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Purpose <p>There is limited information on the relationship between multidisciplinary bundle compliance and long-term outcomes. We explored the association between bundle compliance and outcomes at 3 and 12&#xa0;months after hospital discharge.</p> Methods <p>We conducted secondary analyses of a randomized controlled trial comparing haloperidol, ziprasidone, and placebo for delirium in patients with critical illness. From 2011 to 2017, adult patients with respiratory failure and/or shock were recruited from 16 US medical centers. Participants received a daily ABCDE bundle during their critical illness. We assessed cognition, disability, mental health, quality of life, and survival over 12&#xa0;months of follow-up. We analyzed data using linear mixed effects regression and Cox proportional hazards models.</p> Results <p>Among 566 participants, 418 survived to hospital discharge, 304 were assessed for 3-month outcomes, and 251 for 12-month outcomes. Median proportional bundle compliance was 97%, indicating high overall fidelity. After adjusting for covariates, greater proportional bundle compliance was associated with better functional independence and health-related quality of life, as evidenced by lower 12-month Functional Activity Questionnaire scores (<i>β</i> = – 9.6, CI = – 19.6, – 1.7, <i>p</i> = 0.04) and higher 12-month EuroQol-5D scores (<i>β</i> = 0.5, CI = 0.1, 0.9, <i>p</i> = 0.01). Greater bundle compliance was not associated with better long-term cognition, mental health, or survival.</p> Conclusion <p>In this multi-site cohort with high-fidelity bundle compliance, greater bundle compliance was associated with less disability in instrumental activities of daily living and better health-related quality of life at 12&#xa0;months, though associations were inconsistent and absent across other domains. Future research should evaluate integrated bundle care with post-discharge interventions to optimize long-term recovery.</p> Trial registration <p>The Modifying the Impact of ICU-Associated Neurological Dysfunction-USA Study (MIND-USA), NCT01211522, <a href="https://clinicaltrials.gov/ct2/show/NCT01211522">https://clinicaltrials.gov/ct2/show/NCT01211522</a>.</p>

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Association between ABCDE bundle compliance and long-term outcomes: a secondary longitudinal analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月25日

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  • Leanne M. Boehm,
  • Matthew F. Mart,
  • Marianna LaNoue,
  • Shu-Fen Siao,
  • Brenda T. Pun,
  • David L. Bowton,
  • Matthew C. Exline,
  • Michelle N. Gong,
  • Robert D. Hite,
  • Catherine L. Hough,
  • Robert C. Hyzy,
  • Babar A. Khan,
  • Robert L. Owens,
  • Margaret A. Pisani,
  • Peter Rock,
  • Gregory A. Schmidt,
  • James C. Jackson,
  • E. Wesley Ely,
  • Timothy D. Girard,
  • Nathan E. Brummel

摘要

Purpose

There is limited information on the relationship between multidisciplinary bundle compliance and long-term outcomes. We explored the association between bundle compliance and outcomes at 3 and 12 months after hospital discharge.

Methods

We conducted secondary analyses of a randomized controlled trial comparing haloperidol, ziprasidone, and placebo for delirium in patients with critical illness. From 2011 to 2017, adult patients with respiratory failure and/or shock were recruited from 16 US medical centers. Participants received a daily ABCDE bundle during their critical illness. We assessed cognition, disability, mental health, quality of life, and survival over 12 months of follow-up. We analyzed data using linear mixed effects regression and Cox proportional hazards models.

Results

Among 566 participants, 418 survived to hospital discharge, 304 were assessed for 3-month outcomes, and 251 for 12-month outcomes. Median proportional bundle compliance was 97%, indicating high overall fidelity. After adjusting for covariates, greater proportional bundle compliance was associated with better functional independence and health-related quality of life, as evidenced by lower 12-month Functional Activity Questionnaire scores (β = – 9.6, CI = – 19.6, – 1.7, p = 0.04) and higher 12-month EuroQol-5D scores (β = 0.5, CI = 0.1, 0.9, p = 0.01). Greater bundle compliance was not associated with better long-term cognition, mental health, or survival.

Conclusion

In this multi-site cohort with high-fidelity bundle compliance, greater bundle compliance was associated with less disability in instrumental activities of daily living and better health-related quality of life at 12 months, though associations were inconsistent and absent across other domains. Future research should evaluate integrated bundle care with post-discharge interventions to optimize long-term recovery.

Trial registration

The Modifying the Impact of ICU-Associated Neurological Dysfunction-USA Study (MIND-USA), NCT01211522, https://clinicaltrials.gov/ct2/show/NCT01211522.