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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Walking Home From The ICU Episode 81: Choose Wisely
How does the choice to automatically sedate every patient on a ventilator impact patients for the following weeks, months, and years? Let’s dive deeper into how our favorite sedatives change the course of critical illness. Episode Transcription Kali Dayton 0:00 This episode is really important, but maybe a lot. So I hope to make this
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Walking Home From The ICU Episode 80: Big Picture of Propofol
How does propofol affect muscles? The brain? Outcomes? ERRXpodcast host and critical care pharmacist, Adis Keric, BCPS, BCCP, shares with us the big picture of propofol. Episode Transcription Kali Dayton 0:28 Hello, it has been so exciting to meet with your teams around the country for webinars and presentations. Sharing the research through case studies
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Walking Home From The ICU Episode 79: Step Up and Step Forward
What can happen when a clinician wakes up to the reality of sedation and immobility? ICU revolutionists around the world are stepping up and stepping forward to elevate sedation and mobility practices for their patients. It can take 1 person to make 1 decision and change a patient’s entire life. Hear their success stories! Episode
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Walking Home From The ICU Episode 78: “Never Really Over”
What is it really like to be in a medically-induced coma? As an experienced ICU physiotherapist and war veteran, Aron Welsh provides soul-shaking insight into the graphic trauma of ICU delirium during and after deep sedation. Episode Transcription Kali Dayton 0:00 Okay, welcome back, I need to apologize to those that have tried to
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Walking Home From The ICU Episode 77: Start Where You Are
Are lung-protective strategies only implemented when patients are sedated? Is walking on the ventilator safe for the lungs? How do we transition from “sedating to keep patients safe” to “walking to keep patients safe”? Dr. Ali Fazili from the “Awake and Walking ICU” shares with us his expertise. Episode Transcription Kali Dayton 0:28 Hello, and
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Walking Home From The ICU Episode 76: Less Sedation = Less Work
Is it *really* easier to sedate patients? Ultimately, does giving patient delirium and ICU acquired weakness actually decrease staff workload? Travel nurse, Alex, gives us the real deal. Episode Transcription Kali Dayton 0:28 Alex, thanks so much for coming back onto the podcast are sure you are with us in Episode 32. But can you
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Walking Home From The ICU Episode 75: Communicate. Don’t Sedate.
When Jeff Sweat was about to be intubated, what was he told about what was to come? What information did his wife, Sunny Cannon, receive about the risks and reality of deep sedation? Was is it really like to “wake up” 3 weeks later? How have sedation, immobility, and tracheostomy impacted their family? Had they
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Walking Home From The ICU Episode 74: Walk Them To Sleep
What are the main “treatments” or “tools” to prevent and treat delirium? How can we facilitate “quiet nights” without harming patients with sedation? Peter Nydahl, RN, MScN, PhD, teaches us how to walk them to sleep. Episode Transcription Kali Dayton 0:27 Hello, and welcome back on one of the videos or pictures posted an Instagram
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Walking Home From The ICU Episode 73: Say It Again: Sedation is NOT Sleep
We habitually lie to ourselves and our patients’ families when the word “sleep” leaves our tongues in reference to sedated patients. Why is sleep so vital to survival in the ICU? What prevents our patients from preserving their sanity and cognitive function? What has COVID taught us about the role of sleep in the ICU?
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I stumbled upon Kali’s podcast midway through my anesthesia critical care fellowship in February 2021. At our institution, I got the impression that patients in the ICU either got better on their own or had a prolonged and complicated course to LTAC or death. In her podcast, Kali explained that LTAC was rarely the outcome for patients in the Awake and Walking ICU in Salt Lake City.
Their ICU survivors hardly ever got trached, PEGed, or sent to LTAC, and literally walked out of the hospital in condition as close to their previous health as they could be. Although the concept of using no sedation on ventilated patients was completely foreign to me, it made sense based on what I had read in the literature. I devoured all of the episodes from the beginning, many of them bringing tears and regret for my ignorance, followed by inspiration and hope in later episodes. Listening to her podcast has been one of the most profound experiences in my short, eight-year career in medicine.
After discovering the no sedation, early mobility practice at the Awake and Walking ICU, my focus shifted to bringing it to my own institution. I visited Salt Lake City in March to witness it with my own eyes. Since then, I’ve been in touch closely with Kali and Louise to learn the practical approaches to sedation wean and sedation avoidance for newly intubated patients in the ICU.
Implementation has been challenged by pushback at the bedside, but knowing how most patients can be off sedation and comfortable allowed me to advocate for the patients. So far, four patients were successfully kept off of sedation after getting intubated, and two of them immediately smiled at me as they woke up from induction meds. Kali and the members of the Awake and Walking ICU have decades of experience in this approach.
Mikita Fuchita, MD
Perception Versus Reality: Debunking The Myths About Medically-Induced Comas
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