intensive Care Unit: Part 2 - Non-pharmacological and multicomponent interventions.Critical care (London, England) · 2025Pooled it
- Association between the use of midazolam, fentanyl, propofol, ketamine, and dexmedetomidine and the incidence of delirium in elderly patients in intensive care units: a systematic review.Sao Paulo medical journal = Revista paulista de medicina · 2025Pooled it
- Guideline on positioning and early mobilisation in the critically ill by an expert panel.Intensive care medicine · 2024Guideline
- ICU patients receiving remifentanil do not experience reduced duration of mechanical ventilation: a systematic review of randomized controlled trials and network meta-analyses based on Bayesian theories.Frontiers in medicine · 2024Pooled it
- Major Publications in the Critical Care Pharmacotherapy Literature: 2022.Critical care explorations · 2023Pooled it
- Effects of the ABCDEF Bundle on Delirium, Function, and Quality of Life in Australian ICU Patients: A Pragmatic Randomized Controlled Trial.Critical care medicine · 2026Trial
- Association between ABCDE bundle compliance and long-term outcomes: a secondary longitudinal analysis.Intensive care medicine · 2026Trial
- Dexmedetomidine for treatment of hyperactive delirium in non-intubated ICU patients: the 4D randomized clinical trial.Intensive care medicine · 2025Trial
- Slow-Tempo Music and Delirium/Coma-Free Days Among Older Adults Undergoing Mechanical Ventilation: A Randomized Clinical Trial.JAMA internal medicine · 2025Trial
- Comparison of SAT and SBT Conduct During the ABC Trial and PILOT Trial.Journal of intensive care medicine · 2025Trial
- Long-term outcomes after treatment of delirium during critical illness with antipsychotics (MIND-USA): a randomised, placebo-controlled, phase 3 trial.The Lancet. Respiratory medicine · 2024Trial
- Pain monitoring in intensive care: How does the nociception level index affect treatment and prognosis? A randomized, controlled, double-blind trial.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2024Trial
- Effect of neuromuscular electrical stimulation combined with early rehabilitation therapy on mechanically ventilated patients: a prospective randomized controlled study.BMC pulmonary medicine · 2023Trial
- Effect of early mobilisation on long-term cognitive impairment in critical illness in the USA: a randomised controlled trial.The Lancet. Respiratory medicine · 2023Trial
- Evaluation of a new insertion site for arterial pressure line in intensive care unit management: a prospective study.Journal of clinical monitoring and computing · 2023Trial
- Actigraphy-based sleep and activity measurements in intensive care unit patients randomized to ramelteon or placebo for delirium prevention.Scientific reports · 2023Trial
- Psychiatric insights in thoracic surgery for adults and children: A narrative review.Turk gogus kalp damar cerrahisi dergisi · 2026Article
344 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
27 authors.
Funding
Abstract
objectiveDecades-old, common ICU practices including deep sedation, immobilization, and limited family access are being challenged. We endeavoured to evaluate the relationship between ABCDEF bundle performance and patient-centered outcomes in critical care.
designProspective, multicenter, cohort study from a national quality improvement collaborative.
setting68 academic, community, and federal ICUs collected data during a 20-month period. PATIENTS: 15,226 adults with at least one ICU day.
interventionsWe defined ABCDEF bundle performance (our main exposure) in two ways: 1) complete performance (patient received every eligible bundle element on any given day) and 2) proportional performance (percentage of eligible bundle elements performed on any given day). We explored the association between complete and proportional ABCDEF bundle performance and three sets of outcomes: patient-related (mortality, ICU and hospital discharge), symptom-related (mechanical ventilation, coma, delirium, pain, restraint use), and system-related (ICU readmission, discharge destination). All models were adjusted for a minimum of 18 a priori determined potential confounders. MEASUREMENTS AND
resultsComplete ABCDEF bundle performance was associated with lower likelihood of seven outcomes: hospital death within 7 days (adjusted hazard ratio, 0.32; CI, 0.17-0.62), next-day mechanical ventilation (adjusted odds ratio [AOR], 0.28; CI, 0.22-0.36), coma (AOR, 0.35; CI, 0.22-0.56), delirium (AOR, 0.60; CI, 0.49-0.72), physical restraint use (AOR, 0.37; CI, 0.30-0.46), ICU readmission (AOR, 0.54; CI, 0.37-0.79), and discharge to a facility other than home (AOR, 0.64; CI, 0.51-0.80). There was a consistent dose-response relationship between higher proportional bundle performance and improvements in each of the above-mentioned clinical outcomes (all p < 0.002). Significant pain was more frequently reported as bundle performance proportionally increased (p = 0.0001).
conclusionsABCDEF bundle performance showed significant and clinically meaningful improvements in outcomes including survival, mechanical ventilation use, coma, delirium, restraint-free care, ICU readmissions, and post-ICU discharge disposition.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.