Month: July 2023

Episode 140: Early Mobility in the Burn ICU

Walking Home From The ICU Episode 140: Early Mobility in the Burn ICU

Is early mobility safe and feasible in the burn ICU? Considering the significant barriers such as pain, dressing changes, variable device securement, delicate position needs, etc., how can an ICU team continue to practice early mobility? Episode Transcription Kali Dayton 0:02 Audrey, welcome to the podcast. Thanks for joining us and all your great work

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Episode 139: The Power of RN "Soft-Skills" to Change Outcomes

Walking Home From The ICU Episode 139: The Power of RN “Soft-Skills” to Change Outcomes

It goes without saying that nurses are the gatekeepers of patient outcomes in the ICU. Do ICU nurses *really* aspire to care for unresponsive and atrophying bodies? How does the ABCDEF Bundle impact the nursing role, skillset, and job fulfillment? James Fletcher, BSN, RN seems to fit the mold of a nurse that would thrive

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Episode 138: Early Mobility in the ICU Improves Cognitive Function 1 Year After Discharge

Walking Home From The ICU Episode 138: Early Mobility in the ICU Improves Cognitive Function 1 Year After Discharge

We know that early mobility is a potent tool to prevent and treat ICU delirium. How does it impact cognitive function 1 year after discharge? What do “Early” and “Mobility” REALLY mean? How has drastic variation in methodology in the research led to the confusion and conflict we now see in early mobility practices? How

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Episode 137: Physical and Occupational Therapists in the ICU: Working Together But Not Together

Walking Home From The ICU Episode 137: Physical and Occupational Therapists in the ICU: Working Together But Not Together

Occupational and Physical Therapists save lives in the ICU with their unique and complementary expertise. Bryan Lohse, DPT, CCS and Paul Arnold, OTR/L, CLT share with us how their Awake and Walking CVICU has developed their therapy teams. They address the question of PT & OT cotreatments in the ICU. Episode Transcription Kali Dayton 0:02

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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

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