Journal article
Association between ABCDE bundle compliance and long-term outcomes: a secondary longitudinal analysis
Intensive care medicine
02/25/2026
DOI: 10.1007/s00134-026-08346-0
PMID: 41739187
Abstract
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.PURPOSEThere 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.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.METHODSWe 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.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.RESULTSAmong 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.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.CONCLUSIONIn 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.The Modifying the Impact of ICU-Associated Neurological Dysfunction-USA Study (MIND-USA), NCT01211522, https://clinicaltrials.gov/ct2/show/NCT01211522 .TRIAL REGISTRATIONThe Modifying the Impact of ICU-Associated Neurological Dysfunction-USA Study (MIND-USA), NCT01211522, https://clinicaltrials.gov/ct2/show/NCT01211522 .
Details
- Title: Subtitle
- Association between ABCDE bundle compliance and long-term outcomes: a secondary longitudinal analysis
- Creators
- Leanne M Boehm - Vanderbilt UniversityMatthew F Mart - Allen Institute for Brain ScienceMarianna LaNoue - Vanderbilt UniversityShu-Fen Siao - National Taiwan UniversityBrenda T Pun - Vanderbilt UniversityDavid L Bowton - Wake Forest UniversityMatthew C Exline - The Ohio State UniversityMichelle N Gong - Albert Einstein College of MedicineRobert D Hite - University of Cincinnati Medical CenterCatherine L Hough - Oregon Health and Science University HospitalRobert C Hyzy - University of MichiganBabar A Khan - Indiana University School of MedicineRobert L Owens - University of California San DiegoMargaret A Pisani - Yale UniversityPeter Rock - University of Maryland, BaltimoreGregory A Schmidt - University of IowaJames C Jackson - Allen Institute for Brain ScienceE Wesley Ely - Allen Institute for Brain ScienceTimothy D Girard - University of PittsburghNathan E Brummel - Allen Institute for Brain Science
- Resource Type
- Journal article
- Publication Details
- Intensive care medicine
- DOI
- 10.1007/s00134-026-08346-0
- PMID
- 41739187
- NLM abbreviation
- Intensive Care Med
- ISSN
- 1432-1238
- eISSN
- 1432-1238
- Publisher
- SPRINGER
- Grant note
- National Institute on Aging: R01AG035117, R01AG077644
This study was supported by grants R01AG035117 and R01AG077644 from the National Institute of Health and by the Department of Veterans Affairs Geriatric Research Education and Clinical Center. Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
- Language
- English
- Electronic publication date
- 02/25/2026
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9985139487902771
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