الفهرس 
Effect of ABCDE Bundle on ICU acquired Delirium and WeaknessOnly 14 pages are availabe for public view
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Abstract
The numbers of patients requiring intensive care are increasing worldwide and many of these patients require mechanical ventilation (MV). Mechanical ventilation is a lifesaving procedure (Grigorescu, 2020). About 13– 20 million critically ill patients are admitted to ICUs annually worldwide, of whom up to 50% require MV. (Jacobs etal., 2020).Mechanical ventilation provide adequate ventilation and oxygenation,reduce work of breathing, rest respiratory muscles, improve gas exchange, andmaintain acid-base balance, but it can cause physiological, cognitive and physical impairments such as hemodynamic instability, delirium, muscle weakness, over-sedation, Ventilated Associated Pneumonia (VAP), and increased length of ICU stay (Bilotta et al., 2019).The ABCDE bundle incorporates the best available evidence related to sedation, delirium, immobility and ventilator management. The ABCDE bundle aims to promote patient recovery, improve ICU processes, counteract some significant and frequent complications affecting ICU patients, break the cycle of over-sedation and prolonged MV that causes ICU-acquired delirium and weakness, and thus improve patient outcomes. (Mart et al., 2019).Purpose of the study The purpose of the current study is to examine the effectiveness of ABCDE Bundle on ICU-acquired Delirium and Weakness among Mechanically Ventilated Patients.Research Design:- A quasi experimental design (control and study) was used to examine the effect of ABCDE Bundle on ICU-acquired delirium and weakness among Mechanically Ventilated Patients Setting: The current study was conducted in the Surgical Intensive Care Unit at the Menoafia University hospital, Menoufia Governorate, Egypt. Sample :-A convenient sample of 100 patients was recruited to participate in the current study. Patients who met the study inclusion criteria including (a) Adult patients (18–65 years); (b) Patients stayed in the ICU more than 24 hours; (c) Patients on mechanical ventilation and on sedation. Patients were excluded to participate in the study if they have any of the following conditions: (a) Quadriplegia; (b) Neuromuscular diseases (Guillain–Barré syndrome, Myasthenia Gravis, Peripheral neuropathy) that could impair weaning from MV and mobilization; (c) Richmond Agitation–Sedation Scale score of 4 and 5 (Deep coma) without sedation because patients cannot obey command; (d) Deep Vein Thrombosis; (e) Status epilepticus .Instruments In order to achieve the purpose of the present study, the following instruments will be used:I: A Semi Structured Demographic and Clinical Data Sheet A Semi Structured Demographic and Clinical Data Sheet developed by theresearcher to collect demographic data including: age, gender, ICU diagnosis,duration of mechanical ventilation, ICU length of stay and Cumulative amount of sedative and analgesic medication.II: Acute Physiology and chronic Health Evaluation II( APACHE II) scale APACHE II used to measure the severity of disease for patients admitted to intensive care units during the first 24 hours after admission.III: The charlson Comorbidity Index (CCI) CCI is a method of categorizing comorbidities of patients based on the International Classification of Diseases (ICD) diagnosis codes found in administrative data. Each comorbidity category has an associated weight (from 1 to 6) based on the adjusted risk of mortality, and the sum of all the weights results in a single comorbidity score for a patient.IV: Richmond Agitation-Sedation Scale (RASS) The RASS measure the agitation or sedation level of mechanically ventilated patients in order to avoid over and under-sedation. Also Obtaining a RASS score is the first step in administering the Confusion Assessment Method in the ICU (CAM-ICU), a tool to detect delirium in intensive care unit patients.V: Confusion Assessment Method in the ICU (CAM-ICU)It is the delirium assessment tool constructed with yes/no questions for use with nonspeaking, mechanically ventilated ICU patients. Delirium is defined in terms of four diagnostic features, and is deemed positive when Feature 1 and Feature 2 and either Feature 3 or 4 are present VI: Medical Research Council Manual Muscle Testing (MRC-MMT) scale Scale used to diagnosis ICU-AW by assessing the upper and lower extremities key muscles on a 0 to 5 scale. The summed score ranging from 0 to 60. A summed score below 48 indicates ICU-AW and 48 to 60 indicates muscle strength. The MRC Scale is bilaterally applied to six muscle groups of the upper and lower limbs in order to obtain a summed score ranging from 0 to 60: (1) abduction of the arm;(2) flexion of the forearm; (3) extension of the wrist; (4) flexion of the leg or hipflexion; (5) extension of the knee; and (6) dorsal flexion of the foot. A summed
score below 48 indicates ICUAW and 48 to 60 indicates muscle strength VII: Cardiorespiratory Parameters questionnaire Cardiorespiratory Parameters questionnaire was developed by Holzheimer and Mannick ( 2001) to assess oxygenation parameters which including respiratory rate, PH, arterial partial pressure of oxygen (PaO2), Arterial blood sample was drown from patient and was analyzed via blood gas analyzer (RAPID Point® 500).
Hemodynamic parameters included central venous pressure (CVP), heart rate, and Mean Arterial Pressure (MAP). These parameters were obtained from bed side monitor (NIHON KOHDEN, life scope, BSM 3000 series, Tokyo, Jaban),Except CVP was measured manually.Ethical consideration The permission for conducting the study was obtained from the Faculty of Nursing and hospital director for seeking permission to carry out the study after explaining the purpose of the study. An oral consent was obtained from relatives of the patients who met the study inclusion criteria to participate in the study. At the initial interview, relatives were informed about the purpose, procedure, and benefits of the study and the researcher explained that participation in the study is voluntary and they can withdraw from the study at any time without penalty.Confidentiality and anonymity of patients’ information were assured through coding all data and put all paper in a secured closed cabinet. Questionnaires were fulfilled by investigator herself and the nature of questionnaires didn’t cause any physical or emotional harm to participants.