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Review
. 2025 Sep;37(3):479-492.
doi: 10.1016/j.cnc.2025.05.004. Epub 2025 Jun 18.

ABCDEF Bundle Implementation for Improved Respiratory Failure Outcomes

Kaitlin Adduono  1 , Shu-Fen Siao  2 , Brittany Work  3 , Chih Yun Huang  4 , Cheryl Chia-Hui Chen  2 , Leanne M Boehm  5
Affiliations
Review

ABCDEF Bundle Implementation for Improved Respiratory Failure Outcomes

Kaitlin Adduono et al. Crit Care Nurs Clin North Am. 2025 Sep.

Abstract

Acute respiratory failure (ARF) is a severe condition frequently treated in intensive care units (ICUs) worldwide. ARF presents a spectrum of outcomes, from immediate complications to long-term impacts. This literature review examines the implementation of the ABCDEF bundle to address the complex pathophysiology of ARF. This bundle addresses critical aspects of care, including pain management, agitation/sedation, delirium, immobility, and sleep optimization, to improve respiratory function and support timely weaning from mechanical ventilation. We highlight the bundles' components as necessary in mitigating the adverse effects of ARF and enhancing patient recovery. We also identify barriers to implementation within ICUs.

Keywords: ABCDEF bundle; Acute respiratory failure; Critical care; Intensive care unit; Outcomes.

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Conflict of interest statement

Disclosure L.M. Boehm received grant funding from National Institutes of Health, United States NIA (R01AG077644 and R42AG080891) and does in-kind research with Post-ICU. C. Chia-Hui Chen received grant funding from Taiwan National Science and Technology Council (112–2314-B-002–153-MY3). S-F. Siao received a Doctoral Fellowship from Taiwan National Science and Technology Council (114–2917-I-002–005). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; and decision to submit the article for publication. The contents of this article are solely the responsibility of the authors and do not necessarily represent those of the National Institutes of Health or author institutions.