Walking Home from The ICU Episode 15: Walking Through Severe ARDS
Bryan Carter shares his story about being admitted for severe pneumonia that became severe ARDS, how he was allowed to be awake and walking on the ventilator until he was proned and how his treatment impacted his outcomes. Episode Transcription Kali Dayton Brian Carter is an ARDS survivor. He was admitted for speared streptococcal
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Walking Home from The ICU Episode 14: Different Treatment Different Outcomes
If we treated patients differently, would their outcomes be different? What if patients never stopped walking during critical illness? In this episode, one ICU dared to ask. Episode Transcription Kali Dayton For the past 13 episodes, we have learned about the mental psychological and physical suffering of survivors of prolonged sedation, delirium and immobility.
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Walking Home from The ICU Episode 13: Loved Ones Are Survivors Too Part II
Part II of how caregivers also leave ICU with high rates of PTSD and long-term life impacts. Mike Maranhas shares his side of his wife’s ICU stay and recovery. Episode Transcription Kali Dayton Bella mentioned to me that she had terrible hallucinations and delirium during that time being so profoundly sedated. And even once she
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Walking Home from The ICU Episode 12: Loved Ones Are Survivors Too Part I
Caregivers also leave ICU with high rates of PTSD and long-term life impacts. Mike Maranhas shares his side of his wife’s ICU stay and recovery. Episode Transcription Kali Dayton Now we’ve had penetrating insight into the sufferings of ICU survivors themselves. Yet, we would be missing a big part of the picture. If we dismissed
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Walking Home from The ICU Episode 11: Rehabilitate Rehabilitation
When we send patients to LTAC or SNF to relearn how to walk, what is that like? Susi Rimkus, DNP, shares with us her experience with rehabilitating rehabilitation. Episode Transcription Kali Dayton Now that we’ve heard about the months it took for a patient like Jim, to be able to walk again, let’s look at
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Walking Home from The ICU Episode 10: I Can’t Move
In this episode, Kali talks with Jim and Cheryl Rettinger about what it’s like to be sent to LTAC with no expectations of returning home and what happens when patients have not moved for weeks+. What does their journey to recovery looks like? Plus, they discuss the psychological effects on survivors and loved ones. Episode
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Walking Home from The ICU Episode 9: The Big Picture of Immobility
What happens down the road to patients that are on bedrest during their time on the ventilator? Is there another way? Let’s put it into the big picture. Episode Transcription Kali Dayton 0:28 Now I want to talk about some things that will make us as ICU providers a little uncomfortable. So buckle up and
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Walking Home from The ICU Episode 6: Broken Brains
In this episode, survivors tell us what “cognitive deficits” really look like and the impact they have on their function and lives. Episode Transcription Kali Dayton Today, I want to talk about cognitive deficits. Dr. Ely gave us insight into the brain injury that happens as a result of ICU delirium. For a while, I
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Walking Home from The ICU Episode 5: The Big Picture of ICU Delirium with Dr. Wes Ely
Kali talks to Dr. Wes Ely, sub-specialist in pulmonary and critical care medicine, and creator of the cam scoring tool and the ABCDE F bundle. Episode Transcription Kali Dayton Today, we’re going to be talking to Dr. Wes Ely. Dr. Ely is a sub specialist in pulmonary and critical care medicine, and has been a
Walking Home from The ICU Episode 4: Sedation is NOT Sleep
Kali talks about what prolonged sedation is really like and survivors share their stories about what they really experienced under sedation. Episode Transcription Kali Dayton Today I want to talk about what prolonged sedation is really like. A nurse once told me, “I love to get and give propofol”. So I asked if she had
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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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