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 116: “In Shock” with Dr. Rana Awdish
How does a personal fight for life in the ICU impact a survivor-intensivist’s approach to patient care? Dr. Rana Awdish, author of “In Shock”, shares intimate experiences in and after her ICU stay. Episode Transcription Kali Dayton 00:38 Hello, and happy new year! Ending 2022, I am filled with gratitude for such an incredible year
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Walking Home From The ICU Episode 114: From the Eyes of a Travel Nurse
What was it like as a travel COVID ICU nurse to jump into an “Awake and Walking COVID ICU”? How does true mastery of the ABCDEF bundle impact RN workload, burnout, safety, and career fulfillment? Travel RN, Laurelai, shares with us her experiences and insights. Episode Transcription Kali Dayton 0:00 In episode 76 Travel nurse
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Walking Home From The ICU Episode 113: Introducción a una “UCI Despierta y Caminante”
“Awake and Walking ICU” – Episodio en español. Que experimentan a los pacientes durante sus comas inducidas? Porque y como debemos evitar a la sedation continua durante a la enfermedad crítica? Que es una “UCI Despierta y Caminante”? Este episodio cambiará a la perspectiva de nuestras prácticas en la UCI. Episode Transcription Episodio en español
Walking Home From The ICU Episode 112: Unplanned Extubations
What does research reveal about how and why do unplanned extubations occur? How dangerous are unplanned extubations? We dive into it deep in this episode. Episode Transcription One of the common foundational reasons for giving sedation automatically after intubation is for an inherited sense of safety. Between being uneducated about the risks and repercussions of
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Walking Home From The ICU Episode 111: Both Sides of the ICU Bed With Dr. Wischmeyer
What is like to be an ICU delirium survivor and intensivist? How did Dr. Wischmeyer’s own nutrition research transform his outcomes during his most critical ICU stay? He shares his journey with us in this episode. Episode Transcription Kali Dayton 0:00 Being a patient in the ICU brings a breadth of wisdom and insight. I’m
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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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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