RESOURCES

Leah, Accounting professional and daughter of a beloved father

February 1, 2022

Totally clueless is what my family and I would have been if I hadn’t reached out to Kali about my dad’s ICU journey. What started as a back surgery ended up turning into a three-month hospital stay which then ended up turning into three hospital stays from May through November 2021. Kali helped so much in understanding the ICU medications he was on and how the use of sedatives was in fact causing his delirium and agitation, and not actually his demeanor. We were able to talk to nursing staff and doctors to help gently wean him away from those medications. I have learned so much about ICU medication from Kali and I am not a medical professional. Without her consultation and knowledge, I wouldn’t know where to start when talking to the nurses and doctors.

Also, listening to her podcast helped me to understand the journey she took with her own patients who were being ventilated on high settings. This helped me understand my dad’s settings weren’t detrimental to his health and the issues were more related to the use of sedatives and being stationary in a hospital bed, which led to a longer hospital stay due to immobility and all the effects it can have on the human body.

With Kali’s advocacy and passion about ICU medicine she can change patient outcomes and improve their quality of life after an ICU hospital stay. I firmly know and believe EVERY single intensive care unit in EVERY single hospital needs to consult with Kali on how to change their practices, and EVERY single family who has a loved one in an intensive care unit needs to consult with Kali on the status of their loved one and how to improve their outcome.

About the Author, Kali Dayton

Kali Dayton, DNP, AGACNP, is a critical care nurse practitioner, host of the Walking Home From The ICU and Walking You Through The ICU podcasts, and critical care outcomes consultant. She is dedicated to creating Awake and Walking ICUs by ensuring ICU sedation and mobility practices are aligned with current research. She works with ICU teams internationally to transform patient outcomes through early mobility and management of delirium in the ICU.

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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