Comparison of intensive care unit liberation bundle adherence prior to and during the COVID‐19 pandemic: A retrospective cohort study

Abstract

AbstractThe intensive care unit (ICU) liberation (A–F) bundle is recommended by the Society of Critical Care Medicine guidelines as standard supportive care. Significant deviations were made to providing bundled care during the coronavirus disease 2019 (COVID‐19) pandemic. The objective of the study is to describe how COVID‐19 affected bundle adherence at a single academic medical center. This is a retrospective cohort study of adult medical ICU patients on mechanical ventilation (MV) for at least 48 h and an ICU stay of at least 7 days. Patients were separated into three cohorts based on ICU admission date and COVID‐19 status from April 2019 to March 2021; pre‐pandemic (pre‐COV), pandemic COVID‐19 negative (COV‐neg), and pandemic COVID‐19 positive (COV‐pos). Primary outcomes were median average daily bundle adherence over 7 days and daily complete bundle adherence. Secondary outcomes were individual bundle component adherence rates and patient outcomes. A total of 67 patients were included. Median average daily bundle adherence (pre‐COV 68.6% vs. COV‐neg 51.4% vs. COV‐pos 32.6%; p < 0.001), median number of days with complete adherence (pre‐COV 1 [interquartile range (IQR) 0–1] vs. COV‐neg 0 [IQR 0–0] vs. COV‐pos 0 [IQR 0–0]; p < 0.001), and percentage of patients with any day of complete bundle adherence (pre‐COV 78.6% vs. COV‐neg 14.3% vs. COV‐pos 7.1%) were different among groups and individual bundle component adherence varied. Also, median duration of MV (pre‐COV: 6.3 days [IQR 5.6–9], COV‐neg: 8.9 days [IQR 7.6–14], COV‐pos: 11.6 days [IQR 8.4–21], p = 0.01) and median days alive and free from MV up to Day 30 (pre‐COV: 23 [IQR 21–24], COV‐neg: 20 [IQR 15–22], COV‐pos: 18 [IQR 7–21], p = 0.015) were significantly different between groups. ICU A–F bundle adherence was significantly reduced during the COVID‐19 pandemic in patients with and without COVID‐19 infection.