- Low awareness: only 25.4% of PICU professionals reported knowing the ABCDEF bundle.
- Implementation inconsistent; medication adjustment (87.3%) and family engagement (74.6%) common, while delirium assessment and awakening trials underperformed.
- Managers and researchers should standardise delirium, sedation, analgesia assessments and spontaneous breathing trials in PICU care.
Rev Paul Pediatr. 2026 Nov 2;44:e2026069. doi: 10.1590/1984-0462/2026/44/2026069. eCollection 2026.
ABSTRACT
OBJECTIVE: To describe healthcare professionals’ knowledge and use of the ABCDEF bundle in the Pediatric Intensive Care Unit (PICU) of Hospital de Clínicas de Porto Alegre (HCPA) using an online questionnaire.
METHODS: An analytical cross-sectional study was conducted among PICU healthcare professionals at HCPA. An online questionnaire assessed practices related to awakening and spontaneous breathing evaluation, medication selection and adjustment, delirium assessment, early mobilization, and family engagement. Perceived barriers and facilitators to the implementation of the ABCDEF bundle were also investigated.
RESULTS: A total of 71 questionnaires were analyzed. Participants were predominantly women (91.5%), with a mean age of 41 years; 23.9% were physicians; 42.3%, nursing technicians; and 33.8%, members of the multidisciplinary team. Only 25.4% reported knowing the ABCDEF bundle. The most frequently implemented components were medication adjustment (87.3%), family engagement (74.6%), pain and sedation assessment (60.6%), and early mobilization (60.5%). Delirium assessment is not performed according to 28.2% of respondents, while 21.1% were unsure whether it was conducted. Awakening testing was considered “not implemented” by 38% of participants, and spontaneous breathing trials were reported as “occasionally implemented” by 35.2%. No significant differences in bundle utilization scores were observed across professional categories, work shifts, or levels of education.
CONCLUSIONS: The level of knowledge and implementation of the ABCDEF protocol is low and inconsistent among professionals working in the PICU. The implementation of delirium, sedation, and analgesia assessment and management, as well as spontaneous breathing trials, requires attention from health managers and researchers to standardize the provided care.
PMID:42987090 | PMC:PMC13730240 | DOI:10.1590/1984-0462/2026/44/2026069
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