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Fig. 2 | Critical Care

Fig. 2

From: The future of intensive care: delirium should no longer be an issue

Fig. 2

The ABCDEFGHI bundle—A–I bundle. A—Assessment and management of pain: subjective (NRS, VAS) behavioral tools (CPOT, BPS) should be complemented by novel pain assessment technology (ANI, NOL, PPI), multimodal approach to pain, pain-free noninvasive monitoring, pain-free blood drawing for labs. B—Both SATs and SBTs: daily, regular spontaneous awakening trials and spontaneous breathing trials to limit analgesia and sedation needs. C—Choice of analgesia and sedation: good sedation practices complemented by a rethink of design and connectivity of ICU to facilitate optimal sedation, anxiolysis and comfort using non-pharmacological means supplemented by balanced pharmacological interventions when necessary. D—Delirium detection and management: traditional validated tools (CAM-ICU or ICDSC) complemented by novel tools (wireless EEG, NIRS, noninvasive brain electrolyte monitoring, video-assisted delirium signs recognition, electrodermal activity measured by wristband devices). E—Early mobility and exercise: tailor made stepwise physical and cognitive activity programs using specially adapted equipment (virtual reality) and easy access to the outside world. F—Family engagement and empowerment: allowing visits 24/7 (including children and pets), family can sleep in the same room, large picture frames for family photographs, video panel to allow easy reach of key family members. G—Gaining insight: acknowledging patients’ personal needs, preferences, and habits (music therapy, colors, scents) for holistic and personalized care. H—Holistic and personalized care with ‘Home-like’ aspects: providing familiar, safe environment within a customized ICU including provision of circadian rhythm and adequate sleep hygiene. I—ICU design redefinition: environment where patient’s feel safe, comfortable, with recognizable things, not overwhelming (separate hi-tech environment and noisy alarm systems from patient accommodation; remote, minimally invasive monitoring, natural light, access to nature, VR aids). Abbreviations: NRS, numeric rating scale; VAS, visual analogue scale; CPOT, critical care pain observation tool; BPS, behavioral pain scale; ANI, analgesia nociception index; NOL, nociception level index; PPI, pupillary pain index; ICU, intensive care unit; EEG, electroencephalography; VR, virtual reality; NIRS, Near Infrared Spectroscopy, CAM-ICU, Cognitive Assessment Method for Intensive Care Unit; ICDSC, Intensive Care Delirium Screening Checklist

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