Walking Home From The ICU Episode 178: The Power of Nursing Leadership to Revolutionize the ICU
Although the ABCDEF bundle does not solely rest on the shoulders of nurses, their leadership is KEY. Andrea Silva, BSN, RN shares with his her journey to revolutionizing care in her ICU as an assistant nurse manager. Episode Transcription Kali Dayton 0:00 Kali, this is the walking home from the ICU Podcast. I’m Kali Dayton,
Walking Home From The ICU Episode 173: ICU Outcomes by Dose of Mobility
We know that for each additional 10 minutes of early mobility in the ICU, hospital length of stay decreases by 1.2 days. What else do we know about the relationship between dose of mobility and time on the ventilator? Sarina Fazio, PhD, RN, shares with us her exciting discoveries in her latest research. E Episode
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Walking Home From The ICU Episode 171: The Power of Autonomy and Human Connection During ECMO
Check out this episode with @Christinecasiano as she shares the contrast between being sedated vs. being awake while on ECMO. Register for the monthly ICU Revolutionists zoom meetings here. Episode Transcription Kali Dayton 0:00 Kristina, welcome to the podcast. I’m thrilled to have you on Can you introduce yourself to us? Christine Casiano 0:04 Yes,
It has been claimed that ICU early mobility is a “new and temporary fad”. Is walking intubated patients really that new? Let’s start in 1970 and work our way through decades of research that continues to reaffirm that true mastery of the ABCDEF bundle gives patients the best chance to survive and thrive in and
Walking Home From The ICU Episode 169: Intubated in Your Own ICU
What is like to be intubated in your own ICU? Even when the environment and team are well known, what does an intensivist turned patient experience? Dr. Meta van der Woude shares with us her personal journey through the ICU. Episode Transcription Kali: Dr. Van der Woude, thank you so much for coming to the
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Walking Home From The ICU Episode 168: I Was Reported to the Board of Nursing!
What happened when I was reported to the board of nursing for advocating for early mobility in the ICU? What are the roots of these concerns and this report? How does social media impact culture and practices in the ICU? Jess Hren, BSN, RN, Jenna Hightower, DPT, CCS, Phillip Gonzalez, MOT, OTR/L, BCPR discuss why
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Is it save to mobilize patients with trans-formal devices such as balloon pumps, impellas, and ECMO? Who was the first person to dare to ask, “Why can’t we mobilize patients with trans-femoral balloon pumps?” Stephen Ramsey, PT, DPT, CCS shares with us his journey to developing the Ramsey protocol and revolutionizing mobility in the CVICU.
Walking Home From The ICU Episode 166: The Struggle of an ICU Revolutionist to Save Lives
What is it like for one lone ICU clinician to truly understand the risks of sedation and immobility? What it is like for them to try to implement interventions like awakening trials that have been supported by decades of research? How does lack of support and success increase moral injury, burnout, and the loss of
Are patients sleeping during medically-induced comas? Are they more comfortable and free of trauma while sedated? Can patients hear, feel, and understand their surroundings while in a medically-induced coma? Do patients know when sedation is turn up higher? Do they know which providers will let them wake up and which ones will try to “turn
Walking Home From The ICU Episode 164: Antipsychotics in the ICU with Dr. Marie Rueve
Antipsychotics have been a hot topic in the ICU. Do they treat delirium? Can they be used to replace continuous sedation? When and how can we utilize antipsychotics to optimize care and outcomes? Dr. Marie Rueve from episode 160 joins us again to clear the air on antipsychotics in the ICU. Episode Transcription Kali
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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