The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families
Open accessAbstract
Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called “the postintensive care syndrome.” Patients with postintensive care syndrome are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care. This article explains the science and philosophy of liberating ICU patients and families from harm that is both inherent to critical illness and iatrogenic. ICU liberation is an extensive program designed to facilitate the implementation of the pain, agitation, and delirium guidelines using the evidence-based ABCDEF bundle. Participating ICU teams adapt data from hundreds of peer-reviewed studies to operationalize a systematic and reliable methodology that shifts ICU culture from the harmful inertia of sedation and restraints to an animated ICU filled with patients who are awake, cognitively engaged, and mobile with family members engaged as partners with the ICU team at the bedside. In doing so, patients are “liberated” from iatrogenic aspects of care that threaten his or her sense of self-worth and human dignity. The goal of this 2017 plenary lecture at the 47th Society of Critical Care Medicine Congress is to provide clinical ICU teams a synthesis of the literature that led to the creation of ICU liberation philosophy and to explain how this patient- and family-centered, quality improvement program is novel, generalizable, and practice changing.
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A discussion of goals of care and prognosis is essential to determine which treatments are acceptable and which are not desired.
“A discussion of goals of care and prognosis is essential to determine which treatments are acceptable and those interventions that are not desired [536].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [536]
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Bassett, R. D., Adams, K. M., Danesh, V. C., Groat, P. M., Haugen, A., Kiewel, A., Small, C., Van-Leuven, M., Venus, S., & Ely, E. W. (2015) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(15)41010-4 · Cited by 46 · see citing works
Self-citationCritically ill patients need “FAST HUGS BID” (an updated mnemonic)
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Life after intensive care—It’s life … but not as we know it!*
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
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Self-citationManaging ICU surge during the COVID-19 crisis: Rapid guidelines.
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Benzodiazepines and Development of Delirium in Critically Ill Children: Estimating the Causal Effect
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Delirium in Pediatric Critical Care
Patel, A. K., Bell, M. J., & Traube, C. (2017) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2017.06.009 · Cited by 122 · see citing works
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
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Investigating Ketone Bodies as Immunometabolic Countermeasures against Respiratory Viral Infections
Stubbs, B. J., Koutnik, A. P., Goldberg, E. L., Upadhyay, V., Turnbaugh, P. J., Verdin, E., & Newman, J. C. (2020) · Med · doi:10.1016/j.medj.2020.06.008 · Cited by 71 · see citing works
Hume, N. E., Zerfas, I., Wong, A., Klein-Fedyshin, M., Smithburger, P. L., Buckley, M. S., Devlin, J. W., & Kane-Gill, S. L. (2024) · Critical Care Medicine · doi:10.1097/ccm.0000000000006178 · Cited by 45 · see citing works
- Authors
- Ely, E. W.
- Affiliations
- Vanderbilt University Medical Center (US)
- Corresponding author
- Ely, E. Wesley
- ORCID
- Ely, E. Wesley
- Venue
- Critical Care Medicine
- Published
- 2017-02
- Volume
- 45
- Issue
- 2
- Pages
- 321-330
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC5830123
- OpenAlex
- W2576939111
- Cited by
- 514
- References
- 101
- Citations by year
- 2026: 51 · 2025: 39 · 2024: 62 · 2023: 70 · 2022: 60 · 2021: 79 · 2020: 58 · 2019: 38 · 2018: 39 · 2017: 15
- FWCI
- 38.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG035117, K23AG001023, R01AG027472)
- National Heart, Lung, and Blood Institute (R01HL111111)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- ABCDEF bundle, post-intensive care syndrome, delirium, pain management, agitation, sedation, mechanical restraint, family-centered care, iatrogenic injury, quality improvement, critical illness
- MeSH terms
- Critical Care, Humans, Intensive Care Units, Philosophy, Medical, Personhood, Patient Care Bundles
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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