Category: Walking Home From The ICU Podcast

Walking From ICU Episode 101- The ABCDEF Bundle in the Neuro ICU

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 From ICU Episode 99- How Physical Therapists Save Lives in the ICU

Walking Home From The ICU Episode 99: How Physical Therapists Save Lives in the ICU

When physical therapists are allowed to work at the top of their licenses, how do they save lives? What barriers prevent them from fully contributing their expertise during critical illness? How is mobility a life-saving intervention? ICU Physical Therapist experts, Kenny Venere, PT, DPT, and Kyle Ridgeway, PT, DPT, CCS share with us their experiences

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Walking From ICU Episode 98- Occupational Therapists Change Outcomes in the ICU

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

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Walking From ICU Episode 97- How To Truly Prevent Ventilator-associated Pneumonias

Walking Home From The ICU Episode 97: How To Truly Prevent Ventilator-Associated Pneumonias

How does ventilator-associated pneumonia occur? How does the failure to practice the ABCDEF bundle increase the risks of prolonged time on the ventilator and mortality? What do we know about the impact of early mobility on VAPs? Let’s dive deep into what we know about VAPs and how to drive down the rates in our

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Walking From ICU Episode 96- The Backstory of Ventilator-associated Pneumonia

Walking Home From The ICU Episode 96: The Backstory of Ventilator-associated Pneumonia

Ventilator-Associated Pneumonia has significant lethal and financial repercussions for patients and our healthcare system. So why aren’t we panicking about it? Are hospitals really liable for the costs incurred from this ventilator-associated condition? Dr. Benjamin Wang, MD joins us to share the backstory behind VAPs in our US healthcare system and government. Episode Transcription Kali

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Walking From ICU Episode 95- The Financial Cost of Sedation and Immobility

Walking Home From The ICU Episode 95: The Financial Cost of Sedation and Immobility

When healthcare systems say they don’t have the resources to support proper practices, is that true? How much do deep sedation and immobility cost our ICU teams, hospitals, and healthcare systems? How can we use the research to support our plight for safe staffing ratios and evidence-based practices? Let’s dive deep into the money talk.

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Walking From ICU Episode 94- The ICU Deathtrap

Walking Home From The ICU Episode 94: The ICU Deathtrap

Why are prolonged sedation and immobility lethal? How do our standard practices of automatically sedating every patient on a ventilator deprive them of the chance to survive and thrive? What systemic barriers stop us from implementing evidence-based practices that save lives and drastically change outcomes? Michelle, DNP, ACNP dives deep into powerful case studies that

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Walking From ICU Episode 92- Sedated Because She's Intubated and Intubated Because She's Sedated

Walking Home From The ICU Episode 92: Sedated Because She’s Intubated and Intubated Because She’s Sedated

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

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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

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