Personalizing ICU liberation for critically Ill children: shaping the future of the ABCDEF bundle

Purpose of review Intensive care unit (ICU) liberation bundles aim to reduce acquired morbidities in the growing population of pediatric ICU survivors. This review will explore emerging precision medicine strategies to personalize the implementation of the ICU liberation bundle.Recent findingsThe ICU liberation bundle, also known as the ABCDEF bundle, consists of six interrelated components: A: assess, prevent, and manage pain; B: spontaneous breathing trials; C: choice of analgesia and sedation; D: delirium assessment, prevention, and management; E: early mobility and exercise; F: family engagement and empowerment. Emerging research and technology are advancing personalized approaches to each component, enabling researchers and clinicians to optimize implementation based on patient-specific factors. Key innovations include automated screening and risk stratification using computational models, wearable technologies that detect bundle elements, and genetic assessments to evaluate disease risk and medication responses.Summary This review provides an overview of the ICU liberation bundle for critically ill children and highlights opportunities to personalize each bundle element to enhance survivorship. By integrating advancements in precision medicine, clinicians and researchers can improve the quality of care for the growing population of PICU survivors, ultimately leading to better long-term outcomes.