Ask an answerable question (PICO)：
The incidence of patients in intensive care units (ICU) is as high as 80%. The occurrence of delirium can cause decrease cognitive function, prolonged hospital stay, effects of quality of life, and increased mortality, leading to difficulties in the health care process of health care provider. Most of the patients' s delirium is reversible, Still one third of patients will continue to affect for months, which will increase the risk of dementia, caused by family caregivers of confused, and indirectly increase the medical burden and care costs. Therefore, how to improve the symptoms of delirium in intensive care units patients is extremely important. Reviewing the literature using the ABCDE bundle strategy can reduce the effectiveness of delirium symptoms in adult intensive care units, as an empirical reference for clinical application of adult care units to perform ABCDE bundle interventions.
The Method and Analysis of Literature Review：
This article searches for articles published at home and abroad related to the involvement of ABCDE bundle strategies in adult care units to improve the symptoms of delirium in patients. The search database contains seven electronic literature databases, including PubMed Clinical Queries, CINAHL, The Cochrane Library, Trip, Web of Science, ProQuest, and Airiti library. Using keywords: Care Unit, ABCDE Bundle, and delirium, a total of 250 articles that preliminary the search criteria were extracted. Finally, screening the summary and full text selection choose to match the topic, a total of 4 articles of quasi-Experimental research.
Critical Appraisal：
Four articles were included in the review, choose appropriate review form Joanna Briggs Institute Critical Appraisal Checklist Tools for Quasi-Experimental Studies was used for literature review. Is it clear in the study what is the‘cause’and what is the ‘effect , Were the participants included in any comparisons similar?, Were the participants included in any comparisons receiving similar treatment/care, other than the exposure or intervention of interest?, Was there a control group?, there multiple measurements of the outcome both pre and post the intervention/exposure?, Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed?, were the outcomes of participants included in any comparisons measured in the same way?, Were outcomes measured in a reliable way?, Was appropriate statistical analysis used? nine items, etc. Therefore, the results of four literature reviews are to comply with a standard with the project's 8-9 items. The results of the review were further based on the Joanna Briggs Institute's level of evidence, Inclusion four articles levels of evidence of 2.c.
Results, Conclusions and Recommendations：
In conclusion based on the ABCDE bundle strategy approach of the four articles, meta-analysis were performed for the four studies showed that the ABCDE bundle intervention had significant effects on delirium and 28 days survival rate, with respective effect sizes of 0.63 (95% CI :0.45~0.90) and 1.13 (95% CI :1.04~1.23). There was no significant effect on ICU stays and hospital stays, with an effect size of 0.84 (95% CI :-3.36~1.68) and 1.35 (95% CI :-1.09~3.79) .
According to the JBI recommended strength grade A, it is found that the expected effect of the ABCDE bundle strategy exceeds the adverse effect is clear, and there is sufficient quality evidence to support its use, giving "strong" recommend. The display can reduce the symptoms of delirium patients in the intensive unit; however the ABCDE bundle is a multidisciplinary care intervention strategy ,need that include the professional of each subject to develop standardization to establish the ABCDE bundle in the adult intensive care unit to reduce the symptoms of delirium.
