Testimonials

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.

As you would anticipate, this is a major culture shock for all ICU providers at all levels, including physicians, nurses, physical therapists, and respiratory therapists. We have reached out to Kali Dayton to help with the educational process and provide amazing information for all of the ICU providers, particularly our nurses who clearly anticipate that this program will result in a major culture change. Kali presented a series of webinars which have been fantastic to bring all providers up to a high level of understanding, and to demonstrate that this process is not nearly as challenging as most people initially anticipated.

Since Kali has experienced the Awake and Walking ICU for many years, she is an invaluable source of information and encouragement to all levels of providers who have appropriate concerns as to how challenging this might be. Our clinicians, particularly the nurses, as well as respiratory and physical therapists, have been very impressed with the webinars. This program involves a steep learning curve and culture shock for most providers, as it is counterintuitive and not consistent with the experience of most ICU providers. However, the harm that we have unknowingly caused our patients demands that we must ask ourselves, ‘Is this the best we can do?’

The Mayo Clinic recently reported that the mechanical order set no longer includes mandatory use of sedative medications. Light sedation with a goal of an RASS score of 0 to -2 is the goal. Without any reservation, I heartily recommend the assistance of Kali Dayton if you are interested in exploring this radically new approach to ICU patient care. This program is a major challenge at many levels. Having someone on your side who has walked the walk, to help in the training of all your staff is an amazing benefit.

I am confident that just like at the Mayo Clinic, the Awake and Walking ICU will be standard practice in the next two to five years. At a very selfish level, there is a high probability that all of us will spend some time in the ICU. I suspect we would strongly demand that the care we or our families receive be at the cutting edge, particularly as it relates to decreasing post-discharge cognitive dysfunction, in addition to anxiety, depression and PTSD. I wish you every success as you try to upgrade the quality of ICU care in your community.

Peter J. Murphy, MD, FCCP, MRCPI, BSc

My dad came down with COVID pneumonia at the end of September. We did our best to treat him at home but eventually we realized we needed to get him to a hospital. After about four days in the hospital on oxygen he crashed and needed to be put on a ventilator. We were devastated.

When they put a person on a ventilator, hospital protocol generally is to sedate and paralyze the patient. My dad was sedated and paralyzed for a total of about 17 days. He was completely immobilized. One doctor told us that my dad had one of the worst cases of COVID pneumonia he had seen in a long time. We were, of course, extremely worried. As time went on, his condition worsened. Through a series of miracles, my dad stabilized enough that they were able to give him a tracheostomy. This was the turning point where he was able to get transferred to a LTAC facility (which is a critical care facility for COVID patients).

Fortunately, through a friend, we were put in touch with Kali Dayton. We were told she has had amazing success helping people come down off sedation and the paralytic. One of the side effects of sedation is the patients experience extreme delusions and hallucinations. While we were at the LTAC, Kali was extremely helpful in helping us understand the importance of getting my dad off the paralytic and sedation quickly. She informed us that every day he was on the sedation added weeks onto his recovery. We began pressuring the staff at the LTAC to get him off the sedation. Kali has found that it is critical to get a ventilated patient up and moving and you can’t unless they are off sedation. The staff at the LTAC were very hesitant to take my dad off sedation, at times even telling us he was off it, when in fact, he was still on sedation.

Finally, through much vigilance, we were able to get him off sedation. We then had the task of making sure we had physical therapy coming as much and as regularly as possible to ensure my dad was up and moving as much as possible. Now that he was off sedation we began dealing with the repercussions of having him on sedation meds for so long. My dad experienced horrible hallucinations.

Through the help of Kali, we were able to have discussions with the PA, who was caring for my dad, as to the best pain killers or anxiety meds that would ease him safely off his sedation meds. Eventually, Kali was very instrumental in helping us to get the PA to allow my dad to turn off the ventilator to see how he would handle it. The PA told us he would probably only be able to go about two minutes. My dad was able to be off the ventilator for the entire day! He probably could have gone the night, as well, but they put him back on the ventilator for the night to give him a rest. Within a couple weeks my dad was able to come completely off the ventilator! The PA and LTAC staff were blown away by how quickly he improved.

We do not believe my dad would be here with us today if it hadn’t been for Kali and her knowledge of the importance of getting my dad off the sedation and paralytic and getting him up and moving as soon as possible. We truly believe she was instrumental in helping to save my dad’s life. He spent a total of two months in the hospital (this included ICU, LTAC and acute physical therapy). He has been home for over a month and a half now and is doing awesome! He hasn’t been on oxygen for about two months now. He is getting to the point where he isn’t even using a cane to walk around anymore.

We truly believe Kali is one of the miracles that came into our lives to save my dad’s life. Thank you so much Kali! We will forever be indebted to you!

Heidi Lanthen
Utah, USA

On the night of August 31, 2021, my husband was rushed to the hospital with COVID pneumonia and an O2 saturation of 52. He was put in a medically-induced coma and on a ventilator around 5:30 a.m. the next morning.

Kali Dayton was pivotal to myself and my family in explaining what all of the settings are and every step towards recovery. She spoke and advocated with the medical team on numerous occasions and even spoke with the hospital ethics committee. I believe she is an exceptional professional and helped save my husband’s life. She was huge in reducing the extreme amount of paralytic medication and made sure that we were all working together.

It was very difficult working with some of the hospital staff, but she was amazing and able to break through barriers that would have otherwise been impossible. I am eternally grateful for her. Her podcast, Walking Home From The ICU, was so beneficial and helpful. I encourage everyone who has a loved one in the ICU to listen to it.

Shannon West
Florida, USA

I am a nurse leader responsible for improving practices across the intensive care units of a large health system. As an experienced ICU nurse, I know the culture that most often exists in ICUs is one that promotes and accepts over-sedation that often causes unintended harm. While reviewing the literature to better align our liberation practices with the best evidence, one of our bedside nurses discovered Walking Home From The ICU. The combination of poignant stories from ICU survivors with the expertise of some of ICU Liberation’s leading experts became the impetus for a system-wide evidence-based practice improvement project aimed at changing analgesia and sedation management in our ICUs.

After initially being inspired by Kali’s podcast and the incredible stories it provides, we saw an opportunity for more. We brought Kali in to present a webinar to almost 100 of our critical care team members, including nurses, APPs, physicians, and respiratory therapists. Kali’s presentation struck a needed balance between evidence-based practice information and inspiring stories, highlighting real patients who benefited from a practice that is often very different from what occurs in most ICUs today. The webinar was very well-received by all who attended, and the lessons learned have continued to be referenced by our team members as we strive to create an Awake and Walking ICU culture.

Kali offers a refreshing perspective on critical care, and she supports it with a wealth of knowledge garnered from years as a bedside nurse and advanced practice provider. Kali knows how to speak to clinicians because she is one, and she’s still very connected to the daily lived experiences of those on the frontline of critical care. I believe anyone working in critical care will find inspiration in Walking Home From The ICU to change the harmful culture of sedation in their practice. I would even go so far as to recommend the podcast as required listening for all ICU team members, whether experienced clinicians or new residents and nurses. When additional support is needed, I encourage clinical leaders to utilize Kali’s expertise and experiences to further inspire and motivate their teams. Time spent working with Kali is an investment that will pay dividends in the positive impact it has on the lives of the patients we serve.

Patrick Bradley, MSN, RN, CCRN
Virginia, USA

Before Kali, our hospital struggled with overly-sedated patients and lack of early mobility. Despite multiple efforts to change the culture, we were at a standstill. In one hour, Kali was able to ignite a flurry of conversations regarding her experience with the Awake and Walking ICU and this immediately led to a change in clinical practice.

Patients with less sedation and other neurotoxic medications are spending fewer days on the ventilator. If you are considering starting an ICU early mobility program at your hospital, your first step needs to be to consult with Kali and absorb as much information as you can!

Matthew McClain, DPT
Florida, USA

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.

Implementation has been challenged by pushback at the bedside, but knowing how most patients can be off sedation and comfortable allowed me to advocate for the patients. So far, four patients were successfully kept off of sedation after getting intubated, and two of them immediately smiled at me as they woke up from induction meds. Kali and the members of the Awake and Walking ICU have decades of experience in this approach.

Some institutions such as Johns Hopkins have implemented this as their hospital-wide QI project. If you are interested in improving patients’ lives beyond survival, I highly recommend listening to the podcast and reaching out to Kali for further guidance. If this concept is new to you, as it was for me, it will broaden your perspectives in taking care of your ICU patients, and perhaps renew the sense of purpose in your everyday practice.

Mikita Fuchita, MD
Colorado, USA

The Walking Home From The ICU podcast has been transformational in helping to change the culture in the small community ICU where I work. I am an occupational therapist and have wanted to implement early mobility in our facility for several years now. It wasn’t until I started listening to this podcast that this “want” became more than that. It became a “must.”

The podcast has made it so easy to share the passion I have gained. The stories of the patients and the knowledge of practitioners sharing their clinical practice advice are so valuable.

Kali Dayton has shared with our team her knowledge through a video format as well. She was able to answer nursing related questions that I, as an OT, haven’t been able to answer. She is professional and willing to share her knowledge and passion in order to make changes in the ICU community around the world.

She is inspiring and gives me the courage to keep pressing on to make these best practices a reality in my community.

Kristie Porter, OT
Arizona, USA

As an RN in the Medical-Surgical ICU at the hospital I work at, I began my interest in ICU Liberation through an Evidence-Based Practice project.

While I was initially grabbed by what the literature has to say about over-sedation and patient outcomes, it wasn’t until I discovered Kali’s Walking Home From The ICU podcast that a culture of sedationless ICU care sounded tangible. The group I worked with on the project was both inspired, devastated, and intrigued by the stories Kali illuminates on the podcast, and we were able to bring her to our hospital for a virtual Zoom Webinar, where she presented on the practices in the Awake and Walking ICU.

This webinar was an incredible way to draw attention toward this necessary culture shift as Kali shared stories of patients awake and mobile in the ICU despite the complexity of their illness. The webinar inspired our final draft for the new practice guideline on analgesia and sedation management in the ICU, and since then we have seen intubated COVID patients playing tic tac toe on the door with staff members on the other side, taking laps around the unit, performing their own oral care using a hand mirror, and most importantly, keeping their autonomy and integrity while fighting to leave the ICU to resume the life they had before coming in.

While no change is instant, the webinar was a necessary catalyst for changing the culture at our hospital system, and because of it we are seeing improvements in our practices and culture every day.

Nora Raher, BSN, RN, MSICU
Virginia, USA