Episode 199: Awake, Communicative, Autonomous, and Mobile- A Survivor and Nurse’s Experience
When Molly suffered a severe stroke requiring mechanical ventilation and an EVD, what did Kaira do to prevent further neurological injury? What role did Molly’s ability to communicate while intubated play in her survival? Molly and Kaira both join us to share their perspectives from both sides of the ICU bed. Episode Transcription Kali Dayton:
Episode 198: Age Friendly Care in the ICU- Riding the Wave of 4Ms
CMS is rolling out a new initiative to require hospitals to have age-friendly care: 4Ms. This means that we must prioritize: Medications, Mentation, Mobility, and What Matters. Karen Mack, DNP, MBA, APRN, executive director at NICHE, shares with us how leverage age-friendly care in advocating for Awake and Walking ICUs! Episode Transcription Kali Dayton: [00:00:00]
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Episode 194: Walking While Intubated with an IABP with Bob
What it is like to wake up intubated with an intra aortic balloon pump and then have Teia, your physical therapist, get you walking? Bob shares with us how the ABCDEF Bundle helped him walk home from the ICU. Episode Transcription [00:00:00] This is the walking home from the ICU Podcast. I’m Kelly Dayton, a
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Walking Home From The ICU Episode 151: Breathing Trials with Karsten Roberts
Are awakening trials just for breathing trials? How do we set patients up for successful breathing trials to minimize time on the ventilator? What role does sedation and mobility play into prompt liberation from mechanical ventilation? Karsten Roberts, MSc, RRT, FAARC joins us now to dive deep into spontaneous breathing trials in the ABCDEF Bundle.
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Walking Home From The ICU Episode 86: Ventilator Management in the Awake and Walking COVID19 Unit
How is the “Awake and Walking ICU” keeping their COVID19 patients mentally and physically functional during severe COVID19? Do they face constant ventilator asynchrony and how do they deal with it? Geoff shares with us his vast experience as a respiratory therapist in walking patients on mechanical ventilation during critical illness and now COVID19. Episode
Walking Home From The ICU Episode 159: Building a Dream Team
What happens when resources and staffing are dedicated to providing high touch and high compliance with the ABCDEF bundle? How does adequate staffing, interdisciplinary team dynamics, and quality protocols impact patient outcomes and financial benefits? What is the “secret sauce” of successfully weaning patients from the ventilator? Sam Nimah and Phillip Norris share with us
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What happens to the body at the cellular, neurological, pulmonary, musculoskeletal, and cardiovascular levels when it remains supine for days to weeks? What is verticalization therapy and what does current research reveal about its benefits during critical illness? Verticalization experts, Phillip Gonzalez, MOT, OTR/L, BCPR, Nikki Stephens, DNP, APRN, FNP-C, and Jenna Hightower, PT, DPT,
What is the purpose of awakening “trials”? When should awakening “trials” be done? How can we have successful awakening “trials”? Dr. Wes Ely joins us in this episode to crack the code on sedation cessation. Episode Transcription Kali Dayton: Last week, I did a little survey on social media. I recognize that my followers
The A of the ABCDEF Bundle is for “Assess, Prevent, and Treat Pain”. How do we truly master this tool and how does this impact patient outcomes? Can we assess, prevent, and treat pain while simultaneously striving to have all possible patients awake, autonomous, and even mobile? Joanna Stollings, PharmD, shares what the A of
Walking Home From The ICU Episode 148: The History and True Mission of the ABCDEF Bundle
How did the ABCDEF bundle come to be and what is its true objective? What barriers are causing the ICU community to fall short of full compliance with the bundle and what is the future of the ABCDEF bundle? Michele Balas, PhD, RN shares with us her insights as one of the founders of the
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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