Why ICU Patient Outcomes Must Go Beyond Survival
Improving ICU patient outcomes cannot stop at survival. Every ICU team understands the urgency of keeping a patient alive, whether they’re suffering from shock, respiratory failure, sepsis, trauma, surgery, or multi-organ failure. But survival alone does not tell the whole story. A patient can survive the ICU and still leave with serious weakness, delirium-related trauma,
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Checking the Boxes but Missing the Mark: ICU Rounds
After working in 11 ICUs and training 14 others, I have seen multidisciplinary rounds conducted in many different ways. And I’ve also witnessed how easy it is to check the boxes but still miss the mark. Even in teams that are more progressive with the ABCDEF Bundle who “check the boxes” during ICU rounds, the
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Mobility vs. Positioning in the ICU: Are We Dangerously Confused?
We cannot fix what we cannot confront. So, bear with me as I delve into some hard realities within the ICU community. I am often told, “We do early mobility in our ICU!” However, when I probe deeper into the “mobility” provided, I find that the most common interventions that are considered mobility include: Chair
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Daily Doses of Gravity in the ICU
Throughout my journey in this ICU revolution, I have come to learn that the simplest concepts can be the most profound and the most important. This is going to sound too basic to be significant but hear me out. Gravity needs to be considered a standard “medication” in the ICU. Gravity is the grounding force
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
Raging Tigers and Merciful Angels: The Fight to Humanize Critical Care
Medicine is a field of evolution with a continuous trajectory of exploration, discovery, change, and progress. And this perpetual pattern has been just as reliable as the predictable resistance that comes with change. Past Revolutionists Who Fought to Humanize Critical Care This was demonstrated in the journey of Ignaz Semmelweis (pictured above), a Hungarian
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Why ICU Teams Need Expert ABCDEF Bundle Consulting
In my experience, teaching ICU clinicians about the ABCDEF Bundle can sometimes feel like trying to explain water to a fish. Just as a fish has no context to understand the water it’s swimming in, ICU teams may not always clearly see the preventable harm surrounding them. When clinicians are immersed in the daily realities
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Why Gradual ABCDEF Bundle Implementation Often Results in a Failure to Launch
“Let’s introduce the bundle gradually. We don’t want to overwhelm anyone. Let’s see what the team is willing to do. We can start with awakening and breathing trials, then tackle the rest once we have those down.” This kind of conversation has echoed through medical organizations and clinical leadership teams for years. It’s a logical
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What Clinicians Need to Know About Awakening Trials
I have to admit, I wasn’t a fan of awakening trials at first. During my first two years in an Awake and Walking ICU, we rarely initiated sedation, so the need to turn it off wasn’t a struggle for us. When sedation was necessary, we simply turned it off when we deemed it unnecessary. It
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Reviving Core Nursing Values in Critical Care Through the ABCDEF Bundle
Critical care is an extraordinary and complex specialty that’s continually evolving, with a growing capacity to save and extend life in the face of the most extreme perils. Research, knowledge, and technological developments have transformed nursing skills and our ability to care for patients who are critically ill. Unfortunately, the nursing values and ethics, which
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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.
Mikita Fuchita, MD
Colorado, USA
Perception Versus Reality: Debunking The Myths About Medically-Induced Comas
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