Viewpoint: ICU care often result in new harm and injuries — here's how to fix it

There is an evidence-based approach to reducing death, length of hospital stay, cost of care and additional injuries during intensive care unit treatment, but most hospitals are not using it, according to one expert.

Wes Ely, MD, a professor of critical care medicine at Nashville-based Vanderbilt University Medical Center, shared his ABCDEF care bundle model at the Association of American Medical Colleges' annual meeting Nov. 14 in Nashville. 

The care model allows patients to achieve greater mobility and mental clarity and renew personal connections while healing, he said.

The traditional approach of heavy sedation and immobilization can lead to a number of injuries, such as ICU delirium, post-intensive care syndrome, muscle atrophy, and PTSD and mental health issues — usually a result of hallucinations. 

Delirium predicts a 10 percent increased risk of death and 35 percent increase of brain dysfunction. Patients can lose 10 percent to 25 percent of their muscle mass in four to five days, according to the article.

Dr. Ely said his six-step safety bundle prevents most of these treatment injuries:

  1. A — Analgesia, get rid of the ventilator and the sedation as soon as possible.

  2. B — Both, a daily attempt to remove sedatives and breathing machines.

  3. C — Choice of analgesia and sedation.

  4. D — Delirium, treat it correctly and include environmental steps like lighting to match day/night cycles.

  5. E — Early mobility, get patients up and walking.

  6. F — Family, have them present and engaged.

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