Walking You Through The ICU Episode 11: Families Can Save Lives
Families can advocate for evidence-based and humane care can deeply impact patient outcomes and truly save lives. Kerry shares with us her journey to saving her sister’s life. Episode Transcription Kali Dayton Kerry, thank you so much for coming on the podcast. Can you introduce yourself? Kerry Yes. My name is Carrie Scarda. And
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Walking You Through The ICU Episode 10: The ABCDEF Bundle
In this episode, Kali explains how families should understand the ABCDEF bundle as the gold standard of care to prevent delirium and muscular atrophy in the ICU. Episode Transcription Alright, now that you have quite the foundation of understanding behind the principles of delirium prevention and mobility- let’s tie it all together into a neat
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Walking You Through The ICU Episode 9: Mobility is a Life-Saving Intervention
Mobility is a life-saving intervention. In this episode, Kali will discuss the lethal risks of Immobility and muscular atrophy and how mobility (even and especially on the ventilator) can help your loved one survive and thrive. Episode Transcription Ok, episode 9. I know this is a lot and I commend you for sticking with this
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Walking You Through The ICU Episode 8: Sedation and Medically-Induced Comas
Despite the high risks and harm of prolonged deep sedation, why do most ICUs place every patient on a ventilator into a medically-induced coma? Let’s talk straight about the history and big picture of our ICU sedation culture. Episode Transcription Now that you understand delirium, we have to address medically-induced comas. In all honesty, this
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Walking You Through The ICU Episode 7: ICU Delirium
Helping to prevent and treat the life-threatening complication of ICU delirium is one of your most important missions in the ICU. Let’s dive deep into everything you need to know about ICU delirium. Episode Transcription Ok, let’s talk about some hard and important things- starting with delirium. Your loved one is at risk of developing
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Walking You Through The ICU Episode 6: Ventilators
In this episode, Kali discusses ventilators, including the risks, how they work and how they can be vital in saving lives in the ICU. Episode Transcription Ok, let’s talk ventilators. Your loved one may need to be on a ventilator. Don’t panic. Despite the misinformation and fear out there… ventilators do not kill people. Ventilators
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Walking You Through The ICU Episode 5: Tools for Patient Advocacy
Kali’s guest is Sara Merwin, an MPH level epidemiologist, who shares her perspective about helping patients navigate a hospital and the emergency department. Episode Transcription Kali Dayton Sarah, thank you so much for coming on the podcast. Do you mind introducing yourself? Sara Merwin I’d be delighted to so my name is Sarah Merwin. I
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Walking You Through The ICU Episode 4: Your Role On the ICU Team
Being a family member or loved one of an ICU patient can make you feel extremely overwhelmed and very out of place. In this episode, Kali gives you the tools so you can play a pivotal role on the ICU team. Episode Transcription Welcome to the ICU team. You as a family member or loved
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Walking You Through The ICU Episode 3: Quick! Risks of Medically-Induced Comas
In this episode, Kali dives deeper into the reality, history, and culture of medically-induced comas including the risks of prolonged sedation. Episode Transcription Episode 2: Quick! What you need to know about medically induced-comas. The next few episodes, we will dive deeper into the reality, history, and culture of medically-induced comas. Yet, if you or
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Walking You Through The ICU Episode 2: Welcome to the ICU
The ICU is not a very warm and welcoming place, so in this episode Kali gives you a quick tour into the intensive care unit and the ICU team. Episode Transcription Welcome to the ICU. You likely don’t feel so welcome. It’s not a very warm and welcoming place. No one chooses to go there
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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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