Checking the Boxes but Missing the Mark: ICU Rounds
After working in 11 ICUs and training 14 others, I have seen multidisciplinary rounds conducted in many different ways. And I’ve also witnessed how easy it is to check the boxes but still miss the mark. Even in teams that are more progressive with the ABCDEF Bundle who “check the boxes” during ICU rounds, the
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Episode 195: Public Opinion on Informed Consent and Medically-Induced Comas
If the choice between being sedated or awake and mobile was provided prior to intubation with the risks disclosed, what would the general public choose? Do patients and families have a right to know the risks of continuous sedation? I interviewed strangers in airports throughout the USA to learn more about their preferences. Episode Transcription
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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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Episode 192: Debunking Myths – Sedation and Ventilator Asynchrony
For years we have been taught at the bedside that sedation “improves ventilator asynchrony”. We have believed that patients must be sedated to be compliant with the ventilator. Is that true? What does the research show? Sylvia Stefanos, PharmD, BCCCP joins us armed with the evidence and ready to debunk the myths. Episode Transcription Kali
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Episode 189: The ICU Revolution at Mercy San Juan Medical Center- Part 8 with Dr. Parimal Bharucha
What is the ethical and moral responsibility of a medical director to personally practice, lead, and support their ICU to keep patients as awake and mobile as possible? Dr. Parimal Bharucha shares with us the incredible revolution that has happened in his ICU. Episode Transcription Kali Dayton: [00:00:00] This is the walking home from the
Episode 188: The ICU Revolution at Mercy San Juan Medical Center – Part 7 with Dr. Jodi Coates
When the harm of “normal practices” shifts the perspective of an ICU revolutionist and medical director, what is the next course of action? Dr. Jodi Coates shares how her personal convictions inspired her to lead her trauma ICU to radically transform their sedation and mobility practices. Episode Transcription [00:00:00] This is the walking home from
Episode 184: The ICU Revolution at Mercy San Juan Medical Center- Part 3 with Luke Stratigates
Safe patient handling(SPH) is a fairly new and rapidly growing field. Mercy San Juan Medical Center is fortunate to have a strong SPH department and leadership. Luke Strategates, DPT shares with us the key role he plays in the ICU Revolution as the safe patient handling leader. Episode Transcription Kali Dayton 0:00 This is the
Episode 183: The ICU Revolution at Mercy San Juan Medical Center- Part 2 with Dr. Lawrence Bistrong
What happens when a medical director really sees the reality of “normal practices” and becomes a revolutionist? Dr. Bistrong shares his personal conversion and the key role he has playing in his team’s transformation. Episode Transcription Kali Dayton 0:00 This is the walking home from the ICU Podcast. I’m Kali Dayton, a nurse practitioner and
Episode 182: The ICU Revolution at Mercy San Juan Medical Center- Part 1 with Jeana Flakes
Standardized sedation and immobility are rooted in a gap in education. What is the power of a nurse educator in transforming knowledge, culture, and practice in the ICU? Jeana Flakes, MSN, RN shares how she helped lead the ICU Revolution as a nurse educator at Mercy San Juan Medical Center. Episode Transcription Kali Dayton 0:00
Episode 181: Physician Insights at CHEST
What do physicians understand of the ABCDEF bundle? What are their perceptions of early mobility? How are their teams practicing the ABCDEF bundle in their own units? What do physicians need to be able to lead an Awake and Walking ICU approach in their units? I interviewed physicians while attending the CHEST conference to find
I stumbled upon Kali’s podcast midway through my anesthesia critical care fellowship in February 2021. At our institution, I got the impression that patients in the ICU either got better on their own or had a prolonged and complicated course to LTAC or death. In her podcast, Kali explained that LTAC was rarely the outcome for patients in the Awake and Walking ICU in Salt Lake City.
Their ICU survivors hardly ever got trached, PEGed, or sent to LTAC, and literally walked out of the hospital in condition as close to their previous health as they could be. Although the concept of using no sedation on ventilated patients was completely foreign to me, it made sense based on what I had read in the literature. I devoured all of the episodes from the beginning, many of them bringing tears and regret for my ignorance, followed by inspiration and hope in later episodes. Listening to her podcast has been one of the most profound experiences in my short, eight-year career in medicine.
After discovering the no sedation, early mobility practice at the Awake and Walking ICU, my focus shifted to bringing it to my own institution. I visited Salt Lake City in March to witness it with my own eyes. Since then, I’ve been in touch closely with Kali and Louise to learn the practical approaches to sedation wean and sedation avoidance for newly intubated patients in the ICU.
Mikita Fuchita, MD
Colorado, USA
Perception Versus Reality: Debunking The Myths About Medically-Induced Comas
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