Walking Home From The ICU Episode 67: On to LTACH?
If you were to come out of a medically-induced coma after weeks of delirium and atrophy with a new tracheostomy, only to find yourself unable to hold your head up…would you want to be discharged to an LTACH? Do other countries have LTACHs? Are there other options to survival after the ICU for survivors? Patrik
Learn More > from Walking Home From The ICU Episode 67: On to LTACH?
Walking Home From The ICU Episode 66: Trach and Peg
Why do tracheostomy rates fluctuate so drastically between ICUs? What is the true reason for so many tracheostomies? What are the long-term effects of tracheostomies? Episode Transcription Kali Dayton 0:00 I have been needing to talk about tracheostomies for a while. A discussion on tracheostomy is incredibly relevant to this podcast that is about
Learn More > from Walking Home From The ICU Episode 66: Trach and Peg
Walking Home From The ICU Episode 65: “Create Survivors, Not Victims”
Jeroen Molinger, MSc brings the research to the bedside. He ties together the importance of muscle maintenance, nutrition, and how to create survivors not victims. Episode Transcription Kali Dayton 0:01 Jeroen, thank you for being with us again. I know I’m taking a lot of your time. But I think we all really appreciate
Learn More > from Walking Home From The ICU Episode 65: “Create Survivors, Not Victims”
Walking Home From The ICU Episode 64: Nutrition During Critical Illness
What role does nutrition play in improving outcomes in the ICU? How can we help preserve muscle through appropriate nutrition during critical illness? Jeroen Molinger, MSc continues to upgrade our approach to critical care through exercise physiology. Episode Transcription Kali Dayton 0:28 In the ICU world, there is a new emphasis on ICU rehabilitation,
Learn More > from Walking Home From The ICU Episode 64: Nutrition During Critical Illness
Walking Home From The ICU Episode 63: Muscles Matter
Why is ICU-acquired weakness an independent predictor of mortality? What role does muscular atrophy play in multi-organ failure? When we unnecessarily sacrifice muscles for other organs, how badly do we damage patients’ chances to survive and thrive? Jereon Molinger, MSc, brings eye-opening information to the discussion. Episode Transcription Kali Dayton 1:51 Now let’s talk
Learn More > from Walking Home From The ICU Episode 63: Muscles Matter
Walking Home From The ICU Episode 62: Patient and Families Have the Right to Know the Risks
We say we respect patient autonomy. We provide patients or families informed consent prior to intubation. Should patients and families be warned of the risks and repercussions of sedation and immobility? When sedation is nonessential, should patients be given the choice to be comatose or awake and moving? Episode Transcription Kali Dayton 0:19 If
Walking Home From The ICU Episode 61: “You Can’t Sedate Away Delirium”
What barriers do we have in our ICU culture that prevent us from appropriately addressing delirium? What can we do to foster a better approach to helping delirious patients that are difficult to care for? Dr. Swamy gets real as we discuss the reality of delirium from our side of the bed. Episode Transcription
Learn More > from Walking Home From The ICU Episode 61: “You Can’t Sedate Away Delirium”
Walking Home From The ICU Episode 60: “Just Let Them Sleep”
For decades we have sedated patients with the belief that it is more humane to “sleep” through critical illness. Survivors have told us their experiences were not “sleep” to them. What do neurologists and researchers say about the quantity and quality of sleep during medically-induced comas? Dr. Williams Roberson shares with us her research and
Learn More > from Walking Home From The ICU Episode 60: “Just Let Them Sleep”
Walking Home From The ICU Episode 59: One Nurse Bringing Change to a Hospital System
How can one nurse make bring the change? What can happen when a team catches the vision? How can a team transition their culture from deep sedation and immobility to awake and walking? Nora tells us about igniting her team’s fire and the changes they are celebrating. Episode Transcription Kali Dayton 0:29 Hello, we’ve
Walking Home From The ICU Episode 58: Deadly Treatment for a Deadly Virus?
Louise, ACNP, has dedicated her career to preserving lives in the Awake and Walking ICU. So what was it like for her to have her own loved one die from sedation and immobility? She tells it like it is and gives us a sobering insight into both sides of the bedside during COVID19. Episode
Learn More > from Walking Home From The ICU Episode 58: Deadly Treatment for a Deadly Virus?
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
By clicking the Subscribe button, you agree to this site's Privacy Policy. Your information is always kept safe.
