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How does ventilator-associated pneumonia occur? How does the failure to practice the ABCDEF bundle increase the risks of prolonged time on the ventilator and mortality? What do we know about the impact of early mobility on VAPs? Let’s dive deep into what we know about VAPs and how to drive down the rates in our ICUs.

Episode Transcription

Kali Dayton 0:00
Now let’s dive deep into how ventilator associated pneumonia occurs and what avoidable risk factors contribute to this development. I was recently contacted by a husband whose 57 year old wife was intubated in the ICU for COVID pneumonia. At that point of contact, she’s been intubated for about five days and had continually decreasing ventilator settings and was on a peep of 9 and 60%. Her good husband asked about a sedation vacation, but was told they couldn’t because she had COVID.

When I encouraged him to discuss the ABCDE F bundle with the team, the response was, nope, we can’t do the ABCDEF bundle because COVID is too different. Despite the evidence otherwise. She was at a wrath of negative three and continue to stay that way without an obvious indicator for deep sedation and immobility. By day eight, she was on a peep of five and 40% and I was really encouraging the husband to advocate for a sedation vacation.

In my mind, she should have been awake and walking either the entire time, or at least for the past few days. Yet, even on minimal ventilator settings, the husband was told she’s not ready yet. On day nine, she was given a sedation vacation but was still too drowsy to pass a breathing trial. On day 10. She was able to be on CPAP for breathing trial for three and a half hours, but didn’t fatigue and become tachypneic. So they resumed assist control.

That day she had been answering her husband’s questions and try to communicate. She was harassed of zero and maybe plus one on a very few occasions. Yet that night, she was re sedated. They told her husband the following day that she would only be allowed to do a 30 minute break and trial. She spent four days on a peep of five and 40% on and off of sedation without any occupational or physical therapy despite clear signs of diaphragm dysfunction.

By the fifth day of minimal ventilator settings. She developed a fever, an increase in white blood cell count and the next day her ventilator requirements increased. Despite the new antibiotics, she developed worsening respiratory failure, septic shock, and over the next few days she rested four times before expiring. Had she received the ABCDE F bundle which is still applicable and essential for COVID patients. She would have been awake and moving long before achieving minimal ventilator settings.

This would have had her brain and muscles ready to independently breathe. That very day her lungs had adequately recovered from the acute pneumonia. She would have been spared the additional exposure from the ventilator and very likely would not have developed the new ventilator associated pneumonia. She probably would have been able to be extubated on day eight, after intubation as soon as her pupils by then at 40% and would have had an excellent chance of discharging home to her family to continue to care for her adult daughter with Down Syndrome and enjoy her loving husband and resume her full life.

Their sedation and immobility practices cost the ICU the labor and financial burden of an additional nine days in the ICU on mechanical ventilation as well as the life of this woman. Yes, COVID led her to require mechanical ventilation, but poor sedation and immobility practices expedited and finalized her death. As mentioned in Episode 95. One study looked solely at daily awakening and breathing trials. And it found that turning sedation down or off long enough to allow a patient to be awake enough to take their own breaths every day, decreased time on the ventilator by 2.4 days and decrease the risk of ventilator associated pneumonia by 65%. Imagine the impact of having them awake and mobile the entire time.

If we are failing to do the bare minimum of daily awakening and breathing trials, we may be heading into the territory of being guilty of malpractice and wrongful death. We have Dr. Benjamin weighing With us to discuss the finer details and truth about ventilator associated pneumonia and how we can prevent this lethal and expensive harm. Dr. Wang welcome back. Thank you so much for your last episode. We’re excited for this one. Let’s talk today about the down and dirty about ventilator associated pneumonia. We talked last episode about a lot of the politics legislation behind why it’s such a problem, still How is under reported. Today, let’s address how it’s caused and how we can prevent it.

Dr. Benjamin Wang 5:27
So just to remind your viewers, ventilator associated pneumonia is a hospital acquired pneumonia that affects basically patients who are on a ventilator, but principally, those that are long term with a breathing tube or a tracheostomy tube in place. The cause is pretty clear in the medical literature. They’re technically for theoretical causes.

But at this point, 99% of cases we know are caused by basically one route, you can imagine if you think about it, theoretically, if you weren’t how, how these bacteria get into the lungs is really the cause of this condition. And so theoretically, that the bacteria could come from the blood could come from the outside skin and penetrate the skin into the chest cavity into the lungs have been war, war and and tropical diseases that have case studies on that they’re very, very rare.

Kali Dayton 6:33
I’m gonna raise my eyebrows over here, that wouldn’t be my first thought.

Dr. Benjamin Wang 6:37
These these are all theoretical about I mean, if you approach this from a scientific point point of view, and say, Well, you know, you should consider all the causes, there are really four plausible routes for the bacteria to get into the lungs. I’ve never seen a case, I’ve never seen a study where the bacteria originated outside of a patient’s skin, enter through the skin through the chest cavity, and ended up causing a pneumonia and never seen that usually, that that is theoretical, you know, from the blood standpoint, usually, if you have a very septic patient, and it’s in their blood, and it goes to the lungs, also possible, usually causes a lot more other complications.

And you know, if the bacteria are in the blood, you have a bigger problem at that point. And then, and then the third route, the third and the fourth route, are really through the normal airway channel or through the trachea and into the, into the lungs. And when you put a breathing tube in that basically into a patient’s body, or a tracheostomy tube that basically creates two different spaces, the space inside the tube leading into the ventilator where the gas has been pushed out.

And the space outside of the breathing tube, that that is in contact with the the airway tissue and continuous with the rest of the body’s other systems. And quite frankly, out long story short, we keep the ventilator circuit, the part that pushes air in pretty clean, which humidify it we change the circuits routinely when they’re soiled, we clean the ventilators. So the gas that we put into patients is very clean. And that’s a good thing.

We have filters in place so that we’re not, you know, mistakenly putting bacteria through that route. Which means out of these four theoretical ways that people get pneumonia, there is really one that stands out and is by far the most plausible and most of the literature basically says that 99.9% of these pneumonias is caused because bacteria will leak down on the outside of a breathing tube or a tracheostomy to get around our our protective measures and then enter into lower airways.

And if you think about it, it makes sense because we see some of these kinds of phenomenon in our real life. You know, if you if you’re sitting on Miami Beach and you have a margarita and you happen to drink your margarita out of a straw because you know, you don’t want to mess up your lipstick. That’s my life.

Then you find then you find out that on a Hot Miami Day, there’s condensation on this straw and that condensation will leak down the side of the straw into the margarita. Now it’s not a lot of condensation. But if you think about it, that’s exactly what’s happening inside a person’s body.

When a breathing tube or tracheostomy tube is there. There’s going to be fluid that just accumulates in that area. The bacteria will use that fluid as a place to grow. And then over time, gravity will allow that fluid to leak lower and lower into the airway. And when you think about all the other things we do to the patient, in conjunction with providing mechanical ventilation, then it becomes a very, very clear picture.

Number one, we usually paralyze these patients. Now, when we paralyze these patients, we use a paralytic agent in the beginning to place the two because otherwise, it’s very hard to place the two. But it is also a practice that we continue to paralyze these patients for extended periods of time. And what that also means is, these patients can’t cough. And so if they can’t cough, they can’t protect their airway. So anything that flows down the breathing tube at that point, is going to get past their natural reflexive response to dirty things and bad things going down there and it’s going to get into the lungs. At the same time, when we anesthetize them, we give them anesthesia, that anesthesia will paralyze the specialized cilia cells inside the airway, which are designed to and inside the lungs for that matter, which are designed to basically sweep things out of the airway and prevent infections.

Now, it is due that our sedatives and our anesthetics, it did not know that. Yep, so that is one strike against the patient, that makes them a lot more vulnerable. But also, when you think about it carefully, the positioning of this tube and the patient, also make the patient inclined to having fluid accumulate in that lower respiratory area. And as a consequence, that fluid has nowhere else to go but down into the lower airways, because when you paralyze somebody, they can also they aren’t swallowing either. And when they’re not swallowing their esophagus is, is flat, and doesn’t allow the fluid that we normally swallow on almost a minute, minutely basis to go anywhere. And so we’ve we’ve created this kind of a perfect, perfect system, because we were focused on providing different aspects of that medical care.

Kali Dayton 12:19
And I think the assumption is, if they’re 30 degrees, they’re safe. From that kind of aspiration,

Dr. Benjamin Wang 12:26
The recommendation is actually 30 to 45 degrees. I know when the studies were done, they said 45 degrees would be most beneficial. And nobody does that.

Kali Dayton 12:37
No, because if you have a sedated patient, especially in like an obese patient, I guess probably in the patient at 45 degrees, they’re not moving, they can’t move themselves, they’re gonna slide down. And that’s more work to slide than backups, slide and backups. So 30 degrees is kind of the happy spot where you feel like you’re protecting their airway, Rubinstein aspiration, and yet, you don’t have to keep on sliding them up.

Dr. Benjamin Wang 13:02
Right, right. Now, I’m not advocating for people to stop doing this practice. But what we have to recognize is, obviously, we’re doing the best we can. But it’s still sub optimal, in terms of preventing these, these bacteria and fluids from getting into the lungs. And until somebody can reverse gravity, or get rid of that, we’re going to continue to have the same problem not only with the patient’s positioning, but also the fluid that is building back and inside the patient’s basically throat.

Kali Dayton 13:36
So this is just another piece to my puzzle, trying to figure out why outcomes and the weight can walk in ICU are so much better. And these patients often are almost at a 90 degree angle when they’re setting that because I don’t want to sit at 30 degrees when I’m awake, that’s not comfortable. So an awakened conscious, they want to be up there either. Right sitting high up in the bed, or most often they’re up in the chair, fully at a 90 degree angle. So now appreciating the impact of that has an aspiration, pneumonia or ventilator associated pneumonia? Yeah, absolutely.

Dr. Benjamin Wang 14:12
And it’s really even more than that. Because when they are sitting up, and when they’re when they have early mobility, they’re, they’re able to talk and cough and react. So they’re able to protect their own airway. And in in the anesthesia field, I mean, being able to protect your airway is paramount. It means that a patient is going to be it’s going to do better and that the NSD anesthesiologist who was in charge of a case can kind of rest their hat that you know they’ve they’ve done a good job.

Kali Dayton 14:46
But they ironic thing is we are afraid of coughing when patients are intubated. They say but what if they cough and there’s a difference between the agitated delirious cough when it’s constant, their quote bucking event? Oh, that’s happening, then let’s address the delirium and sedation does not address that.

You get occasional coughing when patients have been reclined in bed and they’re getting up to mobilize, they cough, pause, and we sit there and suction them and clear out their airway. And it’s a good thing it is embraced. But culturally throughout the rest of the ICU community and someone’s coughing, it means that we need to sedate them more. Yes, you’re saying that that substantially increases their risk of developing ventilator associated pneumonia, in addition to giving medication that’s going to paralyze their cilia? Yes. And open the gates for bacteria to just slide right in?

Dr. Benjamin Wang 15:39
Yes, yes. And that’s also, some of the half measures that we’ve been attempting to do in this fashion, actually have shown to be beneficial for the patient, such as we now know that when a patient is you anticipate a patient to be long term ventilated, that you want to do daily sedation interruptions, and an extubation assessment maybe once or even twice a day. It’s recognized that if you can reduce the time a patient spends sedated on mechanical ventilation, they do better.

And so there’s always this, you know, the push in healthcare has been to try and get them off the ventilator completely by taking away sedation for small short periods of time. And then seeing if you can remove the breathing tube and get them up and awake and healthy. And unfortunately, sometimes patients aren’t ready to be taken off the ventilator. They’re not healthy enough. But it also at this at the other end, it begs the question, well, if they’re not able to get off the ventilator, yet. Could we remove sedation again? Could they do fine?

Kali Dayton 16:58
Or never start sedation? That’s, yeah, yeah. Take out that whole complication altogether, and not create the situation in which patients are going to fail those breathing trials, because of diaphragm dysfunction, which will cause weeks longer on the ventilator. Let’s just prevent that so that we do decrease the time on the ventilator, which that alone decreases the risk of ventilator associated pneumonia. The studies are pretty convincing, that the less sedation we use, the less ventilator associated pneumonia, as we have absolutely, oh, you’re providing so many more reasons of why that is.

Dr. Benjamin Wang 17:35
Now, now, healthcare is complicated. And obviously, they’re going to be patients who you’re not going to be able to get off the ventilator. But if you can move them towards in some fashion, being more functional and less impaired, we know for a fact that they they do better. And and one of the statistics with early mobilization, even in it’s kind of unusual formed in infancy and less aggressive state is that it reduces time on mechanical, mechanical ventilation and improves weaning.

Kali Dayton 18:11
So to help prevent ventilators, ventilator associated pneumonia, we have decreased and or avoided sedation, yes, positioning, early mobility, allowing for coughing. What else

Dr. Benjamin Wang 18:25
We also have now the respiratory therapists are in charge of this, they do a lot of AD and nursing is often in charge of this too, they do daily, chlorhexidine, oral oral washes, you know, they also brush the teeth, and kind of suction the fluid that accumulates in that area for a couple of hours. And all of that has been shown to be for the most part special. Although there is some, some data that Clora Hexing mouthwashes seem to increase mortality rates. Interesting.

Kali Dayton 18:59
Why is that?

Dr. Benjamin Wang 19:00
We don’t know. We don’t know. And even though people would like to think that they know. We really don’t know. And it’s it’s across the board. So we know that doing some number one doing oral care in general has improved rates of pneumonia in these patients. But for some reason, when you use something else other than Clora hexa diene, the patients do a little better. But to this day, 99 95% of hospitals here in the United States are still using chlorhexidine. And I’m not advocating change, it’s just we have to be aware of of the data that’s out there. That’s an important piece.

Kali Dayton 19:42
Frequency impacts the efficacy of that intervention.

Dr. Benjamin Wang 19:46
There are places that are much more aggressive with oral care, and then some places that aren’t there. There just isn’t as much good data on whether it makes a difference. Do it every four hours or six hours or even every two hours. hours, it seems to be that most hospitals have settled on a four hour kind of, you know, four hour kind of schedule to do it. I mean, and then the other side of this also is when you do these mouthwashes in oral care, one person may do a better job than another or one person, you know, may do it for longer. And there’s just no way to standardize that practice right now, either. So it’s very user dependent.

Kali Dayton 20:30
There are a couple of mechanisms of benefit, right, there’s the actual cleansing, whether the sectioning, so you don’t have as many secretions to slide down. And those that do slide down are cleaner, theoretically, that we have the cuff and that is somewhat protective of the airway. Tell me more about what the cuff does and does not do. Okay, protecting airway from those secretions.

Dr. Benjamin Wang 20:58
So as I mentioned, we do when we go around, and when the nurses and the respiratory therapists, they go around to the the bedside, and they do suctioning, they will put a little catheter into the mouth as far as they can go. And they will suction the fluid that they can get out from there. And oftentimes, they’ll get a good, you know, 50 CC’s out or 2020 or 50 CC’s at any given point, which means they know the fluid is there.

The problem is that little suctioning device doesn’t get down nearly far enough. And it doesn’t work when you’re not by the bedside. And so what happens is, even though you know, there’s fluid that you can get out, the fluid that is causing the pneumonias, and keeping people on ventilators longer is actually much deeper, and you can’t see it. And so, you know, when when we talk about breathing tubes, these are just basically tubes with a balloon on one end. And these balloons basically are called cuff balloons, they sit in the airway, and they’re very good for blocking the airway enough so that you can push gas now.

Over the years, we’ve we’ve used a different a number of different types of these cuffs. And in you know, in the beginning, when we were doing this, you know, 50 years ago, we were using high pressure and low volume cuffs, because those gave you very good seals. The problem was, when you use them, when you use a little bit too much pressure, they cause so much trauma in the airway, that these patients would actually come back with traumatic injuries,

Kali Dayton 22:42
stenosis…

Dr. Benjamin Wang 22:43
and develop stenosis. And so we came to the conclusion that we didn’t want to use these tubes, we have these cuff balloons we use, we invented low pressure high volume cuffs that were much softer. And if I were to liken the type of cuff that we use today, it’s almost like a very, very thin, if you were to take a plastic glove and blow them up, it’s very similar to you know, the surgical gloves and the plastic gloves that you you see that we normally use in healthcare.

If you blow that up, that’s the kind of soft consistency and I’ve even say many times they’re even softer than the material that we use for for latex gloves. And plastic gloves for the matter. And the problem is, they’re very good at being non traumatic, these cups, but they’re very bad at sealing the airway against fluid.

Because you can imagine if you use a very soft, very almost kind of a flimsy cough. So you can seal the airway to gas when you encounter something that’s a little heavier like a fluid, or secretions from the patient’s mouth or you know, it’s like saliva, that saliva is just gonna push right past that, that cough and get into lower airways. And once it’s down there, that’s it. There’s nothing that we have in place that can that can prevent that stuff from causing problems.

Kali Dayton 24:12
Just flourishing in a nice to moist, warm lung. Right, right. So now talk about your solution to that and the technology you’ve developed to help address that aspect of preventing VIPs.

Dr. Benjamin Wang 24:27
So, you know, back when I was I was practicing, I recognized I was reading the literature and the literature basically says that after about an hour of mechanical ventilation, nine out of 10 patients will have a volume, a certain volume of that fluid get into their lungs. After three hours, it’ll be 100%. Which means when you look at somebody who is put on a ventilator for days, even even weeks sometimes during the pandemic, we see people who are on the ventilator for months.

They are at any given point most likely aspirating bacteria into the lungs. And the only reason that they don’t develop a secondary infection is number one, maybe because the the antibiotics are working, that we put them on. Or number two, their home host their own immune system is tackling it, or they have an pneumonia, we just aren’t seeing it. You see?

So my company, I started a company a number of years ago. And our goal was basically to create a breathing tube that could suction, remove the fluid that causes the pneumonia. Because the interesting thing is we know where the fluid is. We just can’t see it. So the idea was,

Kali Dayton 25:56
….or always access it.

Dr. Benjamin Wang 25:59
Yes, yes, we can access it, we know it’s there. We know where it causes problems. So the idea behind my company nev app was to create a breathing tube with the ability to play suctioning in the area where the fluid accumulates. And if you can reduce the amount of accumulated fluid continuously.

The idea is the fluid doesn’t leak down, doesn’t get past the cough, doesn’t enter the the lower airways and doesn’t cause pneumonia. And then, as a consequence, and we know this from the literature, if you can do this successfully, the patients get off mechanical ventilation sooner, and they get less pneumonia, and they are more easily mobilized and easily weaned and we use less antibiotics. And they actually survived. They the mortality rate drops in these patients.

Kali Dayton 26:55
And other countries that are actually tracking and reporting their ventilator associated pneumonia rates. They’re reporting what did you say? 40 To 50% 45 to

Dr. Benjamin Wang 27:05
50%.

Kali Dayton 27:07
rate in there. COVID-19. Patients?

Dr. Benjamin Wang 27:09
Yes, yes.

Kali Dayton 27:10
Which we’re, we’re not that different.

Dr. Benjamin Wang 27:13
No,

Kali Dayton 27:14
We just don’t report it? No. How much impact could this kind of approach to manage him until he’s ventilated patients make in the burden on our health care system right now we have patients get better, quicker, less pneumonia is less mortality, less dysfunction, because they’re excavated sooner. Between the early mobility and the improved technology, this can make a huge impact.

Dr. Benjamin Wang 27:39
Absolutely, you know, if nobody can tell what’s going to happen in the future. There are predictions that right now in this point in time, we are actually sitting in the eye of the storm, this Omicron variance is very likely to come in the next couple of months spread much more rapidly than the Delta variant and cause an enormous surge that has the potential to really damage our healthcare system.

And here we are two years after the start of this pandemic, and everybody is tired. Our health care system is already strained. When you talk to health care leaders in in Michigan and Minnesota and Iowa and Arkansas, Louisiana, all over the Midwest and the Northeast. What they’re telling us is we have labor shortages, respiratory therapists, nurses, doctors, even custodial staff, have decided to retire because they are just tired of fighting this pandemic. And so we’re at this point in which our healthcare system is not in the best state it could be.

And we’re on the precipice of basically a big surge of these infections. This type of intervention is likely to make more economic, clinical, and societal difference and impact than anything else we could possibly do. You know, I remember the beginning of this pandemic, when everybody was clamoring about, oh, we don’t have enough ventilators, this is going to be terrible.

We need more more masks and PPE. And we need more testing and this such and everything, and our society decided to throw enormous amounts of resources into these things. For the most part, we did that. And here we are two years later, and the problem is coming our way. And none of what we have done is really going to make a huge amount of impact and difference at this point. You know, we can test it. If we had three times more testing. It might be beneficial if we had you know three times more P PPE wouldn’t wouldn’t be, that wouldn’t be a bad place to be. If we have three times more ventilators probably wouldn’t do anything.

Kali Dayton 30:09
How we’re managing them on ventilators.

Dr. Benjamin Wang 30:11
Right? Right? These kinds of details, they really matter a lot. And if there’s anything about this pandemic that we can learn is that we need to listen to science. And we need to focus and be aware of the details. Because when you are not aware of the details, and you don’t follow the science, problems tend to tend to come back and hurt us.

Kali Dayton 30:35
Yes, I so many takeaway lessons from this pandemic. And the painful irony I’ve seen is that we as medical community have begged the public to understand and apply the research and the science, in order to save lives, decrease the burden on the health care system, all these things. And yet, when it comes to a lot of our practices in the ICU, we are not taking the same advice.

We are not applying the science and the research to sedation and mobility practices. And we’re causing this perfect storm to create lethal and burdensome problems like ventilator associated pneumonia is 33. It was in March of 2020. Right as I felt like we were on the shore, waiting for this tsunami of COVID. To come over us, I put out an episode. So Episode 33, calling the domino effect, trying to say the same thing, we’re getting all these ventilators but we aren’t gonna have enough staff.

And if we’re going to have this huge surge of patients on the ventilator, we need to have practices that will get them off the ventilator. So it will be prepared to open up ventilators, beds, Resources staff, for the newly infected patients. Because we if we have all of our COVID-19 patients languishing for four months, or for weeks or months, that occupies so much labor and then the follow up the rehabilitation of those few survivors.

It is too much and it is not sustainable. In the episode with the waken, walking COVID ICU, their average time on the ventilator for COVID-19 patient is 10 days. Even if a patient is on the ventilator for four weeks, they still walk out the ICU out of the ICU and the rehabilitation is minimal. Why are we not apply as evidence based interventions during the time of crisis when it is absolutely essential like this could save our specialty.

Dr. Benjamin Wang 32:30
I think the national average for COVID patient on mechanical ventilation is somewhere between 15 and 22 days. And when they get a ventilator associated pneumonia, you can multiply that time by three

Kali Dayton 32:45
By three, the hard thing is oftentimes get trade. Oftentimes they cause this or they develop this in pneumonia while they’re in El tak while they’re outside of the ICU. So the ICU starts it starts as sedation starts, then mobility causes atrophy punted off to another facility. And sometimes they show up with its ventilator associated pneumonia is, again like an episode or last episode, we talked about how they’re under diagnosed.

Yep. And yet, so I just don’t think we’re really zooming out within the big picture and realizing the burden of that. And a lot of these things, we say, we don’t have the resources for it. We don’t have the finances for it. Yet. Your endotracheal tubes are not that expensive?

Dr. Benjamin Wang 33:30
No, no, they’re not. If you consider, if you consider the most expensive breathing tube out there may be $25. And the cost of one day of mechanical ventilation, before the pandemic was about $5,000 a day. So we’re talking about I mean, the beautiful thing about these interventions is they’re very cost effective. It doesn’t take

Kali Dayton 33:57
Higher and sooner instead of sedating the patient. And you will say days, two weeks on the ventilator. You’ll improve safety, you’ll improve outcomes and a sitter is not that expensive, or safe staffing ratios or just the education to help the staff understand how to make their jobs easier through the ABCDEF bundle. Right. We don’t invest in the effective interventions.

Dr. Benjamin Wang 34:21
No, we don’t. And healthcare is guilty of the same problem because we’ve created structures in healthcare, to basically make things hard to change, and hard to learn and hard to hard to listen to the good science. You know, we basically create a system where we keep the doctors and the nurses and the respiratory therapist working very hard. And then we don’t give them a lot of support when they say you know, I want to do something a little different.

So what happens many times is health care workers are enormously incredible and tenacious people, you know, in order to really survive in health care, you got to develop a thick skin pretty early on, and be able to run, roll with the punches, because you’ll get knocked down a lot. We both know. That’s, that’s just I mean, the nature of what our system looks like in our education process looks like. But when you knock a person down too many times, at some point, they don’t, they don’t focus on new things anymore and trying to improve what they’re doing. They’re just trying to survive day in and day out. And that’s where you really lose a lot of the, the, I guess, the spark that people need to be in healthcare,

Kali Dayton 35:47
…and the good ones, yeah, people that are there to make a change, to save lives to have human connection. They’ve been stripped of that. And then they wonder, why are we here, and especially, I just, I feel for these incredible listeners of the podcast, they reach out, they’re saying, I want to make this change. And I love that they’re in that and I believe in and that’s why I do the podcast.

I wish we had a better system that would say, Thank you for caring, not caring about that. Thank you for going that extra mile doing the research. Yes, let’s bring the group together, let’s talk about the research. They don’t support innovation, support quality improvement, and that is really soul crushing for compassionate caregivers that are scientific and that do want to implement the science.

Dr. Benjamin Wang 36:34
Yeah. You know, in healthcare, we always talk about systems, like, you know, if something happens, it wasn’t because of an individual in the healthcare, healthcare industry or this facility, it was because the system wasn’t in place to make that error or that problem, you know, on impossible. And so like, one of the systems that we don’t have in this country, is a system of innovation, and a central system of innovation. If you’re a pharmaceutical company, and you have $10 million, you can pay for innovation, you can pay for study, you can pay for attention, you can pay for people to take your solution seriously.

But that’s not healthcare, that’s business. Right? Healthcare is not about making the most money. Health care, is about finding solutions that make the whole system work better. And if we are, if our country is serious about having a health care system, we should also be serious about findings, some way to not only develop the innovative proof, regardless of financial incentives, but also disseminate that proof in a manner that makes not only economic sense, but healthcare sense.

You know, instead of every hospital in the United States on its own, trying to do what’s better for itself, trying to innovate, trying to take data and everybody trying to interpret what works. We should have in this country centers for healthcare innovation, hospital centers, that take projects in an innovation in not looking for a financial incentive, but are funded entirely maybe by the federal government or by the state, so that they can do things that don’t make a lot of economic research sense, that don’t make a lot of business financial sense, but make a lot of healthcare sets.

Kali Dayton 38:49
An example of that is why are we not quickly actually doing a study on the awakened walk in I see that just in a system that acknowledges that their mortality rate is less than half of the multiple other COVID ICUs in the system, like oh jet, but they don’t invest in disseminating, that they’re not doing the research on it, that they’re not standard standardizing that within their own system?

Yep. Why? Yeah, a system like that, what you’re talking about an organization where we could say, “hey, let’s do a study on this hospital, and understand what they’re doing so that we can share that with everyone and have an impact on the rest of the world.” If that was a drug that was making that kind of impact on mortality. We have a study published by now. Yes. But remember, patient mobility practices. It’s not attributable to one company per se, and it can’t be bottled up.

Dr. Benjamin Wang 39:44
Yeah. If if you look carefully, and you ask yourself, honestly, in this country, who is responsible for distributing and perpetrating innovation through health care systems? And the answer is Private industry, private industry.

Kali Dayton 40:06
You look at these competitions that are out there, a lot of them are technology, healthcare technology, competitions, how to improve healthcare with technology and or pharmaceuticals, and not so much with addressing the roots of the system.

Dr. Benjamin Wang 40:19
Right? Right. Because Because if you need to pay for attention, if you need to pay for data, if you need to pay for penetration and use and practice, then the things that get the funding to be able to pay for that are the ones that make business sense, and are expensive. And if we want innovation to be truly equitable, not only to the patient, but to the innovators and the people trying to perpetrate good solutions, we have to come to grips with the system that we have, keeps putting more expensive things in front of our health care providers and our health care systems and saying this will solve your problems. Classically, that hasn’t been the case.

Right? You know, I know many of your viewers may also be on on Medicare, they may have noticed their Medicare premiums have gone up a bit. And that wasn’t because of the pandemic, it was actually because of health care innovation, because a drug company came out and said, I have a new drug that I’d like you guys all to pay for. And it’s very expensive. So, I mean, at some point, somebody has to realize, yeah, you know, these are, these are great innovations, we have to pay for them. But there are a lot of other innovations that we probably don’t have to pay anything more than we already paying or even less, that we are, are missing out on sometimes. And many of these interventions can be rapidly impactful right now.

Kali Dayton 41:56
Especially during time of crisis, right? Another way of another surge, we’ve already seen that what we’re doing doesn’t work, already have evidence, examples, outcomes that are drastically different than maybe our home units, it’s time to jump in and turn the ship around before the next wave hits.

Dr. Benjamin Wang 42:14
Yeah. And if you think about how much time we have, there are only there’s only a certain there are only certain interventions that make sense during a time like this, where you don’t have a lot of time to really implement a huge amount of changes, small changes, looking at the details, admitting we have a problem and moving in that direction, can make a big difference during this time.

Kali Dayton 42:41
Absolutely. And summary ventilator associated pneumonia has are a huge, burdensome, lethal and expensive problem right now, especially during the COVID 19 pandemic. You offer technology that will help decrease time on the ventilator through preventing ventilator associated pneumonia, and sedation and a mobile attic has already shown to decrease ventilator associated pneumonia.

I will your information on the blog about that as well as the studies that you’ve mentioned. And if your team is interested in implementing Dr. Wayne’s technology, his new endotracheal tube and or early mobility and delirium prevention practices, please contact us web dot h n IC consulting. And Dr. Wayne’s website will be linked on the blog found there in anything else you would share that IC community Dr. Wayne?

Dr. Benjamin Wang 43:29
No, I think we covered it. And I think we probably talked about a lot of things that many of our, our clinician colleagues are very well aware of during this pandemic.

Kali Dayton 43:39
I think so. But I don’t know that we get the full picture like you’ve provided. So thank you so much.

Dr. Benjamin Wang 43:44
Oh, my pleasure. Thank you for having me.

Transcribed by https://otter.ai

 

 

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