B55-28 The Impact of Language on ICU Bundle Compliance and Time on Ventilator

Abstract Rationale Limited English Proficiency (LEP) has been associated with adverse healthcare outcomes across a range of clinical settings. In the intensive care unit (ICU), management of intubated patients involves daily assessments guided by the A-F bundle, which aims to optimize readiness of extubation, establish adequate pain control, minimize delirium, promote early mobility, and encourage family participation in care. For LEP patients and families, language barriers may hinder effective communication and the completion of these assessments. Given that adherence with the A-F bundle has shown to reduce hospital mortality, delirium, and ICU readmissions, this may contribute to outcome disparities among non-English-speaking patients. Methods This is a retrospective cohort study conducted at an urban tertiary medical center. The study population included intubated patients admitted to the medical intensive care unit between November 15, 2024, and July 1, 2025. Our goal was to compare compliance with the A-F bundle and days on the ventilator between English-speaking and non-English-speaking patients. Inclusion criteria consisted of adult patients (≥18 years old) who underwent intubation during their ICU admission. We excluded patients with chronic ventilation status via tracheostomies prior to admission. Two-sample t-tests were performed to evaluate differences in compliance across the A-F bundle and days on the ventilator between the two groups. To assess for potential confounding variables, we performed a linear regression comparing age, BMI, and APACHE scores to intubation duration. Results 95 patients met inclusion criteria: 82 were English-speakers (49 males, 33 females, mean age 60.4 years) and 13 were non-English-speakers (9 males, 4 females, mean age 68.7 years). Days on the ventilator did not differ significantly between the two groups after controlling for age, BMI and severity of illness. However, bundle compliance did. Compliance with spontaneous awakening trial (SAT) safety screening, SAT, spontaneous breathing trial, and exercise safety screen demonstrated statistically significant differences (p ≤ 0.05) between groups, with English-speaking patients having higher compliance rates than non-English-speaking patients. Conclusions While LEP does not appear to affect days on the ventilator, significant differences in A-F bundle compliance suggest inequities in care delivery for LEP patients. These disparities may reflect systemic barriers, including inadequate translator availability, inefficiencies in translation workflows, and provider biases. Addressing these gaps through improved language-access protocols and staff training may enhance equity, consistency, and quality of critical care for non-English-speaking patients. Future studies should assess if these patterns hold true in larger samples of patients across multiple centers. This abstract is funded by: None