Episode 199: Awake, Communicative, Autonomous, and Mobile- A Survivor and Nurse’s Experience
When Molly suffered a severe stroke requiring mechanical ventilation and an EVD, what did Kaira do to prevent further neurological injury? What role did Molly’s ability to communicate while intubated play in her survival? Molly and Kaira both join us to share their perspectives from both sides of the ICU bed. Episode Transcription Kali Dayton:
Lessons Learned From the TEAM Study
“See? From this we see that mobility does nothing!” This is the common rebuttal that I have received from at least a few physicians in every single ICU I have trained since the TEAM Study was published in The New England Journal of Medicine in 2022. There is often a sparkle of mischief in their
Episode 198: Age Friendly Care in the ICU- Riding the Wave of 4Ms
CMS is rolling out a new initiative to require hospitals to have age-friendly care: 4Ms. This means that we must prioritize: Medications, Mentation, Mobility, and What Matters. Karen Mack, DNP, MBA, APRN, executive director at NICHE, shares with us how leverage age-friendly care in advocating for Awake and Walking ICUs! Episode Transcription Kali Dayton: [00:00:00]
Learn More > from Episode 198: Age Friendly Care in the ICU- Riding the Wave of 4Ms
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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