How Simulation Training Can Help to Improve ICU Patient Care
Despite many exciting advancements in technology and research, ICU sedation and mobility practices continue to be stuck in the past. A big part of this problem stems from ICU culture, which encourages clinicians to fear change and be resistant to new ideas and approaches. But regardless of these issues with ICU culture, the truth is,
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Walking Home From The ICU Episode 127: Saving Lives and Over One Million Dollars
When the ICU at St. Joseph’s Hospital in Colorado invested less than $100,000 into becoming an Awake and Walking ICU, what was their return on investment? How has supporting the training, education, and support of their team impacted their team dynamics, morale, and patient outcomes? Nancy Mcgann, PT, shares with us her team’s exciting success!
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Walking Home From The ICU Episode 126 Delirium Podcrawl Episode
Tina from Good Nurse Bad Nurse co-hosts with Kali to explore how gaps in delirium education and support can turn lethal by a “Bad Nurse” and how a “Good Nurse” can change and save innumerable lives for generations to come. Episode Transcription Kali Dayton 0:05 This is a special episode as part of a pod
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Walking Home From The ICU Episode 125: Responding to Agitation in the ICU
As Dr. Swamy said in episode 61, “You can’t sedate away delirium”. Yet, when patients are delirious and agitated, how can we keep patients and clinicians safe? How do we avoid and even discontinue sedation while keeping lines and tubes intact? What role do restraints play in agitation and trauma for patients? Are soft wrist
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Walking Home From The ICU Episode 124: Alcohol Withdrawal and Phenobarbital
Alcohol withdrawal can send our patients into a spiral of delirium and downstream complications in the ICU. What are the risks of benzodiazepines for our patients even during alcohol withdrawal? How can we give our patients the best chance to walk away from ETOH withdrawal and critical illness? Dr. Obiajulu Anozie, MD joins us in
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Over the last few years I have become aware of the PICS (post-intensive care syndrome) condition and the very serious negative impact that it has on our ICU survivors. I have become much more aware of the potential negative impact of anxiety, depression, PTSD and cognitive dysfunction. Many patients whom we consider saves in the sense they leave the ICU alive have many issues that most people would consider far from a successful experience. Their lives are often dramatically changed in a very negative fashion.
I am a professor of medicine and have been an ICU director for over forty years. What I find very disturbing in my own experience and that of many other intensivists is that this outcome is generally considered acceptable; the patient survived and will get better with time. We have little access to these patients and almost zero information about their condition unless they are unfortunate enough to return to our ICUs. Very few of us have a PICS clinic where we would have a chance to better understand the challenges that some of our patients encounter, and there are very few systems in place to provide feedback to us as ICU clinicians. Therefore, we are blissfully ignorant of the many challenges that a substantial number of our survivors encounter. This is a major problem. The vast majority of ICU survivors and their families will experience cognitive, emotional and physical symptoms which often have devastating impacts on their lives. At this time, with PICS clinics being a rarity, there is no reasonable mechanism for intensivists to have a solid perspective on the frequency and severity of this condition.
How patients and their families are treated in the ICU often has a major impact on how the patient and families survive post discharge. It is generally agreed that most sedation infusions, particularly benzodiazepines, frequently have higher incidences of delirium and post-discharge dysfunction. There are a few hospitals in this country where sedative infusions are rarely used and the incidence of the complications described above are dramatically decreased. I have visited one of these hospitals and was amazed to see how effectively patients on maximum ventilator support can be managed, even walking without sedative infusions. In an effort to explore this treatment option in greater detail I have identified Kali Dayton. She is a nurse practitioner who has practiced in this Awake and Walking ICU for many years and is an amazing source of information on this topic. After extensive discussion with many colleagues, administration and many others, and reviewing the major potential benefits of the program for our patients, we have decided to introduce this program into our hospital.
Peter J. Murphy, MD, FCCP, MRCPI, BSc
Perception Versus Reality: Debunking The Myths About Medically-Induced Comas
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