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 103: Communication Is a Basic Human Right- Especially in the ICU
This episode explores the value of communication in the ICU and the impact of our sedation and immobility practices on the basic human right of communication. Episode Transcription Kali Dayton 0:38 This episode is dedicated to communication and the ICU. This has taken me a long time to publish in part because it is so
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 98: Occupational Therapists Change Outcomes in the ICU
How can occupational therapists help decrease time on the ventilator and time in the hospital? How can they preserve function and quality of life? What skills do they bring to preventing and treating delirium? Why should they be promptly utilized in a patient’s journey? Corinne, Mallory, and Rachel share give us insight into the value
Susanne was admitted to the ICU for ludwig’s angina. When she required intubation only for airway protection, she was placed on the conveyor belt of ICU care. How did deep sedation and immobility impact her physical and psychological outcomes? How much more unnecessary time did she spent suffering in delirium on the ventilator? She tells
Walking Home From The ICU Episode 91: The Awake and Walking ICU in Denmark
Are there any other “Awake and Walking ICUs” outside of Salt Lake City, Utah? Dr. Thomas Strom shares with us his team’s success and research in Denmark. He provides powerful insight into the gaps and future of critical care medicine. Episode Transcription Kali Dayton 0:37 Okay, I am so excited about this really powerful episode.
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Walking Home From The ICU Episode 89: Dropping the Grenade On the ICU
What role does the choice of sedation in the field or ED play in the delirium that unfolds in the ICU? How can inter-departmental collaboration improve sedation practices and patient outcomes? How can the ICU better understand delirium and respond appropriately to new admissions from the other facilities and the ED? Jeff Polland, BS, NRP,
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Walking Home From The ICU Episode 88: Bring In Speech Language Pathology
How do speech-language pathologists save lives? How can we more fully utilize them in the ICU? How can PT, OT, AND SLP help, halt, or reverse pulmonary disease processes during acute and critical illness? Let’s discuss how they prevent harm and restore humanity in the ICU. Episode Transcription Kali Dayton 0:28 Okay, way back in
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Walking Home From The ICU Episode 87: Is Their Silence Worth Their Suffering?
Mark Hudson, an ICU survivor podcast host, is all too well acquainted with delirium. He has dedicated himself to advocating for fellow patients and survivors to prevent the torture of delirium. He tells it to us straight and guides us towards improvements. Episode Transcription Kali Dayton 0:00 Okay, a huge objective of this podcast is
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Walking Home From The ICU Episode 82: Burnout
Burnout What role do constant poor patient outcomes play in the pandemic of ICU staff burnout? What if we had a system that supported staff to practice evidence-based medicine? Would a more humane environment and process of care improve our morale? Would improved patient outcomes support staff retention? Liz McQueen, BSN, RN, shares with us
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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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