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

Abstract

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.