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Kali talks with Christiane Perme, the post-ICU rehabilitation specialist, who shares with us what happens after patients are sedated and immobilized for weeks, what the rehabilitation process for COVID19 survivors will be like, and how long will it take for them to be able to sit, stand, and walk again.

Episode Transcription

Kali Dayton  

Today, we have Christiane Hervey with us. She is a post ICU rehab specialist and expert. They give seminars around the world. And she’s kind enough to join us today. Thanks so much, Chris, for joining us.

Christiane Perme  

Thank you for inviting me and then very excited about this opportunity.

Kali Dayton  

Good. Well, can you tell us a little bit about what your career timeline has been like?

Christiane Perme  

Okay, for I am a physical therapist, and for the past 30 years for I primarily work as a physical therapist intensive care unit. So I have been mobilizing patients and walking them on mechanical ventilation and dying most recently on ECMO for like this is my daily practice as a physical therapist.

Kali Dayton  

So you’re one of the rockstar superheroes of the ICU that we’re so grateful for. And I just want to pick your brain about some things that are way beyond my expertise. Can you explain to us, especially in the ICU, the difference between bed rest and immobility and how that impacts patients long term outcomes?

Christiane Perme  

Yes, it’s very important for all of the clinicians who practice in intensive care to clearly understand the difference between bed rest and immobility. When you talk about bed rest, that means that patients are placed in supine position and they are not allowed against gravity at all. Oh, like some people think of that patients would recover when they are on bed rest, they recover faster, it’s the opposite. 

You know, bed rest is very, very dangerous. And we know that because of there are more than 60 years of scientific evidence in the literature, primarily studies that are done by NASA have the very bad side effects of bed rest, that’s where they get healthy, younger adults. And they place those individuals for prolonged bed rest for you know, weeks, and then they are able to do all kinds of tests to see what happens to them. So we know based on those studies that bed rest, even for a healthy individual is very dangerous. So again, bed rest is just not allowing a person to be against gravity. Now when we talk about immobility, this is a little different, I want you to think about immobility is like a when you have a limb on the cast. 

So if you have a broken arm, and for example, they put a cast on the arm. So once you immobilize that limb, you take away the person’s ability to completely move those muscles, and to really connect with those muscles. So if you have a little bit of idea, like when you take the cast off, um, you’re gonna see massive atrophied decrease of motion at the joint level. In addition to that, you’re going to see a significant decrease in the coordination. Just like I said earlier, these individuals are not able to think about those muscles, and therefore they kind of lose the ability to coordinate. 

So basically, you could have a patient in ICU on bedrest, but he would be, for example, awake, he could be turning the band, he could be lifting the arm lifting the leg, he could be turning the TV channels and things like that. So the patient is constantly thinking about their muscles and utilizing those muscles. The only problem is that they are not against the gravity, as opposed to a patient who is and when we talk about immobility, we are talking about the patient who said they get it once patients are sedated, or they are also placed on neuromuscular blockers. We take completely away the ability of the patient to really think about those muscles and to move those muscles. Does that make sense to you, Kali?

Kali Dayton  

Oh my gosh, that makes so much sense. When we look at these big studies of the A2F Bundle. We see so much improvement by just lighting and sedation. And yet, when I the last study that was done in 2018, only 12% of all of those patients out of 15,000 patients were actually standing or taking steps. And yet there were such big improvements and outcomes just by lessening sedation. So you’re saying that most patients in the A2F bundled were on bed rest, but they weren’t so much immobilize because they could actually move parts of their body. 

And I, my practice and in my ICU, most, if not all of my patients are walking right after intubation and all throughout. But the only exception for what is if they are prone or have an open abdomen. So I kept on seeing these these terms better as an immobility be used, so interment interchangeably, but you just explained it perfectly. And it makes more sense to me, because I see that even bed rest is better than immobility. So why is it so hard for us? I mean, you’re talking about changing the culture of sedation to allow for bed rest, whoa, allow people to actually move and change channels and reposition themselves. But then how do we go from even that, to mobilizing patients? What are some of our obstacles? What do you find it so difficult in making that happen?

Christiane Perme  

Well, to be honest with you, I think there are several reasons. Mobilizing someone who is intubated has multiple lines and attached to life support equipment, it’s labor intensive, it’s time consuming, you have to be very careful, because you do not want to miss launch any lines and cause patients you know, more trouble. So it is not a simple, you know, process, it has to put a lot of thought into the process and make sure that everything is done correctly. In addition to that, you always have to think about whether you want to admit or not. But there’s always like the issue of time, you know, we have to understand that nurses are always very busy. 

And sometimes they’re able to help, sometimes they’re not, if you look at that, you know, physical therapists also, we have to provide care to not only the ICU, but all the hospital. So we have a large numbers of patients that we have to see on a daily basis. So but none of those things should be an excuse. Because in my opinion, the patient mobility should be, you know, a priority in the plan of care. It doesn’t matter how sick the patient is, I mean, the patients should be mobilized. It should be on the plan of care. On a daily basis, like you said, unless they’re exceptions, if the patient has to be prolonged, if they have an open abdomen, or if they have an open chest in those cases, of course, body would not be a priority.

Kali Dayton  

And so since we’ve always struggled with mobilizing patients as a standard, what do you see been some concerns as far as the rehabilitation goes, for our COVID-19 patients now?,

Christiane Perme  

Well, for the COVID-19 patients, that has been a huge challenge, because the problem that is happening is that patients are kind of not all the times receiving the care they need as far as mobilization by physical therapists. And the reason for that is that as all of us know, there’s this incredible need for PPE conservation. So we have to be very careful how you utilize the, you know, limited number of PPS that we have. So for that reason, sometimes we are trying to make sure that we don’t go into the room. 

So we kind of talk to the nurses and ask them to kind of help us and do some things with giving instructions to the nurses. So they can do some exercise with the patients or help them out of bed to avoid using large numbers of PP. Again, another reason is that we are trying to limit the number of clinicians that go into the room to see those patients because of the potential risk of spreading the virus. Yeah, their problems also is like social isolation. There’s no family present. So in the past, we would just ask the family to do these exercises and things like that. Now, we don’t have to do that and another in Leslieville. One, the other thing that we are seeing is that usually the equipment that we use to mobilize these patients, we are not to have access because we are not able to take those equipment inside the room. 

Kali Dayton  

Yeah, they’re huge obstacles. And so a lot of these patients in this ICU especially, I think  things are starting to change now but throughout this COVID era, that’s our we have been promptly intubating people after six liters, and because of our intensive sedation culture that we’ve clung to, they’re still being deeply sedated, right after intubation. So these patients are being sedated, right after six liters nasal cannula, so even sooner in our course of illness than other kinds of pneumonias. 

So now they’re deeply sedated and mobilized. by your your definition. And so now we’re definitely not moving them. You know, we maybe weren’t super great at it before, and we’re definitely not moving them now. And we’re seeing that these patients have really, really sick lungs. A lot of them need pronation at least. And this ends up being a course of weeks. So from your perspective, what you’ve seen what happens to the rest of their bodies after they’ve been deeply sedated on the ventilator, not moving a muscle for weeks?

What does that look like? And then what does it take to build that back up and rehabilitate a body like that?

Christiane Perme  

Yes, that is a great question. So we have to understand that muscles, if we don’t use it, we lose it. And rate that we lose the muscles is quite fast, it’s much, much faster than we are able to regain the muscles. So basically, after weeks of bedrest after weeks of being critically ill. And at this point, we don’t even clearly understand how this virus really affect, you know, all of the other, you know, body systems, including muscles nerves, but these patients will present with significant muscle weakness on all four extremities, they’re also going to present with significant deconditioning, which is the inability to tolerate the upright position. 

So anytime that you sit them on the side of the bed for a few minutes, or you stand them for a few minutes and take a few steps, they’re exhausted. And the reason why they’re one of the reasons they’re exhausted because their bodies have pretty much lost the ability to function against gravity. And that takes time, everything is going to take time. So weak, I don’t think that at this point, there’s any kind of special physical therapy, occupational therapy rehabilitation, that is going to make these patients get better, any faster. Because there is a cycle where it’s going to happen before those patients return to full function. 

Let me just give you an analogy. So you kind of understand a little bit better what I’m talking about. As a physical therapist, I’m going to give an example of a patient who has knee surgery, let’s talk about a complex next knee surgery like an ACL reconstruction. If you know someone who had an ACL reconstruction, you’re probably going to know that their quadriceps muscle that the muscles on the affected leg, they atrophy extremely fast with that surgery, that leg becomes very weak in comparison to the other one. And if you think about how long does it take for you to fully recover the muscles on the leg that had surgery. And for the most part, we are talking about a young healthy patient who had an ACL reconstruction. 

This is a patient that is probably does not have a systemic inflammatory response going on. This patient pretty much sleeps well, during the night, he has a very good nutritional status. So this is not a sick patient. It’s a healthy patient that just had a knee operation. But we are talking about months and months and months for us to be able to really fully recover just a couple of muscles in that limb. Does that make sense? What I’m talking about now. So when we are dealing with a patient who has pretty much every single muscle of the body has been affected, we have to be patient. And we have to understand that he will take perhaps a couple of months for these patients to get better. 

Kali Dayton  

And what is that process initially? So when someone leaves the ICU after they’ve been immobilized for weeks, generally there trades pigs still ventilator dependent, when they first roll into an L tack in general. What is it like? For example, to dangle them that first time you said you mentioned that it’s that they fit too quickly? And it’s difficult, but how many people does it take to sit them up? 

Christiane Perme  

Well, I’m going to be honest with you, I would hope that by the time the patient gets to an LTACH, I mean, they have already been mobilized to a certain degree, you know, prior to that. So I would be surprised if by the time they get to an LTACH that would be the first time they would be you know, at least sitting on the side of the bed. But to sit up patient on the side of the bed. I would say that it takes at least two staff members for safety, key reasons. Particularly if they’re on the ventilator, because if these patients become, I mean very weak or hypertensive or something, it’s very unlikely that one person would be able to safely return the patient back, you know, to the bed without dislodging any lines or tube. So usually could be a nurse and a nursing assistant, that would be very likely they would be able, you know, to handle a patient like that.

Kali Dayton  

And how long does it take until the patient can engage their muscles themselves? Maybe put their hands on the bed hold themselves up? What have you seen? How long does it take to get for them to get to that point?

It could take for a couple of days, to a couple of weeks. It all depends, really, because basically what happens when there’s a physical therapy console for this patient, we do a very detailed examination and evaluation of the patient. So we go there, and we pretty much do an assessment of every single muscle in the patient’s body. In there, we determine what are the muscles that are the weakest, and we in the functional limitations. So based on this initial assessment in this evaluation that we do, then we come up with a plan of care for those patients in a goal. 

Christiane Perme  

Okay, so let me give you an example. Let’s say that when I sit the patient on the side of the bed, the patient, it takes moderate to maximum assistance for the patient to sit on the side of the bed, if I let go, he’s going to just completely fall backwards. Okay, so my goal, perhaps in two weeks is for the patient to be able to sit with minimal assistance, or perhaps unsupported. 

So basically, as a physical therapist, we work towards these goals. Let’s say that the patient, and I’m just giving you random examples. So you can kind of understand what I’m talking about. Let’s say that the first time I see the patient, the patient is able to stand, but he’s unable to take any steps because he’s very weak. So perhaps, we usually set goals for two weeks, in two weeks, my goal would be that the patient is able to take, you know, five or 10 steps in place, or perhaps be able to, you know, walk five feet. So basically, we would have to really do a completely, you know, assessment of the patient. 

So we could determine what is the best treatment for this patient. And that also would kind of give us an idea how long it’s going to take for the patient to recover. For example, if I come to see a patient, and the first time in the patient is unable to raise the legs up off the bed and maintain the knee straight, I can guarantee you that is going to take a couple of weeks, if not months before this patient is able to stand up and walk again. Because the he’s going to have to be able to regain, you know, the muscle strength and also functional strength. Does that help?

Kali Dayton  

Oh, that helps it a lot. I mean, we on Twitter and seen a lot of discussions about COVID-19 rehabilitation. And these new programs and all these things and so on made the important point of this is what’s always been happening, this is what is always needed. We’re just seeing them at higher concentrations now that we’re having so many more people, and ARDS come in all at once. I’ve also seen people in New York and these hotspots be panicked because they can’t. 

They’re few survivors that they have after being on the ventilator. They don’t necessarily have anywhere to send them now, l tacks or fold are not taking COVID positive patients, we’re gonna see a lot of obstacles in the rehabilitation world. And it might be kind of a mixed blessing because in reality in the ICU, we don’t see those weeks of rehabilitation that you’re talking about. We don’t see the whole process. We just know that. Maybe we got them excavated, we at least got them traped and we send them out to a care facility and then it’s not my patient, not my problem. So what do you see, in the era of COVID having a much higher influx of these kind of patients with this kind of rehabilitation need coming moving forward? What is that going to be like for your field? For the ICU specialty and the nurses? What is that going to change with throughout our ICU culture?

It’s going to be a challenge for everyone. I mean, these patients even before COVID, they are a challenge throughout the continuum of care. They are a challenge for nurses, their challenge for physicians, they’re challenging for PTS, for OTs, for speech therapists, just because of the complexity of their problems, they are a challenge. One thing that we have to also be very aware is the fact that when patients are recovering, they do not have a whole lot of cardiopulmonary reserve. 

Christiane Perme  

So basically, they do not have the strength to do a whole lot of activity. So they may be able to just do a little bit at a time. And that is another reason why it takes so long for those patients, you know, to recover. Usually, we have to talk to patients, and make sure that they’re not discouraged. It’s very important that everybody, you know, physical therapists, nurses and doctors that we don’t go in there and just keep asking the patient “Are you walking yet? How come you’re not walking? Are you just not getting enough therapy?”

A lot of times what I have seen in my practice, the patients, they feel very bad, because they think they’re not doing enough. And I’m gonna be honest with you, with my experience, those patients, they do want to get better and they’re doing everything they can to get better, but it is a slow process. So a lot of times, we just have to help patients really understand that every little gain that they make, it’s going to be a victory, and just go from there. 

But like I said before, it’s going to be a huge challenge for everybody. So what has been happening lately, since we do not have a lot of elective surgeries, and we have actually much less patients in the hospitals, we are using our staff to really provide intensive therapy to these patients, in hopes to help them return home and not having them go to another level of care. Because, as you said before, another level of care may not be an option for those patients for a variety of reasons. So we are trying to see and do the best we can hopefully be able to send those patients home from the hospital. 

Kali Dayton  

Oh, that’s such an important point, too, is combining the resources that we have to to avoid having to send them to this care facilities, I think, and again, the culture, the practices changed so much hospital, the hospital, but sometimes there’s an assumption that someone is hit a certain level of critical illness, they’re going to be sent to a care facility. It’s just automatic. I talked to one travel nurse that was from a different part of the country. And he said, “Yep, anyone two or three days after they’re intubated, they’re trach’d, peg’d, you just know that they’re going to go to an LTACH.”

 That made me so sad, because as I’ve mentioned before, 98% of our survivors walk home. And so it’s been a challenge with the PPE, the isolation, the severity of ARDS, and then the numbers that they’ve come in to maintain that standard. But I think it is important to do the preventative care as well. I mean, we can I think it’s important to understand what happens when they are immobilized for weeks. So that one we can prepare a patient’s have a game plan, be patient with them, all those things, but I also think it should serve to inspire us to change our practices from day one, the moment that they’re admitted to the ICU to ask, “What can we do to prevent that kind of weakness?”

And so for example, we just had a 69 year old with really severe COVID, ARDS, cytokine storm, all of it. He came in, he was on pretty minimal vent settings for the first few days, and he ended up in the hospital for 30 days. So from his admission to the ICU, he walked on the ventilator in his room, walked to the door, wheeled back, walked to the door wheeled back, we took stools from the bar, he was stepping on stools, he was using the arm bike and the chair and doing all those things for the first six days. And then that cytokine storm hit and he suddenly could not even tolerate being supine. 

So we had him prone on lighter sedation, and even still, he was able to his own push ups on the bed. He was helping turned himself. After a few days delirium got worse, and we had to sedate him more he was paralyzed for two days. So he ended up being preowned. And doing none of this against resistance for eight days. And then as soon as he could tolerate being supine again, this team was so determined not to see him go to an attack, that they had him sitting up right away. So he went from not being able to be supine. As soon as he could be supine. 

They had him dangling, and then standing and then working his way up to walking and four days later he was excavated. And by the time he left the ICU, he was walking again and 10 days later he was discharged straight home on like two or three liters nasal cannula. still needing a lot of rehabilitation and home physical therapy, but he did go home, straight home and was safe to do so. So This is all happening in a situation in which we’re not overloaded. We have staff available right we can have this ideal culture. But we all did it with the intent that he would be able to resume life. We didn’t just say this is Kobe, we have to immobilize deeply sedate, put everything on hold, because this is different virus, we still stuck to what we knew worked and what would you say to the ICU community about preventing this kind of weakness and creating these kind of rehab needs?

Christiane Perme  

Well, first of all, I just want to let you know that this story, patient’s story that you just said, is absolutely phenomenal. And that says a lot about the entire team working with this patients and the division that they have. And most important of everything that you said is that everybody had the same goal. And I think that is what I would like that, you know, the ICU community could understand that. immobility is a safety issue. It’s a safety issue that is not being addressed. So basically, a lot of times we hear “oh, the patients are not being mobilized. Do we need more PTs in the ICU, we need more PTs in the ICU.” 

I do not necessarily agree with that. Because there’s no point in sending more PTS to the ICU, if there’s a culture, like a medical culture that between medical and nursing physicians and nurses that there’s two sedating the patients. So the number one thing that needs to be done, is to make sure that we allow the patients to be somewhat I mean, they can be lightly sedated for comfort and all that. But the patients have to be able to at least minimally participate with activities and be able to move their limbs in order for us to achieve the goal that you just said. 

So basically, a couple of things that I would like the ICU community to really understand. First of all, mobility is everybody’s job. There’s a lot of places, they’re just sitting there, they write a PT consult, and they are waiting for the PT, you know, to come and move the patient. So early mobility alone does not help patients. The most important component of the mobility is the frequent mobility, not necessarily just the early mobility, because the way I look at it, you can have the best physical therapist in the world and the best patient in the world. 

We come for the physical therapy session for 30 to 45 minutes, let’s say 30 minutes in a day, if the patient doesn’t do anything else for 23 and a half hours, it’s very unlikely that you’re going to have the results that you just said. Another thing that I think would be incredibly important that we would talk about functional ability the same way, for example, an example would be talking about medication for safety. When a patient comes to the ICU, and every time they go to another setting, like to the floor to another hospital, there is a medication reconciliation, when patients come home to the hospital, we want to know what kind of medications they were taking home. Correct. 

So I don’t understand why we do not have a functional mobility reconciliation that when we come when a patient comes into the hospital, to the ICU, that everybody in the team fully understand the patient’s previous level of function, I can tell you that every time in the 30 years that I’m in the ICU, I can safely say that more than 90% of the times when I asked the nurse if the patient could walk before the ICU, say they have no idea. If I ask the physician, they have no idea unless they knew the patient prior to the hospital. So very important that when all of us understand the prior level of function, I think we can take much better care of these patients. 

So basically, clinicians in ICU are always fearful of this line could be dislodged, the patient could be you know, excavated. I mean they those fears, I can tell you they are you know real and I’m not saying that they should not be concerned about that. But the question that I would ask is that is there anybody who is fearful or concern that this patient may never walk again? And I really don’t see that I don’t see because unfortunately that will weakness for patients Intensive Care Unit have become just so normal that every everybody is okay with it. Oh, it’s okay that he’s weak because it’s okay. has been here for a long time. In my opinion, it’s not okay. So what is it that we could do to really prevent those things, every single one of the ICU team members, they must anticipate the risk and the consequences of the bed rest for every single patient that they care for.

So again, this functional mobility reconciliation, I think that would be very, very helpful. Also patient and family education, I think it’s important to teach simple exercises to the patient and expect them to do it. I am not asking for example, for a nurse to do my job. But if the patient is able to lift the leg, if they walk into the room just to change an IV or something like that, if we had a culture of saying, “Okay, I’m here, when I’m changing this ID, I would like to see you moving our legs, just lift her legs three times on each side”, I mean, simple things like that we could incorporate when you’re, when the nurses are going to bathe the patient, if the patient is a little bit more awake, ask them, “Can you turn?” and you make sure that we are asking the patients, you know, to do those activities. 

And I also want to say something that is very, very important: we have to give our patients permission to move their arms and legs. I cannot even tell you how many times in my career, when I tell my patients I would like you to do this exercise is up and down, lift your leg up and down. Throughout the day, they kind of asked me, “Are you sure it’s okay for me to lift the leg?” And I said, “Well, of course it is, Why is that?”  “because the nurse keeps telling me that if I raise my arm that they’re going to tie my arm down. And I’m afraid that if they if I lift my leg that they’re gonna find my leg down.”

 So a lot of times when patients are intubated and sedated, and we tell patients, those things, “do not lift her arm don’t lift her arm.” However, once the patients are extubated, we kind of forget to tell them that it’s okay for them to move their limbs because sometimes they’re scared to do that. You don’t know that they can move the legs and the arms. 

So I think those are the things that would be very important. And like I said, one more time, mobile is everybody’s job. For example, physicians, sometimes physicians underestimate the power they have as educators. I think it would be amazing when they wronged and they asked the patient, “Have you been out of bed? Have you been doing your exercises?” because if it comes from a physician, the patient sometimes taking that much more serious than if I say that as a physical therapist, for some reason, you know, so everybody must be included in the patient’s point of care. 

As far as mobility, I kind of think I have a simple solution to this that could be used for every single patient in every single ICU throughout the world. The minute that patients are awake and able to understand simple activities, perhaps we should expect that patients at least raise their arms and their legs 100 times throughout the day, all at once. But if we keep thinking, having the patient to think about those limbs throughout the day, we can make a huge difference. 

That’s the homework that every single one of my patients always got for me, every patient that I evaluated for physical therapy, when I get a physical therapy counsel, I give them and not only that, I put a sign in front of the patient that I want them to do 100 leg lifts and 100 arm lifts. And like I said, it’s throughout the day, I don’t want them to do 100 times at once. Because I want them to be thinking about those muscles throughout the day. So usually I give them little hands like, okay, when it’s if you’re watching TV, and there’s a commercial break, that should be your reminder that you have to lift your legs up a little bit, or maybe your arms. So that’s what I think that every team member in ICU should know about helping those patients recover.

Kali Dayton  

And that is teaching me so much. I kind of walked into an ICU where the culture is pretty well established already. So I see a lot of those, those principles, but I don’t necessarily identify them because I it’s so normal or ingrained. But now that we have people come in and train with those who travel nurses, people from other ICUs and other specialties coming. I’m having physical therapy come to me and not know how to respond when a nurse says, “Well, the patient didn’t sleep well last night. We’re just going to skip PT today.” Or, “they’re a little bit delirious. So we’re gonna we’re just going to hold off today.” 

And the physical therapy comes to me because “I don’t even know how to respond because that’s, that’s not normal.” You know, there’s such a culture where usually they come into the room and the patient is already sitting in a chair on the ventilator, ready to walk. You know, for nurses, it’s so comfortable. It’s so innate for them to say, “Good morning, get up in the chair, we’re going to be alive today.”

 And then it makes more sense why physical therapy, they bring them patients, these bands, and they sit in the rooms and they move the band remove their legs with the band’s will lay in their bed. Now that you have me thinking about it, that’s what they do. They teach them the nurses remind them to do it. And I think it gives the patients a sense of autonomy control, they know that even when they’re laying there, especially with COVID, they’re laying there isolated in a room, having no control over them being there, how sick they are. 

They can do their homework, they can control how strong they stay, they can do what they’re asked and know that they’re contributing to their recovery. So those are such important points, Chris, that’s brilliant. It’s so nice to have your insight. And I think your point about the focus of the safety, I mean, Dr. Wes Ely, just talked a little bit ago on the dog MD, which I totally recommend his his interview, I can put the link on the medium website. He said that he was in Korea taking a tour and was discussing with the team about waking the patient up and getting them off sedation and someone said, “Well, what do they pull out their tube?” And a nurse from across the unit yelled back and said, “but what if they never walk again?” And it was just a profound moment, a profound question that I don’t think we’ve really asked in the ICU until recently. 

I think you as a physical therapist, you’ve been asking it for 30 years, but for the rest of the team to have that perspective. And as far as a functional assessment. And the culture that I’m immersed in right now, that is innate, every nurse knows, if this patient was in a nursing home beforehand, what they were able to do, were they walking with a walker, one man came in and he hadn’t walked in a few weeks to a few months, we didn’t even know how long. But the whole team knew that. And I knew that that was going to make it hard for him to get excavated. And they knew that they were not going to let that go on. And he developed the ability to walk while he was in very, very severe pneumonia and mild ARDS. 

So if everyone knows where they were at where they are now. And where they want them to go. Because functionality is the goal, not just survival. I’m worried about us, you know, right now we can really count our death rates with COVID-19. But I think this is an opportunity to bring in thrival, functionality, those as long term goals. Even in such a difficult situation, because these are going to be vulnerable patients. And as you’ve explained, they’re going to be difficult to rehabilitate, unless we incorporate and start instilling this kind of culture and focus from day one. And do everything possible in the heart situation to prevent this kind of deconditioning.

Christiane Perme  

You’re absolutely right.

Kali Dayton  

Well, thank you so much for joining us any last pearls of wisdom for us? Well,

Christiane Perme  

I think pretty much I have shared my most important topics, my thoughts. And I just would say again, mobility is everybody’s job and should be a priority in the plan of care for every patient in ICU and in a hospital. 

Kali Dayton  

Chris, that’s going to be the catchphrase from now on: Mobility Is Everyone’s Job. I’m taking it. I’m quoting you. I’m using it. Thank you so much.

Christiane Perme  

Thank you for this opportunity.

Christiane Perme’s Website for Seminars and Training: www.permeicuseminars.com

 

Transcribed by https://otter.ai

 

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