Effect of the COVID-19 Pandemic on ICU Liberation Bundle Adherence

ABSTRACT

Introduction: The 'ICU Liberation Bundle' is recommended by Society of Critical Care Medicine guidelines as standard supportive care. Significant deviations were made to providing bundled care during the COVID-19 pandemic. Implications on patient outcomes are unknown. Research Question or Hypothesis: What influence did COVID-19 have on bundle adherence and clinical outcomes? Study Design: A single-center retrospective cohort study of adult medical ICU patients requiring mechanical ventilation (MV) >= 48 hours and ICU stay >= 7 days. Patients with comfort measures within 48 hours, long-term care residents, and hospital transfers were excluded. Patients were separated into three cohorts based on ICU admission time and COVID-19 status (Pre-pandemic [pre-group] April 2019-March 2020;Pandemic COVID-19 negative [COV-neg] and Pandemic COVID-19 positive [COV-pos] April 2020-March 2021). Method(s) Assessment of daily bundle eligibility and adherence was performed over the first 7 days after intubation. Primary outcomes were average daily adherence and days of complete adherence. Secondary outcomes included days alive and free of MV and delirium, readmission, and mortality. Categorical data were compared using Fisher's exact test and continuous data using Kruskal-Wallis/Mann Whitney U tests. Result(s) A total of 410 patients were eligible. A random sample of 170 patients found 137 meeting inclusion of which 31 were excluded. An additional random sample was performed including 67 patients in the final analysis (pre-group n=21;COV-neg n=21;COV-pos n=25). Baseline demographics were similar. Median daily adherence and days of complete adherence were statistically different across cohorts (pregroup 68.6% [65-72.8] vs COV-neg 51.4% [45-60.7] vs COV-pos 32.6% [22.6-47.6];p <0.001) and (pre-group 1 [0-1] vs COV-neg 0 [0-0] vs COV-pos 0 [0-0];p <0.001), respectively. Days alive and free of MV was significantly higher pre-pandemic (pre-group 23 [21-24] vs COV-neg 20[15-22] vs COV-pos 18 [7-21];p=0.0149). No other outcomes were different. Conclusion(s) ICU bundle adherence was significantly reduced during the COVID-19 pandemic with possible implications on patient outcomes..