Walking Home From The ICU Episode 115: Sedation By Race
We know that prolonged sedation and immobility are lethal. We also know that there are significant racial disparities in outcomes in the ICU. How does race impact sedation practices? What role does sedation management play in racial inequality in critical care medicine? Dr. Thomas Valley shares with us his invaluable research into sedation by race.
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Tyler’s Story: How Evidence-Based Practices Helped Preserve an ARDS Survivor’s Quality of Life
Most patients who are admitted to the ICU in need of mechanical ventilation have to suffer through days or even weeks of deep sedation, immobility, and all the ill effects of these practices. But for patients with acute respiratory distress syndrome (ARDS), this lack of adherence to evidence-based practices can spell the death of their
Walking Home From The ICU Episode 114: From the Eyes of a Travel Nurse
What was it like as a travel COVID ICU nurse to jump into an “Awake and Walking COVID ICU”? How does true mastery of the ABCDEF bundle impact RN workload, burnout, safety, and career fulfillment? Travel RN, Laurelai, shares with us her experiences and insights. Episode Transcription Kali Dayton 0:00 In episode 76 Travel nurse
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Walking Home From The ICU Episode 113: Introducción a una “UCI Despierta y Caminante”
“Awake and Walking ICU” – Episodio en español. Que experimentan a los pacientes durante sus comas inducidas? Porque y como debemos evitar a la sedation continua durante a la enfermedad crítica? Que es una “UCI Despierta y Caminante”? Este episodio cambiará a la perspectiva de nuestras prácticas en la UCI. Episode Transcription Episodio en español
I stumbled upon Kali’s podcast midway through my anesthesia critical care fellowship in February 2021. At our institution, I got the impression that patients in the ICU either got better on their own or had a prolonged and complicated course to LTAC or death. In her podcast, Kali explained that LTAC was rarely the outcome for patients in the Awake and Walking ICU in Salt Lake City.
Their ICU survivors hardly ever got trached, PEGed, or sent to LTAC, and literally walked out of the hospital in condition as close to their previous health as they could be. Although the concept of using no sedation on ventilated patients was completely foreign to me, it made sense based on what I had read in the literature. I devoured all of the episodes from the beginning, many of them bringing tears and regret for my ignorance, followed by inspiration and hope in later episodes. Listening to her podcast has been one of the most profound experiences in my short, eight-year career in medicine.
After discovering the no sedation, early mobility practice at the Awake and Walking ICU, my focus shifted to bringing it to my own institution. I visited Salt Lake City in March to witness it with my own eyes. Since then, I’ve been in touch closely with Kali and Louise to learn the practical approaches to sedation wean and sedation avoidance for newly intubated patients in the ICU.
Implementation has been challenged by pushback at the bedside, but knowing how most patients can be off sedation and comfortable allowed me to advocate for the patients. So far, four patients were successfully kept off of sedation after getting intubated, and two of them immediately smiled at me as they woke up from induction meds. Kali and the members of the Awake and Walking ICU have decades of experience in this approach.
Mikita Fuchita, MD
Perception Versus Reality: Debunking The Myths About Medically-Induced Comas
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