Walking Home From The ICU Episode 40: Cultural Revolution
Kali talks with Patty, a nurse, about what was it like in the early phases of the “Awake and Walking ICU” and how the new practice was introduced. We ask how the culture revolutionized in spite of opposition and who rejected the change? How did nurse Patty go from incredulous to emphatic? Episode Transcription Kali
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Walking Home from The ICU Episode 39: Ethical Turmoil
Kali talks to Jim, about what is it like to be “born” into an awake and walking ICU and then be immersed in a different culture. Jim shares with us his culture shock and ethical turmoil as he strives to maintain his best practice in a new environment. Episode Transcription Kali Dayton What is it
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Walking Home from The ICU Episode 38: “THEY’RE AWAKE?!?”
Kali talks to Alex, about what is it like to jump into an awake and walking ICU as a travel nurse. Alex shares with us her first shock and impressions upon entering a different culture and she teaches us the changes and wisdom her practice has gained. Episode Transcription Kali Dayton What is it like
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Walking Home from The ICU Episode 37: Culture Shock
Kali talks about how much of our practice is driven by culture vs. evidence. What role does ICU culture play in our perspective, knowledge, and patient outcomes? How often do we dare to ask “Why?”, “What if?” or, “Why not?” Episode Transcription Kali Dayton The first time I ever stepped into an ICU was as
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Walking Home from The ICU Episode 36: We Need To Talk
Kali discusses what would happen if we expected to be able to communicate with all patients on mechanical ventilation. How would that impact our practices? What role does communication play in patient survival and outcomes? Episode Transcription Kali Dayton What would happen if we expected to be able to communicate with all of our mechanically
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Walking Home from The ICU Episode 35: Mobility is EVERYONE’S job
Kali talks with Christiane Perme, the post-ICU rehabilitation specialist, who shares with us what happens after patients are sedated and immobilized for weeks, what the rehabilitation process for COVID19 survivors will be like, and how long will it take for them to be able to sit, stand, and walk again. Episode Transcription Kali Dayton Today,
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Walking Home from The ICU Episode 34: Recommendations From a 4 -Time Ventilator Survivor
Kali talks with Ann Bannon, who was intubated four times and awake on the endotracheal tube and ventilator for months. She gives us valuable insight into how to help the new flood of ventilated patients. Episode Transcription Kali Dayton Ann, thank you so much for joining us. Appreciate you coming on our show and helping
Walking Home from The ICU Episode 33: COVID19- The Domino Effect
Kali talks about what can we do to improve mortality in the midst of a pandemic and how, as times have changed, our practices must change as well. Episode Transcription Kali Dayton Hello, and welcome back. A lot has been happening in our ICU world. Over the past few weeks, I feel compelled to talk
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Walking Home from The ICU Episode 32: Delirium Day
In commemoration of Delirium Day, it is most appropriate to hear from one of the leading delirium experts, Dr. Sharon Inouye! She shares with us her professional and personal experiences with delirium in all aspects of hospitalization. Episode Transcription Kali Dayton Hello! Today, March 11 is delirium day. So not in celebration, but in commemoration
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Walking Home from The ICU Episode 31: Nurse Manager
In this episode, Nancy talks with Kali about her transition to the awake and walking ICU as a nurse manager. She explains the nurse manager’s role in preserving a culture of humanity in the ICU. She shares with us how sedation cessation saved her own mother’s life. Episode Transcription Kali Dayton Nancy, thank you
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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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