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Sedation is often given with the hopes of sparing patients the discomfort and awareness of the struggles of the ICU. Yet, does that ultimately prevent harm and suffering? Antonette Montalvo, APRN shares with us what it meant to her to be able to fight for her life with her eyes open.

Episode Transcription

Kali Dayton 0:02
Throughout this podcast, we talk a lot about patients being awake, engaged, aware of their surroundings, communicative, autonomous and even mobile outside the bed. I share my experiences in an awakened walk in ICU where I worked for years caring for at least hundreds of patients that were awake and walking.

And though that was the norm and pretty casual and that ICU, I don’t ever want to minimize the real discomfort and challenge of being intubated on the ventilator. justifiably, many clinicians have concerns about patients being uncomfortable. And I think that is fair, it is uncomfortable to be intubated.

I’ve never had a patient say, “Please don’t extubate me. I am enjoying the endotracheal tube.” But when it comes to severe discomfort, agitation, absolute intolerance. I’ve rarely seen patients achieve the level of intolerance dyssynchrony thrashing agitation, as I’ve seen during awakening trials.

When all we’ve experienced is of minimizing sedation is peeling it back after it’s been full blast for days to weeks, and then we have patients coming out thrashing, that it’s easy to attribute that scenario, to the presence of the endotracheal tube and the ventilator. When we see the absolute trauma and tear in their eyes, we as clinicians are not about that.

We did not come into medicine to watch and even cause suffering and harm. So when we see that presentation subside, when we turn sedation back on, then we’ve come to have this relationship with sedation in which we believed that that is the humane intervention that makes the suffering go with that, as Heidi Engel says is the “Chardonnay at the end of the day”, right? “Patients are sleeping, they’re more comfortable.”

So when we’re talking about what is best for the patients, what is going to be even just more comfortable, we need to do a true risk versus benefit analysis. We can either have patients be awake, aware of the endotracheal tube and yes, somewhat uncomfortable. They’re not going to be able to drink or eat and they’re going to be aware of that. They’re not going to be able to talk and they’re going to be bothered by that. So yes, that’s uncomfortable.

But what’s the alternative? We need to understand and appreciate the risks and repercussions we sign our patients up for when we choose sedation. And the main risks are two conditions called ICU delirium and ICU acquired weakness.

When we sedate our patients, on average, they’re eight times more likely to develop delirium (1). When that happens, they are twice as likely to die during that admission (2), for every one day delirium, there is a 10% increased risk of death. Six months after discharge, delirium survivors are still at a three times greater risk of death(3). And that risk is still elevated one year after discharge (4). Delirium survivors are at 120 times greater risk of long term cognitive impairments (5) that we’re now sometimes calling post ICU dementia (6).

They’re also at greater risk of post ICU PTSD (7). And it makes sense if you’ve listened to this podcast and you’ve heard survivors talk about vividly and graphically living through watching babies burn and trying to save them, believing that they themselves or their loved ones are kidnapped, being sexually assaulted torture of all kind, when I deeply believe and if it lived through their spouse betraying them, perpetrating the harm to them, or even divorcing them. All of that is not comfortable.

And or it can require months to years of intensive psychological trauma therapy that is not comfortable. They live lives with panic attacks, flashbacks, disorientation, they lose the careers ability to drive the ability to care for themselves or others, that is not comfortable.

And then if we’re looking just at ICU acquired weakness, it’s not comfortable to be stuck in bed for weeks to months, it’s not comfortable to lose the ability to lift a finger, let alone sit, stand, walk, swallow, it’s not comfortable or easy to rebuild the ability to sit, stand, walk, swallow, tricky ostomies are not necessarily comfortable. It’s not comfortable to develop complications, like stenosis that then require repeated dilations and even resections. Later on, it’s not even comfortable to look in the mirror every day and see a scar that reminds you every day, every time of the traumas that you’ve endured. That’s not comfortable.

We need to appreciate the impact that our sedation has on their duration and quality of life. Some early mobility studies don’t show a difference in mortality, but then we need to look at what was the early mobility data was it passive range of motion or was it walking aside the bed, was it sitting on the side of the bed weeks after intubation? Or was it walking even 24 to 48 hours after intubation? When to look at how long after the ICU are we measuring? Is it a few months or and guess they may be alive a few months after discharge. But are they in LTACH still on a ventilator trying to recover? Or are they at home, safe and free of the complications that happen? After ICU acquired a weakness?

We know that the main cause of death for patients that develop ICU acquired weakness is sepsis (8), which makes sense as the weaker you are, the less able you are to independently breathe. The longer you are stuck on a ventilator and in bed, the more likely you are to develop ventilator associated pneumonia, any kind of hospital associated pneumonia aspiration pneumonia, you’re at greater risk of developing hospital acquired pressure injury. The longer you have lines and tubes leading to CAUTIs and CLABSIs and so on.

So yes, giving my myotoxic medications and preventing utilization and preservation of muscles during a period of time in which muscles are already been catabolism and attacked by critical illness. Absolutely changes outcomes and can greatly determine duration and quality of life. And again, ICU acquired weakness is not comfortable and will last far longer than an endotracheal tube.

Look back to the episodes with Suzanne Roth (9), David burrows, Susan East (10), Eileen Reuben(11), Mark Hudson (12), Caleigh Haber (13), Denise Balzada (14), Jim (15), Aaron Walsh(16), Megan Wakley (17), Jeff Sweat (18), Spencer Freeman (19), David Richards(20), Amber Latsch(21), and the dozens of delirium and ICU acquired weaknes survivors in episodes 103, 52, and 4.

Go to the transcription of this episode and I will link each of their episodes because I want you to really listen to them. They were so vulnerable and shared intimate insight into deep trauma and suffering because they did not want others, future patients future survivors to experience what they have experienced and continued to struggle with every day of their lives.

As you listen to them think about how different their experiences in the ICU and then the rest of their lives could have been, if they had been allowed to fight for their lives will on their feet with their eyes open. I’m excited to now to hear it from a powerful ICU survivor, Antonette, whose fate was greatly determined by her powerful and compassionate ICU nurses.

 

 

Kali Dayton 0:02
Antonette, thank you so much for coming on the podcast. Can you introduce yourself to us?

Antonette Montalvo 0:07
Absolutely. So my name is Antoinette Montalvo. It’s great to be just on your show and be able to share a little bit of my story. from a professional standpoint, I am owner of Antonette Montalvo consulting coaching services are serve as a community health consultant and coach and mentor for nurses.

And I’m also a pediatric nurse practitioner, and then, which we’ll probably dive into as well. From a personal standpoint, I have definitely understood what it means to be awake and walking in the ICU. So I’m excited to share a little bit of my story, but the tagline I go by as the visionary nurse, and a lot of it has stemmed from my experience of experiencing a very intense and challenging situation after the birth of our second son. And that just kind of prompting me to say if I have another breath in my body and life to live, I definitely have vision to share. So that’s a little bit of my background and insight.

Kali Dayton 1:00
Yeah, I’m so excited to dive into your story. I’m always looking for people to share what it was like to be awake while intubated. Because especially during the COVID era, there weren’t a lot of you out there. So tell us what led you to be in the ICU and what that journey looks like for you.

Antonette Montalvo 1:18
Yeah, so it’s one of those things that you never really imagined that it’s going to happen, you don’t think you’re going to be in the ICU. And again, especially as a health care provider, you’ve delivered care in certain situations. And it’s not to say that you’re never going to experience these types of things. You just never experienced in routine, seemingly routine situations that it’s going to happen.

So after the birth of our second son, so I was in the hospital, you know, delivering I had to have a routine C section, actually, because I had placenta previa. And so it was just a safer option for us to deliver overseas section. It was the first time delivering overseas section and it was supposed to be routine. But then, immediately after delivering, it seemed as if I wouldn’t stop bleeding.

They had taken me back to observation, and I was out of a war at that point. And I was literally just in the process of breastfeeding they were going through, but the lactation consultant was going through things and as she was continuing to check to make sure that I had slowed and bleeding, it wouldn’t stop. And at the moment I could you know, I could I’m in the hospital, I’m with the lactation consultant.

And at that point, you know, at that time, I really just thought that maybe I was just tired. And I realized that, you know, I was feeling a lot colder, I felt like I had not much energy. But, you know, I just assumed it was just because I had just birthed a baby, right? I thought that was just because of delivery.

And also, you know, a C section is, is a major surgery, you know, regardless of whether it’s to deliver a baby or not, and so, I just assumed, you know, those are the things that were going on. And as she was checking, you know, she was doing a fundal massage to see what was going on. And I just kept bleeding. And I kept bleeding.

And, you know, she continued to monitor. And so we went back to, you know, the regular room on the floor, and I was, you know, the family was there who all around, and the OB came in the room, the one who was the follow up after the delivering OB that I had, and he’s like, “We have to talk about something. It seems that you are experiencing, you know, DIC disseminated intravascular coagulation. And we have to take you back to the or right away.”

And it’s not what you expect to hear, after you just delivered your child. And so, you know, our oldest was there, my parents were there, my brother had come to visit to my uncle, my husband, we were all there. And no one was expecting, you know, this news. So after maybe an hour of having time with our newborn, I had to hand over my newborn to my husband, and they rushed me back to the ER. And at that point, it became an entire world when of situations, there were many different things and different options that were thrown out there.

And I’m sitting there in the or saying, “This can’t be like, This is wild.” But at the same time, I was incredibly calm, I was an incredibly calm and, you know, you know, for those who have maybe heard, you know, some of my visionary, there’s podcasts on my platform, my faith is very important to me. And so I know it was my faith and my faith in God that was keeping me calm in that moment, because there’s no other way that I would have been as calm as I was, there’s just no other way.

So while they’re trying to figure out what’s going on, and they’re throwing out all these different options, and I’m like, we really need to, I need to think through this like as best as I could, while I’m feeling my body and my life literally slipping away from me. And at that point I ever it was just kind of like this pause and everyone was like, “We need to do a couple of different checks. Number one, are you feeling pain? Number two, we need to call your other OB to figure out what might be some other options for you. And number three, we need to get you you know, calm because we don’t want, we don’t want you to be anxious.”

And they immediately at that moment mentioned, you know, they weren’t talking to me but in the background, they said, you know, “Maybe we should crank up the Ativan to make sure that she stays calm.” And I said, “I don’t need an Ativan, I’m not anxious.” And that threw everyone for a loop, because they were like, “Wait a second. Every day, individuals who are delivering don’t necessarily talk about Ativan, they don’t know Ativan.”

And at that point, someone literally said, like, “The only thing that would make this worse is if you were a healthcare provider.” and I said, “I’m a nurse practitioner,” and everything went dark.

And I woke up, I guess, hours and hours and hours later, what I found out later is probably 12 hours later, and I was in the ICU. I was intubated. I was hooked up to every single line possible, I was told that I had dreamed the blood bank that they had to pull every single possible bag of blood out. And when I everything was dark, and I was like, number one, thank you, God that I am alive. I am alive right now. I am alive, I am alive.

And then realizing that I was intubated. And I’m here thinking “Did I just deliver my baby?” At some point, I didn’t know what time it was, I didn’t know what was going on. And I kind of you know, saw a clock on the wall and it was maybe four or five o’clock in the morning. Now I had I had delivered at 12pm The day before. So somewhere between that time, one to four is a blur to me, I’m sorry, is a blur to me.

And I, I sat there thinking to myself, “Okay, I’m here, I’m alive. I am hopeful and sure that my baby is fine. And I got to figure out what’s coming up next.” And so from that point, I had two wonderful nurses, Alice and Dallas. I will never forget them, I will never forget them. They were amazing. To say the least, I literally want to think of them as angels in disguise.

Quite honestly, these nurses were so attune to my needs at that moment. And their biggest concern was, “We need to get you back to your baby. We need to get you back to your baby, we need to make sure that your care has progressed to get you back.” And when I realized how open and available they were, I was like there’s there’s going to be a good opportunity to move forward again, the entire time was at peace. And I remember Alice saying, “We’re going to make sure that you’re dialed back on all sedatives so we can get you extubated faster, because that’s the goal.”

And she was ready for it at that moment. She was quick on her feet. And she made sure. And then Dallas when he would come in and they would switch shifts, he realized that I wanted to communicate, I wanted to be able to express what what I was feeling what was going on, I wanted to ask about my baby I was he knew I was fully awakened coherent. So he brought me a clipboard, he’s like, “We’re gonna write this out, like whatever you need, we’re going to make it happen.”

And he they were so they were so communicative. Even though I couldn’t verbally express everything that I was trying to say, I wrote things down, he made sure that, you know, when they were doing suction, that it was very gentle. He was attentive to, if there was any pain, he made sure to explain everything that had happened to me. And they made sure they said “Our goal is to get you out of here.”

And so in the meantime, Alice was coordinating to make sure that, you know, our newborn could come down and I could at least maybe attempt to breastfeed while I was down there. The lactation consultant came down, they were very much continuing my care as an OB patient in the ICU because they knew this is not where you’re supposed to be, regardless of the circumstance that it looks like around you. And so literally within maybe 12 to 24 hours, it’s kind of hazy in the timeline, that I was eventually. And obviously, there’s a lot in between that I was eventually extubated because of their quick thinking, their ability to recognize that I was with it, I was ready.

And this was not where I was supposed to be for the long term. And so sure enough, I was extubated and was able to go back to the floor so that I could continue on my care as a woman who had just delivered a baby, you know, two days prior to that. So that’s a little bit of the snapshot and story. I know, it’s a lot to take in. But it’s one of those things that has definitely marked just the direction of where my life goes now.

Kali Dayton 9:29
That is wild. And I I’m totally with you with giving the credit to those nurses, Allison Dallas, that in that moment, they had the power in their hands to really dictate what happened throughout the rest of your course and the ICU. And the hospital and even the rest of life that easily could have happened is that they could have just seen the ventilator could have just seen the endotracheal tube and said, “Therefore we automatically have to sedate them. We don’t when we don’t expect patients to be awake, compliant. To our communicative on the ventilator, we don’t adjust our sedation.”

And maybe it’s proceed as an extra work extra things to do to give you a pen and paper. But that allows you to be calm, to be compliant to be a part of the process. It sounds so simple, but it’s not the power of a pen and paper. And what kind of things did you ask?

Antonette Montalvo 10:23
So it was it was I try to look back at it now. And I think I almost maybe maybe I saved it. And I’d have to dig that up from somewhere. But it was just basic things of like, “What happened, exactly?” Or I would ask like, you know, when they were asking me about just general care with the with a trach? You know, is this comfortable?”

And I would say yes or no, you know, “Is this suction working for you? Is there anything else you need?” And so I’d write like, you know, “My mouth is dry, is there a way that you can get me a swab just to swab around my lips, you know, how you’re getting updates on how my newborn was doing?” Getting kind of a fill in, and I would just tell them, you know a little bit about myself, I would tell them, you know who I am, I would tell them, thank you, I would just encourage them, they were just all these different things.

But it was just a conversation to just feel like I understood what was happening around me. And then they would, you know, ask me if there was anything else I needed if I was comfortable if the bed was adjusted well, and so I would tell them, you know, maybe you can adjust it this way, maybe this can happen. And it was just either nods or writing these things down.

And that was so empowering and liberating, because I realized, later on in that process, where you know, Allison Dallas had finished their shifts, and they were doing kind of the final respiratory check, there was a respiratory therapist that came in, who was not as in tune with what had been happening in my care, you know, several hours before.

And that person to no fault of their own, kinda was just treating me as someone who was in the ICU. So when they came to suction me to kind of, you know, evaluate the final evaluation before the attending physician was going to say, you know, it’s time to be excavated. This person just kind of, for lack of a better term, they were a bit aggressive. They were a bit aggressive. And I and I want to say that respectfully, I want to say it the right way.

But they even in the process, you know, the suction and the cleaning, and the swabs had been so gentle and patient centered with my nurses that were there with Alice and Dallas, but the respiratory therapists admitted afterwards, you know, usually she she says she said patients are usually sedated. “I’m really sorry, I wasn’t aware that you know, of what was going on, you know, people aren’t usually awake when they’re here.”

And it really was a stark contrast for you know, the hours before that, where I felt at ease, regardless of the situation, I felt calm, I felt like yes, even though this is a really difficult situation, I can get through this very easily. But it was in that very last moment, I would say was probably the last 30 minutes of being in the ICU was the hardest, it was the hardest, because it was during that experience that I thought, oh, no, I didn’t go through all of this, to suddenly have like myself, you take it out by this very aggressive situation that was happening.

And again, you know, as you probably seen in your own practice, and in different places, people are probably mostly sedated, they might be completely sedated. They may not be as responsive, they may not be in communication, they may not have been in the situation that I was in. And so you’re not thinking that they’re going to be responsive to what you’re doing. You’re just doing your job, you’re trying to suction and make sure there’s no excess secretions. And so it was a very interesting comparison in that process of how everything came together, especially at that endpoint.

Kali Dayton 13:39
Yeah, it’s a whole new experience to have feedback from a patient to say I like this, like this. When we continue this conveyor belt approach of in debates, the date, section, turn, keep station going. We really don’t have to be that patient centered. I hate saying that. But it’s the truth of it. When I have patients that are less responsive, I feel differently.

And I know that I act differently than when I know that they’re involved and present in that moment. And I wish I could talk to Allison Dalston, to hear what that meant to them to hear feedback from you. But I think most listeners, have by now had some experience for themselves, of being able to have a patient connect with them, talk to them communicate at least. And that’s just so much more rewarding.

]And that’s what I hear from listeners is that especially coming out of COVID, where it was so isolated of so dehumanize, it was so cold. Now we get to have real connections with patients and they saw you as a mother, a nurse practitioner, they weren’t in it for the long haul for you not just I’m just trying to get through my shift, keep the heartbeat just for my shift. It was hear these overall goals and that’s going to impact my choices minute by minute. Absolutely.

And a lot of people ask, how can you tolerate being intubated? Is it for nurses, we see patients come out of awakening trials when they’re delirious. They come out thrashing agitated, they’re biting the to trying to pull it out. That’s the expectation for all patients that all patients will be like that because in a tracheal tube is so uncomfortable. But obviously, you were not that way. How did you handle that?

Antonette Montalvo 15:19
I can’t attribute it to myself. And I, and I’m going to be honest, and always I know is the grace of God. Because even when I think back to it, there is it. There’s no real logical way that I could have tolerated what was happening around me. When I say and my husband has given kind of account afterwards, it’s like, it was not a pretty sight to be hooked up to I think they said it was 24 bags of blood, um, to have all kinds of things going on.

And then also to be, you know, intubated at that time, when I woke up, I there’s there’s no explanation, you know, even in a very, you know, funny, but maybe not so funny way. I was so at peace again, because I know it was a kind of supernatural God given piece that I was literally grading papers on my phone. While I was in the ICU while I was intubated. I’m sure my students had no idea what was going on.

But I was actually finishing up the end of a semester class as an adjunct husband, I was finishing an adjunct course that I of course, did I was at that was an adjunct for a nursing course. And they had their final exam and a student had a trouble with their exam accessing their exam. And so I was literally resetting their exam so they can re access the exam to start their final exam again, because something had shut down, something had happened. And so I had to allow them to, you know, access back into the exam. And I looked at myself were intubated. While it was intubated, while I was intubated, I said, “Antoinette, you know, most people don’t have to”, I’m having this conversation, myself, “don’t have to do this.” But here I was.

Kali Dayton 16:54
If there was ever a time to pause and say “I’m unavailable”, that’s probably a good moment for that.

Antonette Montalvo 16:59
It was a good moment for it. And again, that’s why it’s so uncanny the level of peace that I had, I paid that pitcher just to show that it was beyond me, it was literally beyond me. Because I felt that at ease that calm that I felt like even though I was in this situation, I could still, if anything, gave me a little sense of normalcy. And it really helped me not have to think so hard about what was going on. Because again, what else are you going to do?

If you’re just there, you can’t do anything else. So the fact that they even brought me my phone, the fact that they even gave me opportunity to communicate, that was actually very helpful for me, because it helps keep my mind at ease as well and not have to just sit there for hours thinking, here I am. Because again, any other person, I’m sure it would be very difficult.

What do you do during that time, as you’re sitting like, yes, you want to be able to advance your care, but you still have to just be patient, you have to be able to allow the time to pass. And so I definitely think those communication tools and those abilities to not only write with my and communicate with a notepad, but also even have my phone and do that.

Even though it sounds bizarre at that point, I think it actually was very helpful for me to stay at ease in the middle of the supernatural piece that I was receiving, so that my mind could just say, You know what? It’s gonna be okay. Like, if you can do this right here while you’re sitting, it’s really going to be okay. So again, a lot of times there’s not real, a real explanation behind. It was, yeah, it was a God given piece for sure.

Kali Dayton 18:31
And I absolutely believe that. I’ve also seen patients be very similar. I mean, I’ve had patients, we give them laptops, and they still don’t use their laptops throughout. But I remember one patient had instance in in stage interstitial lung disease, and he wouldn’t let us. Well, he was ready for extubation. But he needed to send out some final emails before he went. And so he was able to say his goodbyes via email because he has laptop there.

And it was totally worth it totally coherent. But because he was he knew that because of his lung disease, he was not going to be free of mechanical ventilation. And so that’s Yeah, and I’ve had another nurse, a podcast listener who was intubated, say how bored she was. Perhaps that’s a problem too, if you even without delirium, if you’re too bored, then your mind starts wandering and you fixate on things.

So she appreciated being able to crochet or knit I can’t remember which one it was, but while she was there, and so things like that. It’s even fun for the clinicians, because you get to know that person, you get to see them as a human, seeing them do human things. Really helps you see what we’re working towards the end goal of having them resume their lives.

Antonette Montalvo 19:43
Absolutely agree. Absolutely agree. And I think that’s, that’s such a big key is maintaining that human level because, again, you know, in certain situations in our clinical practices, there’s going to be moments where it doesn’t, you’re you’re trying to make that connection because of one reason or another refer there’s extreme trauma, if there is moments where they’re not, you know, they’re not conscious. You just want their body to be alive, like you’re trying to maintain the physiological standard of life. But I think that ability to recognize the human portion of it is such a key instrumental component of maintaining life as well to for sure.

Kali Dayton 20:22
Right? Keeping their souls involve their souls alive, I think we really can drain people of their will to live when we subject them to delirium for prolonged periods of time, that easily could have happened to you. I’ve heard of similar situations. But that went a different way, where they were sedated, and then they developed delirium, they come on agitated, then we respond to the agitation with more sedation.

So they take it off to try to get the breathing tube out, see them thrash translation back on, and they, you could have spent days longer developed more complications, which could have led you to be on the ventilator first longer. But you rather, were able to be off the ventilator when you no longer had a need for it. And that’s because Alison Dallas, asked the question, does she have an indication for sedation? Hmm. And they allowed you to be a part of your process, which is amazing. What other recommendations would you give to the ICU community as an ICU survivor?

Antonette Montalvo 21:18
I think the biggest thing, again, is being attentive to the patient, it can be very easy. And I mean, we’ve already said it before, but just reminding yourself to be attentive, you know, we have these checks, right? As we go through, you’re making your checklist of checking lines, you know, checking blood pressure, checking everything else that’s going on, which is important, which is absolutely important.

But then also making again, those basic human checklists, write that into your checklists, you know, making sure that did I communicate with the person, whether they’re conscious or not? Did I talk out loud, you know, we do all these, you know, simulations in nursing school, right? We have to be very good at doing, you know, practicing on those mannequins, if anyone remembers having to do any type of like OSCEs, or any type of assessments in nursing school, the biggest thing that they train you to do is knowing how to communicate with that patient.

And so I think, maintaining that same level of approach that you had in nursing school, we know those mannequins, you know, obviously, it’s a lot more high tech now. So you have some that can respond to you. But they couldn’t respond to you, right? So whether that person is that person is fully conscious or not still respond to them as a human? Did I talk to them? Did I explain things to them? Did I explain the care whether I recognize if they fully get it or not?

Sometimes it’s just helpful number one, to be able to still involve that person in there. So you don’t fall into the trap of just thinking that this is a you know, a body for lack of a better way to say it, if they may not be coherent, or responsive. And then always just being attentive to those very slight changes, those very slight changes that come along, because again, when you’re getting in the process.

When you’re getting in the, in the you know, you’re going through the motions, you’re running between patients, there might be a lot that’s going on, it’s always good to just refocus and recenter yourself and saying, Am I scanning this person, for this person for anything that’s different, and really being attentive to what’s happening to them, outside of, you know, the mechanics that might be there.

Kali Dayton 23:18
And I would say, that’s another reason to allow for communication. A lot of times patients can tell you what they’re experiencing, and what’s changing before you even see it show up in the monitor, or in physical exam. One listeners said that they had a patient that was intubated that complained of chest pain.

So they did a chest X ray, and they found a large pneumothorax. And as they were looking at the chest X ray on the machine, they arrested. Wow. And they immediately knew why they arrested and obviously intervened, ran a code, but they knew why they could put a chest tube they could intervene on that pneumothorax otherwise, how long would it have taken them to identify that pneumothorax? That’s not my first differential when it code happens. So it’s life saving to allow patients to tell you what they’re what they’re experiencing, what is changing? How can I listeners contact to you tell us more about your podcasts what you’re up to now?

Antonette Montalvo 24:16
Yeah, absolutely. So very simple. Again, you know, just going to visionary nurse.com is an easy way to search for me across all social media platforms. Because accident, one toll is sometimes a little bit harder to search for. So www.visionarynurse.com is a great way to get connected, it’s the same name of the podcast as well. But if they just go to that they can find information about me ways to, you know, connect with me, and just, you know, even get a chance to hear and see how the experience that I had has transformed my outlook on life.

And so a lot of what I do, especially throughout my business as a coach and mentor is being able to provide that professional development in that coaching and that leadership, especially for nurses to recognize us have a unique opportunity to influence someone’s life, whether it’s in the ICU, whether it’s in community, whether it’s in a business setting, there are so many different ways that we can apply our nursing skill set.

I mean, I love what you’re doing with your podcast as well. And taking the experiences that you’ve had in your clinical setting and saying, You know what, something can be better for the future patients and the current patients that that may be in the same situations, and being able to recognize that your expertise, your your work, as a nurse can go far beyond the bedside. But then of course, that bedside care that you can provide can be transformed when you recognize your visionary influence. So it would be amazing to connect with people and journey along with with where they’re going and the influence they may have with other people.

Kali Dayton 25:45
But this podcast is full of visionaries. The listeners are revisionists, their icy revolutionists, I think it all aligns perfectly of the power that we have individual clinicians, whether nurses or whatever discipline to optimize our role and completely influence and change lives for the better. And you’re a good example of why we do what we do in the ICU. It’s amazing what you’re doing now, following your ICU stay. I’m so glad you’re doing well. And a lot of that is because you were treated so well with the humanistic approach. Thank you so much, Antoinette.

Antonette Montalvo 26:15
Thank you. Thanks for having me.

Transcribed by https://otter.ai

 

Resources

1. Pan, Y., Yan, J., Jiang, Z., Luo, J., Zhang, J., & Yang, K. (2019). Incidence, risk factors, and cumulative risk of delirium among ICU patients: A case-control study. International journal of nursing sciences, 6(3), 247–251. https://doi.org/10.1016/j.ijnss.2019.05.008

2. Salluh, J., et al. (2015). Outcome of delirium in critically ill patients: systematic review and meta-analysis. British Medical Journal, 350. https://www.bmj.com/content/350/bmj.h2538

3. Ely, W., et al. (2004). Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Journal of American Medicine Association, 291(14). https://pubmed.ncbi.nlm.nih.gov/15082703//bmri/2017/3539872/

4. Pisani, M., et al. (2009). Days of delirium are associated with 1-year mortality in an older intensive care unit population. American Journal Respiratory Critical Care Medicine, 180(11). https://pubmed.ncbi.nlm.nih.gov/19745202/

5. Girard, T., et al. (2010). Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Critical Care Medicine, 38(7). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638813/

6. Mart MF, Pun BT, Pandharipande P, Jackson JC, Ely EW. ICU Survivorship-The Relationship of Delirium, Sedation, Dementia, and Acquired Weakness. Crit Care Med. 2021 Aug 1;49(8):1227-1240. doi: 10.1097/CCM.0000000000005125. PMID: 34115639; PMCID: PMC8282752.

7.Sandeep, G., et al. (2019). Post-traumatic stress disorder (ptsd) related symptoms following an experience of delirium. Journal of Psychosomatic Research, 123. https://www.sciencedirect.com/science/article/abs/pii/S0022399919301837

8. V. an Wagenberg, L., Witteveen, E., Wieske, L., & Horn, J. (2020). Causes of Mortality in ICU-Acquired Weakness. Journal of intensive care medicine, 35(3), 293–296. https://doi.org/10.1177/0885066617745818

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