Effectiveness of a modified ABCDE bundle on ICU psychosis among cardiac postoperative patients at a selected tertiary care hospital, Coimbatore

Authors

  • Geetha S. Department of Nursing Foundation, Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, India
  • Nirmala M. Department of Medical Surgical Nursing, PSG College of Nursing, Coimbatore, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263528

Keywords:

Postoperative care, Intensive care unit, Intensive care delirium screening checklist, ABCDE bundle, Cardiac surgery, Critical care nursing, Delirium

Abstract

Background: Intensive care unit (ICU) delirium is a common postoperative complication among cardiac surgery patients and is associated with prolonged mechanical ventilation, increased hospital stays, higher healthcare costs, and poor clinical outcomes. Evidence regarding modified ABCDE bundle interventions specifically designed for cardiac postoperative patients remains limited. This study evaluated the effectiveness of a modified ABCDE bundle in reducing ICU delirium among adult cardiac postoperative patients.

Methods: A true experimental, pretest-posttest control group design study was conducted among 30 adult cardiac postoperative patients admitted to the Cardio-Thoracic Intensive Care Unit of a tertiary care hospital in Coimbatore, Tamil Nadu. Participants were allocated into an intervention group (n=15), which received the modified ABCDE bundle in addition to routine care, and a routine care group (n=15). ICU delirium was assessed using the Intensive Care Delirium Screening Checklist (ICDSC). Descriptive statistics and paired and unpaired t tests were used for data analysis.

Results: Baseline characteristics were comparable between groups. Post-intervention, the intervention group demonstrated significantly lower mean ICDSC scores than the routine care group (1.20±1.469 vs. 5.33±2.809). The intervention group also showed a greater reduction in delirium severity following implementation of the modified ABCDE bundle.

Conclusions: The modified ABCDE bundle was effective in reducing ICU delirium among adult cardiac postoperative patients and may be incorporated into routine nurse-led postoperative ICU care to improve patient outcomes.

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References

Pun BT, Balas MC, Barnes-Daly MA, Thompson JL, Aldrich JM, Barr J, et al. Caring for critically ill patients with the ABCDEF Bundle: results of the ICU Liberation Collaborative in over 15,000 adults. Crit Care Med. 2019;47(1):3-14. DOI: https://doi.org/10.1097/CCM.0000000000003482

Sosnowski K, Lin F, Chaboyer W, Ranse K, Heffernan A, Mitchell M. The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: a systematic review and meta-analysis. Int J Nurs Stud. 2023;138:104410. DOI: https://doi.org/10.1016/j.ijnurstu.2022.104410

Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825-e873.

Ely EW. The ABCDEF Bundle: science and philosophy of how ICU Liberation serves patients and families. Crit Care Med. 2017;45(2):321-30. DOI: https://doi.org/10.1097/CCM.0000000000002175

Stollings JL, Devlin JW, Pun BT, Puntillo KA, Kelly T, Hargett KD, et al. Implementing the ABCDEF Bundle: top 8 questions asked during the ICU Liberation ABCDEF Bundle Improvement Collaborative. Crit Care Nurse. 2019;39(1):36-45. DOI: https://doi.org/10.4037/ccn2019981

Balas MC, Pun BT, Pasero C, Engel HJ, Perme C, Esbrook CL, et al. Common challenges to effective ABCDEF bundle implementation: the ICU Liberation Campaign experience. Crit Care Nurse. 2019;39(1):46-60. DOI: https://doi.org/10.4037/ccn2019927

Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859-64. DOI: https://doi.org/10.1007/s001340100909

Krewulak KD, Stelfox HT, Ely EW, Fiest KM. Risk factors and outcomes among delirium subtypes in adult ICUs: a systematic review. J Crit Care. 2020;56:257-64. DOI: https://doi.org/10.1016/j.jcrc.2020.01.017

Chen H, Mo L, Hu H, Ou Y, Luo J. Risk factors of postoperative delirium after cardiac surgery: a meta-analysis. J Cardiothorac Surg. 2021;16(1):113. DOI: https://doi.org/10.1186/s13019-021-01496-w

Cupka JS, Hashemighouchani H, Lipori J, Ruppert MM, Bhaskar R, Ozrazgat-Baslanti T, et al. The effect of non-pharmacologic strategies on prevention or management of intensive care unit delirium: a systematic review. F1000Research. 2020;9:1178. DOI: https://doi.org/10.12688/f1000research.25769.1

Costa DK, Valley TS, Miller MA, Manojlovich M, Watson SR, McLellan P, et al. ICU team composition and its association with ABCDE implementation in a quality collaborative. J Crit Care. 2018;44:1-7. DOI: https://doi.org/10.1016/j.jcrc.2017.09.180

FradeMera MJ, Arias-Rivera S, Zaragoza-García I, Martí JD, Gallart E, José-Arribas AS, et al. The impact of ABCDE bundle implementation on patient outcomes: a nationwide cohort study. Nurs Crit Care. 2022;27(6):772-83. DOI: https://doi.org/10.1111/nicc.12740

Moraes FDS, Marengo LL, Moura MDG, Bergamaschi CDC, Del Fiol FS, Lopes LC, et al. ABCDE and ABCDEF care bundles: a systematic review of the implementation process in intensive care units. Medicine (Baltimore). 2022;101(25):e29484. DOI: https://doi.org/10.1097/MD.0000000000029499

Huang X, Lei L, Zhang S, Yang J, Yang L, Xu M. Implementation of the ABCDEF bundle in pediatric intensive care units: a cross-sectional survey. J Int Med Res. 2021;49(1):1-11. DOI: https://doi.org/10.1177/0300060520987770

Faisal H, Farhat S, Grewal NK, Masud FN. ICU delirium in cardiac patients. Methodist Debakey Cardiovasc J. 2023;19(4):74-84. DOI: https://doi.org/10.14797/mdcvj.1246

Khan SH, Lindroth H, Hendrie K, Wang S, Imran S, Perkins AJ, et al. Time trends of delirium rates in the intensive care unit. Heart Lung. 2020;49(5):572-7. DOI: https://doi.org/10.1016/j.hrtlng.2020.03.006

Oliveira FR, Oliveira VH, Oliveira TM, Lima JW, Calderaro D, Gualandro DM, et al. Hypertension, mitral valve disease, atrial fibrillation and low education level predict delirium after cardiac surgery in older adults. BMC Anesthesiol. 2018;18(1):1-9. DOI: https://doi.org/10.1186/s12871-018-0481-0

Sanchez D, Brennan K, Sayfe MA, Shunker SA, Bogdanoski T, Hedges S, et al. Frailty, delirium and hospital mortality of older adults admitted to intensive care. Crit Care. 2020;24(1):609. DOI: https://doi.org/10.1186/s13054-020-03318-2

Xue Y, Liu W, Su L, He H, Chen H, Long Y. Quantitative electroencephalography predicts postoperative delirium in cardiac surgical patients after cardiopulmonary bypass. Front Med (Lausanne). 2023;10:1173486. DOI: https://doi.org/10.3389/fmed.2023.1163247

Zhang S, Han Y, Xiao Q, Li H, Wu Y. Effectiveness of bundle interventions on ICU delirium: a meta-analysis. Crit Care Med. 2021;49(2):335-346. DOI: https://doi.org/10.1097/CCM.0000000000004773

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Published

2026-09-29

How to Cite

S., G., & M., N. (2026). Effectiveness of a modified ABCDE bundle on ICU psychosis among cardiac postoperative patients at a selected tertiary care hospital, Coimbatore. International Journal of Research in Medical Sciences, 14(10), 4593–4600. https://doi.org/10.18203/2320-6012.ijrms20263528

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Original Research Articles