Prehab vs. Rehab: Which Approach Should be Prioritized in the ICU?
For the past five years, I have been engrossed in exploring the history and current culture of the ICU, as they relate to the ABCDEF Bundle. As a result, I’ve been faced with having to compare my ingrained understanding of early mobility to the cultural “norms” I see at the bedside, as well as in
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Why ICU Culture Is a Barrier to Early Mobility
While it’s clear that the ABCDEF Bundle saves lives and helps to restore the quality of life for ICU survivors, many intensive care units continue to standardize deep sedation and immobility. But why is this? Why does one ICU use sedation on less than 20% of intubated patients, while another sedates 100% of these patients
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Health care inequality in critical care medicine is multifactorial and negatively impacts patient outcomes [18]. During COVID-19, for instance, it was noted that Hispanic patients were more at risk of having severe COVID-19 infections, and despite their younger age, they had a higher mortality rate. Socioeconomic disparities, lack of access to health care, timing, and
How the ABCDEF Bundle Can Help Mitigate RN Burnout
Nurses enter critical care medicine to alleviate human suffering, support patients in their most vulnerable moments, be patient advocates, do no harm, and save lives. But being a critical care nurse is physically, emotionally, and mentally challenging. Many factors have resulted in the loss of thousands of expert nurses, creating the staffing crisis we’re currently
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How ICU Staffing Ratios Relate to the Awake and Walking ICU Approach
The Awake and Walking ICU approach is deeply rooted in science, pathophysiology, and logic. Yet some of the best fruits of this method are humanity, compassion, dignity, and love. We use this approach to humanize the ICU, and I believe that is a desire of most ICU clinicians. But the reality is, no matter how
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The Financial Benefits of the ABCDEF Bundle
The ABCDEF Bundle is easily the best tool we have to improve patient care and outcomes in the ICU. If you know anything about these evidence-based practices, you’re probably well aware that they can decrease length of stay and readmissions, and reduce patients’ chances of dying, while making it more likely that they’ll return to
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Patients and Their Families Have the Right to Know the Risks of Sedation
Patient autonomy is a pillar of clinical ethics, and it’s vital to the integrity of any clinical practice. Observance of this principle works to uphold patients’ rights, fosters trust and collaboration, respects diversity, and empowers individuals to actively participate in decision-making regarding their healthcare. In our efforts to protect patient autonomy, one of the best
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ICU Rounding Culture: What Needs to Change and How We Can Help
One of the biggest barriers to improving ICU patient care is a lack of interdisciplinary collaboration, especially when it comes to ICU rounding. In theory, rounding should give clinicians the opportunity to review and discuss each patient’s care, and then come together to ensure that care is a reflection of best practices and the patient’s
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Unplanned Extubations: Dispelling the Fear and Understanding the Reality
When I think back to how I started my career as a nurse, it really does seem like a date with destiny. I could have gotten a job at any ICU, but for whatever reason, I landed my first nursing gig at a high acuity medical-surgical intensive care unit in Salt Lake City, Utah, which
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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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When patients are so ill that they require a ventilator in the ICU, the antiquated approach of heavy sedation and immobilization should be avoided in order to help prevent the immense burden of physical and cognitive disabilities suffered during survival. To understand this better, listen to Walking Home From The ICU. You will see what ICU consultant Kali Dayton provides to your team.
Her training will catalyze changes in your practice to improve outcomes, decrease costs, and allow your patients to return to their full lives. Learn to love your job again as you embrace whole person care instead of caring for inert sedated bodies. Kali is leading ICU teams to become Awake and Walking ICUs through true mastery of the ABCDEF Bundle.
I endorse her mission and look forward to the standardization of this evidence-based approach in ICUs all over the world.
Dr. Wes Ely, author of "Every Deep Drawn Breath," leading founder of the ABCDEF Bundle and ICU CAM delirium screening tool, and Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University Medical Center
Perception Versus Reality: Debunking The Myths About Medically-Induced Comas
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