Walking Home From The ICU Episode 133: “SOAR: Sedation Off Awake and Rehabilitate” with Dr. Fuchita
When Dr. Mikita Fuchita heard about an Awake and Walking ICU, he had to see it with his own eyes. After visiting the Awake and Walking ICU, how did Dr. Fuchita embark on bringing his colleagues together to update their sedation and mobility practices? He shares his personal conversion and his team’s journey with us
Walking Home From The ICU Episode 121: Tips and Tricks
Having patients awake during mechanical ventilation can require a new skill set and approach to patient care. Let’s talk about some of the tips and tricks for improving patient comfort and care. We’ll hear it from an RN/podcast listener/ICU survivor and Louise Bezdjian, APRN from the original Awake and Walking ICU. Episode Transcription Kali Dayton
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Walking Home From The ICU Episode 110: Occupational Therapy in the Trauma ICU
The trauma ICU has unique risks to agitation, delirium, and long-term impairments. How does occupational therapy help the trauma ICU team avoid sedation, maximize mobility, and radically transform patient outcomes? Phillip Gonzalez, OTR, MOT, shares with us his expertise and success as an occupational therapist in the trauma ICU and traumatic brain injuries. Episode Transcription
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Walking Home From The ICU Episode 109: The ABCDEF Bundle for Traumatic Brain Injuries
Traumatic brain injuries can have distinct exceptions that necessitate deep sedation and immobility. How then can we apply the ABCDEF bundle to protect injured brains and restore lives? Charlotte Davis, BSN, RN, CCRN and Richard Rivera, BSN, RN-BC share their expertise and their team’s incredible success with the ABCDEF bundle in the settings of TBI.
Walking Home From The ICU Episode 108: The ABCDEF Bundle in the Trauma ICU
The trauma ICU has a variety of high-acuity and difficult conditions that can cause obstacles and hesitation to change sedation and mobility practices. How does the ABCDEF bundle apply to the trauma ICU? Dr. Gregory Schaefer joins us now to discuss his expertise and team’s success in practicing the ABCDEF bundle in the trauma ICU.
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Walking Home From The ICU Episode 107: Awake and Moving in the CVICU
Critically ill cardiovascular patients can be very high-risk and high-acuity patients with numerous devices and multiorgan failure. How and when can we safely initiate early mobility? What role should physical and occupational therapy play in the CVICU? Jenna Hightower, PT, DPT, CCS shares her incredible expertise and ground-breaking work in early mobility in the CVICU.
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Walking Home From The ICU Episode 106: Early Mobility During ECMO
As ECMO programs have grown in demand and popularity during COVID19, what have we learned about the safety, feasibility, and benefit of early mobility? Why is there such a significant disparity in mobility practices between ECMO teams? Dr. Julian Macedo shares with us his expertise and insights into early mobilization during ECMO. Episode Transcription Kali
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Walking Home From The ICU Episode 105: The ABCDEF Bundle in the CVICU
How does the ABCDEF bundle apply to the CVICU with a variety of diagnoses, acuities, and devices? Anna Dalton, DNP, ACANP, in an “Awake and Walking CVICU” shares with us the evolution their team has experienced in improving their mastery of the ABCDEF bundle. Episode Transcription Kali Dayton 0:38 Okay, the next three episodes are
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Walking Home From The ICU Episode 101: The ABCDEF Bundle in the Neuro ICU
What does the ABCDEF bundle look like in neurocritical care? When patients suffer conditions such as intracranial hypertension that necessitate sedation and immobility, how does the ABCDEF bundle apply? Neurointensivist, Dr. Neha Dangayach, shares with us her team’s strong ABCDEF culture and practices in the neuro ICU. Episode Transcription Kali Dayton 0:06 In a recent
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Walking Home From The ICU Episode 93: The Awake and Walking COVID ICU
Why is the mortality rate for COVID ICU patients in the Awake and Walking ICU less than half of the other COVID ICUs in the same hospital system in the same community? How have sedation and mobility practices impacted rates of central lines, vasopressor use, paralysis, tracheostomies, and LTACH admissions? How has this ICU continued
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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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