Episode 197: Raging Tigers and Merciful Angels- The Fight to Humanize Critical Care
In this powerful episode, we hear raw, heartfelt stories from ICU revolutionists who are bravely challenging the status quo in critical care. Amidst threats to their jobs, personal attacks, and widespread resistance, these clinicians refuse to turn a blind eye to the harm caused by sedation, immobilization, and dehumanization. From battling bullying by colleagues to
Episode 196: Delirium and Workplace Violence
Does sedation improve safety in the ICU? What is the relationship between delirium and workplace violence? Nurse and survivor of workplace violence, Kelsey Springer, MSN, RN, CCRN join us now to share her experiences and the research. Episode Transcription [00:00:00] This is the walking home from the ICU podcast. I’m Kelly Dayton, a nurse practitioner
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Episode 193: Empowering Respiratory Therapists with JJ the RT
What does JJ the RT have to say about last episode’s exploration of sedation and ventilator asynchrony? Are respiratory therapists prepared and empowered to optimize their role in Awake and Walking ICUs? How can create an environment that fosters RT excellence? JJ explores it all in this episode. Episode Transcription Kali Dayton\: [00:00:00] This is
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Episode 192: Debunking Myths – Sedation and Ventilator Asynchrony
For years we have been taught at the bedside that sedation “improves ventilator asynchrony”. We have believed that patients must be sedated to be compliant with the ventilator. Is that true? What does the research show? Sylvia Stefanos, PharmD, BCCCP joins us armed with the evidence and ready to debunk the myths. Episode Transcription Kali
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Episode 186: The ICU Revolution at Mercy San Juan Medical Center Part 5 – Respiratory Therapy
What role do respiratory therapists play in creating Awake and Walking ICUs? How did Candace Wistrich, RRT, BSRT and Nelya Kapitula, RRT, BSRT lead their respiratory therapy department to move the revolution forward? They join us now to share their team’s journey! Episode Transcription Nelya Kapitula, RRT, BSRT 0:00 Candace and Nelya, thank you so
Walking Home From The ICU Episode 86: Ventilator Management in the Awake and Walking COVID19 Unit
How is the “Awake and Walking ICU” keeping their COVID19 patients mentally and physically functional during severe COVID19? Do they face constant ventilator asynchrony and how do they deal with it? Geoff shares with us his vast experience as a respiratory therapist in walking patients on mechanical ventilation during critical illness and now COVID19. Episode
Walking Home from The ICU Episode 25: Respiratory Therapists
Kali talks with Cash, RRT, who shares his tips and secrets to walking and even showering patients on the ventilator. He reveals how having patients awake and walking has impacted his ICU career. Episode Transcription Kali Dayton Cash thanks so much for joining us. So as a respiratory therapist Share with us your expertise,
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Episode 191: Insights from SCCM Congress- Current State of Affairs
What do ICU clinicians really know about patient perspective of sedation and immobility? What are their personal wishes if they were intubated in the ICU? What do ICU providers really understand about the ABCDEF bundle and how is it going in the ICU community at large? I hit the halls at SCCM Congress to find
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Episode 189: The ICU Revolution at Mercy San Juan Medical Center- Part 8 with Dr. Parimal Bharucha
What is the ethical and moral responsibility of a medical director to personally practice, lead, and support their ICU to keep patients as awake and mobile as possible? Dr. Parimal Bharucha shares with us the incredible revolution that has happened in his ICU. Episode Transcription Kali Dayton: [00:00:00] This is the walking home from the
Episode 188: The ICU Revolution at Mercy San Juan Medical Center – Part 7 with Dr. Jodi Coates
When the harm of “normal practices” shifts the perspective of an ICU revolutionist and medical director, what is the next course of action? Dr. Jodi Coates shares how her personal convictions inspired her to lead her trauma ICU to radically transform their sedation and mobility practices. Episode Transcription [00:00:00] This is the walking home from
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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