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If you were to come out of a medically-induced coma after weeks of delirium and atrophy with a new tracheostomy, only to find yourself unable to hold your head up…would you want to be discharged to an LTACH? Do other countries have LTACHs? Are there other options to survival after the ICU for survivors? Patrik shares with us his experience and role in guiding family and survivors out of the ICU.

 

Episode Transcription

Kali Dayton 0:00
Patrik, we are so excited to have you on here. Can you tell us about yourself and what your course has been?

Patrik Hutzel 1:20
Yeah, thank you. Thank you, Kali for inviting me to your podcast. I’m very excited to be your guest here. And I think it’s great that you reached out to me because I feel like the lone voice with what we’re doing here. And I haven’t found anybody else that’s even coming close to what we are doing. And finally somebody’s reaching out. That’s doing similar things to what we’re doing. And it’s really great talking to somebody that’s like minded.

But to answer your question, telling you a little bit about myself. I’ve worked in ICU critical care. for over 20 years. I started out first in 1999 in Germany, which is where I’m from originally did my nurse training there started in ICU there. And then after a couple of years in ICU, I became part of a startup company in Germany and we were the first ones in Munich at the time, launching intensive care at home services.

We were basically the first ones taking ventilated patients home with a tracheostomy, weaning, end of life, anything that you could think of really when it comes to ventilation and tracheostomy in a homecare environment. So we were real pioneers then. And you know, after a couple of years doing that, or then eventually went to the UK working ICU, they did my critical care training in the UK.

And then eventually came to Australia in 2005. Again, working in ICU. And with my experience in Germany when I was working in the UK or in Australia, I thought, “Well, why is there no intensive care at home?” I was just gobsmacked really by seeing all these long term ventilated patients in ICU and wondering well, why can’t they go home here? You know, what’s the what are the obstacles? You know, but you know, and eventually I did start the same here in Australia launched it in about 2012.

The door certainly didn’t open quickly, was sort of very long, drawn out process. You know, as you know, the industry is very conservative. Nobody wants change very hard, which is then why I eventually came up with the Intensive Care hotline because I couldn’t get the intensive care at home off the ground. And I thought to myself, what else do I need to offer? To raise awareness to change the paradigm to change the thinking? And that’s when I came up with, “Okay, well, I’ve got to educate families in ICU the minute they enter ICU”- which is why I came up with intensive care hotline, you know, and again, after having worked in ICU for 20 years, I thought I had a lot to offer.

You know, I’m not a doctor. But after being at the bedside for 20 years and having managed it. I was also the nurse manager in ICU for over five years. Now after having seen everything I believe well, I thought I had seen everything. But I changed that point of view when COVID hit because I wasn’t in ICU when COVID hit. You know, we are running intensive care at home now successfully. So I’m way too busy to even think about what’s happening in ICU. But you know, I had thought to myself, you have seen it all in ICU. But now that I wasn’t correct, because I wasn’t in ICU when COVID hit.

Kali Dayton 4:26
Has COVID impacted how many patients are needing continued tracheostomy care?

Patrik Hutzel 4:31
I would argue yes, I would argue yes. Especially with a hotline with the Intensive Care hotline, the number of phone calls we’ve had, since COVID has gone through the roof. And you know, and I know that one of your questions later down the line is you know, is sedation impacting on having more and more tracheostomy and I happen to believe especially with COVID patients going into ICU with ARDS, ARDS, getting prolonged increases the need for sedation, what I from what I’ve seen and therefore the longer someone is sedated, and deconditioned, our belief, the bigger the risk, they end up with a tracheostomy.

Kali Dayton 5:08
That’s so interesting to have your perspective starting in the 90s. Because that is when we were really heavy on the benzodiazepines and deaths, combining all the possible sedatives at once and complete immobility. And so it was really common to be in this situation, right? And you watched, you probably saw some sort of shift a little bit transformation and ICU world throughout the decades. And here you are getting these calls. Does the care that patients are receiving with COVID sound like a time warp has happened? And we’re back?

Patrik Hutzel 5:44
Yes. Oh, absolutely. And again, you know, like I said, I haven’t worked in ICU probably for a couple of years, even when when we were starting out with intensive care at home, even as we were getting very busy, or still did a little bit of work in ICU, but not for the last couple of years. And like you said, Yes, practices have changed. And I do believe that there has been a time when you know, sedation has been reduced.

And maybe the indications for tracheostomy were getting less but I do believe with COVID, and it sounds to me like you’ve been in the midst of it, you know, with especially what I’ve seen now with ARDS and most patients being prone to when they’re in ARDS. I do remember starting out in ICU in the early days, a lot of patients with ARDS being proned and bucket loads of benzos, morphine, fentanyl, bucket loads, and loads of patients ending up with a trach.

Kali Dayton 6:35
Then because back then being able to care for ARDS patients was new right to have patients on a ventilator that long was new, and incredibly intimidating. And so you didn’t dare move them.

Patrik Hutzel 6:47
Nope.

Kali Dayton 6:48
And even though back in 2007 study came out, and it was safe and feasible to mobilize and walk patients that are in acute respiratory failure. Here we are in 2021, we have gone back to what you started with back in the 90s, even though we know now, unlike what you got where you guys were out in the 90s.

We now know that benzodiazepines can lead to mortality, that it’s lethal, but we’re back to doing it. And so here you are running your own business, you’re getting calls from family members asking, “What do I do now that my loved one is going to be ventilator dependent?” They’re wanting to send them to a care facility or you’re consulting with people in different countries, correct?

Patrik Hutzel 7:29
All over the world. All over the world, Where are the calls from? Predominantly from the US and Canada, but that is just in the UK. But that is just a case of volume? You know, I mean, you’ve got, I don’t know 400 million people in the US here in Australia, we’ve got 25 million people. So the UK has 50 or 60 million people. So it’s just a case of volume.

You know, I get calls, we get calls here from Australia, too. But proportionately way more calls from the US. But I also think it’s part of the issue in the US is that there are LTACHs, right? So people in the US are really at crossroads when their loved ones have a trach because they realize if they’re doing their research, “okay, if I consent to a trach, my loved one will end up in LTACH”.

And then they find you know that doing the research about LTACH and they find all these negative reviews online. They don’t need to go to intensive care hotline to find out about the reviews of an LTACH. So they realize, “okay, well my loved one needs a trach then they go to LTACH…”, the read the reviews are really negative, “what do I do?” And in the future, I know I can send them to you because you have an alternative for this.

Kali Dayton 8:46
Well, ideally, if, if a loved one were to call me when their their loved one has been admitted to the ICU. My advice would be don’t let them sedate them right away, keep them awake and moving and active. And so your calls are coming when they’re already at that crossroad, when they’ve already probably spent weeks on the ventilator and they’re already so deconditioned they’re in a tough spot.

Patrik Hutzel 9:11
But most calls are coming too late.

Kali Dayton 9:14
And you’ve seen tracheotomies of all kinds, right? I know that neuro is a hard exception if you’ve had brain injuries, trauma. That is its own animal. But as far as respiratory failure, what do you see as being the main cause of needing a tracheostomy and what is the course like after that once they’ve been prone? paralyzed? Deeply sedated for so long? What happens?

Patrik Hutzel 9:41
Great question. Great question. The main indication for a tracheostomy from my end is really too much sedation deconditioning. And what I tell families is this and this is the question that I’m asking them. Have you ruled out? Or have you checked?

No, no have You check that the intensive care team has done everything beyond the shadow of a doubt, to avoid the tracheostomy and get your loved one off the ventilator in the breathing tube. That is the most important question that I asked families. And they often don’t have the answer because they don’t know what they don’t know.

Kali Dayton 10:24
Maybe the ICU team isn’t even aware of how to do everything possible to prevent a tracheostomy. I know that it can be deeply ingrained in their cultures that if someone is going to be on a ventilator for a while, they’re automatically going to end up with a trach and pague. Because they don’t know how to rehabilitate them or how to preserve their strength, right? How can a team educate the family when they themselves don’t even know?

Patrik Hutzel 10:52
Exactly. And also the biggest one, one, another big challenge that I see is the paradigm in ICU where that stopped us nurses, respiratory therapists, okay? You’ve got two or three options, either recover and go to step down hospital ward, whatever, either die, or go to LTACH. It’s a very limited paradigm. And that’s the paradigm they’re operating in without looking at.

Okay, what else do we need to do to improve things? I do believe people in ICU are more and more complacent. I’m a bit old school, of course, you know, I mean, I started in the 90s. I’m very much old school mobilisation, you know? Yeah, I’m very much old school, you know. And then I hear when I talk to families, no physical therapy for the first three weeks. And I just got like, “how is that even possible?”

Kali Dayton 11:46
Well Patrik, during COVID, I did a survey on Instagram, and about 40% other responders that physical and occupational therapy were removed from the ICU when COVID hit. It just is so counterintuitive. For me, when you’ve got this pandemic with acute respiratory failure, that’s when you need to bulk up your physical therapist. That’s how you get people out of the ICU. And yet, we did the exact opposite.

And then you’re getting the call saying, “now we’re stuck.” And you’re you’re coming from different countries where they don’t have LTACHs. But here in the US we do and so I think that complacency comes from “we save the organs, we get through the critical phase, and then we ship them out, not my patient. Now my problem. LTACH can deal with it.”

And I don’t think so from a malicious place. But it comes from oblivion. They don’t have to face the mess that they’ve made. But you did in your career. Back in the 90s. There was there were no LTACHs. So if you let them to condition you’re the one trying to haul their flaccid bodies out of bed and get them back to breathing on their own. But we don’t have to do that here.

Patrik Hutzel 12:58
Oh, no, I do. But like you said, it’s not coming from a malicious place. Because as we all know, ICUs are busy and just running an ICU day by day is just a challenging task in and of itself. You know, I would not blame anyone in ICU, but we are I believe ICUs are falling down. They’re so busy managing their day to day business, you know, they’re not looking outside of, you know, like you said, for lack of a better term, or they’re not looking at some of the mess they made. Now who’s picking up the pieces.

Kali Dayton 13:33
Critical care is such a maze, right? You have so many things going on so many pieces have put together. But in any kind of maze like a corn maze you you’ll hop towers, like lookout towers, right? Someone has to be out there looking at the end from the beginning, but we’re failing to do that we just are trying to get through a shift through that moment. And we just we’ve gotten lost and so people are calling you and what are you advising them and what do you what kind of resources do you provide them?

Patrik Hutzel 14:00
Yep, look, I tell you what we do we have in the meantime now probably hundreds or 1000s of case studies on our website when we publish what we talk to people about you know we record some of the recordings and get them transcribed you know, so there’s really 1000s of case studies now on our website if someone wants free advice they can just listen to read to the read the transcripts or they can listen to the videos you know or listen to the podcast but I can tell you people families in ICU come with four main problems.

Four main problems number one, not their loved ones is not with their loved ones are not waking up after an induced coma. What should I do? That’s number one.

Number two is trach or no trach. Right.

Number three is end of life situations or what I refer to as perceived or real end of life situations. You know they might say “hey, they told me tomorrow at one o’clock they want to stop life support from my mum or from my dad, what should I do?” My question to them is, “well, is it a real end of life situation or a perceived end of life situation?”

In my mind, a real end of life situation is? Well, there’s nothing you can do to save someone’s life. Okay? A perceived end of life situation as well does the ICU team thinks it’s best for the patient to pass away because they think they have no quality of life, or whatever the reasons are? Or what’s your point of view? Would you take your loved one home on a ventilator? For example? You know, that’s not for me to judge. That’s I do believe there is a difference between a real and the perceived end of life situation.

Kali Dayton 15:38
And it’s so difficult because every area geographically has different resources available. So if I was in that situation, granted, I would be throwing a fit and would let my loved one be in a medically-induced coma for weeks, but no LTACH here. It’s at least like one nurse to 20 patients.

Patrik Hutzel 16:01
Yep. Yes.

Kali Dayton 16:01
So how different is the care home? And how does that change outcomes? Do they have a better chance of surviving when they come home? Like in Australia, we need health care at home? How is that rehabilitation different? And how’s their quality of life different? Because that would change? For me that would change the conversation.

Patrik Hutzel 16:16
Yeah, yeah. Okay. Yeah, absolutely. It does change the conversation to quality of life. Okay, let’s just take a couple, let’s just look at the pediatric space in particular. But I can come to the adult space as well. We have a lot of pediatric clients in the home, whether they’re toddlers, teenagers, all ages, really. So let’s take a toddler or a teenager, being stuck in ICU long term, or let’s take them home with 24 hours critical care nursing, and get them back to school, get them back to school or to kindy. Do I need to say more about quality of life?

Kali Dayton 16:52
The outcomes of patients in critical care. And so I’ve always wondered, if the family was really involved that they were actually home and they were in their own environment? How much would that help, delirium and the recovery and their motivation. We just heard a story in last episode from Louise, where patient was maxed out on all their ventilator settings, they thought that they were dying, that was with COVID. So they allowed the family to come in the next day, he was nearly extubated, I mean, he was on his way to recovery. And he said, once he could talk that he needed them there. I don’t know how to logically explain that. But how much of a difference does that make? If someone’s so deconditioned hypoactive delirium to be in their home in their own setting? What do you see?

Patrik Hutzel 17:34
What do I see a massive improvement in quality of life a massive improvement in you know, people have can stop going to ICU, I mean, the whole picture changes immediately, you know, families are at home, their client, their loved ones are at home, you know, quality of life is is so much better in a home care environment.

You know, I mean, it’s and but on top of that, it also helps hospitals, I mean, critical care beds are in high demand, and ICU bed, whether it’s here in Australia or in the US with my research costs five to $6,000 per bed day, you can do intensive care at home roughly for half of the cost, right. So it’s a win win all around.

So when when all around an end, and you free up not only the cost, you free up a critical care bit that can be used for the next patient that needs a critical care, but especially now with COVID. You know, a service like intensive care at home just highlighted, while we’re taking patients out of ICU, we’re keeping ICU beds empty. Again, COVID just highlighted what needs to happen in the critical care environment anyway, from our perspective,

Kali Dayton 18:50
It exposed so many things, and I saw on Twitter, especially when New York was in their surge or towards the end of their surge. And they’re talking amongst themselves saying, “okay, so we have some survivors. But where do we send them?”

Patrik Hutzel 19:04
Exactly!

Kali Dayton 19:05
“Rehabilitation centers are maxed out, there’s nowhere to put them but there’s still dependent on the ventilator, because they were deeply sedated and weren’t moved. Where do we send them?”- and I think it was a huge and is a huge burden on our rehabilitation services. But in LTACHs, you have physical therapists, occupational therapists, techs, aids, people that it takes a lot of hands to get an adult newborn up. So when they can barely hold their own head up, let alone breathe on their own. It takes a lot of manpower to rehabilitate them. So how does that work at home?

Patrik Hutzel 19:37
Oh, yeah, that’s a good question. Yeah. So look, we do work with physical therapists. We do work with occupational therapist. There’s often also a second person there like an aide like a support worker or disability support worker that assists the nurse with mobilization with, you know, hygiene, and so forth. And also if if going out, you know, going to school, there’s probably a second person there as well.

Kali Dayton 20:06
And for adults, how do they get the manpower? Like the lifting strength to get up?

Patrik Hutzel 20:12
Yes. Great, great question. So most Well, I wouldn’t say most all of our clients really have the equipment in the home, whether it’s a lifting machine, a hoist, so often even a ceiling I so yes, homes need to be prepared for someone to go home. It’s not as simple as you know, we’re taking someone home from ICU next week. It’s definitely not as simple as that. But I guess with our experience, we know what what resources need to be put in place to make it happen.

Kali Dayton 20:40
And are these people are becoming functional again?

Patrik Hutzel 20:43
Depends. It really depends. So we’ve had clients that have been weaned off the ventilator at home that have been the cannulated. We have other clients where, you know, they spend their end of life at home that could range from weeks to months to years. We have other clients that, for example, have sustained a C one spinal injury.

And if they are otherwise healthy, they could live for decades. Right? And they want to live, right. And again, we’re talking about young adults that are going to school that are going to university, but we’re talking about some middle aged adults, for example, with motor neurone disease that still work in a job that can use a computer again, picture the alternative, which would be in ICU, or were some ICU teams, depending again, on the ICU might push for end of life saying, Oh, well, this person wouldn’t have any quality of life. Let’s just stop everything. Well, I argue something very differently here.

Kali Dayton 21:47
And it sounds so much more humane.

Patrik Hutzel 21:50
Yeah, it gives people a choice. Give people a choice. You know, if somebody doesn’t want to live with motor neuron disease with a C1 spinal injury, that’s their choice. But if someone does want to live, that is their choice also.

Kali Dayton 22:03
And when you don’t sedate people automatically, they can be part of that discussion. They get to make their choice, we don’t deprive them of their autonomy, and for in the kind of COVID situation or in this acute respiratory failure. What if we…. how would things change? From your perspective, if we gave people the choice on whether or not they wanted to be in a medically induced coma?

At the very beginning, if that option was available with all the information, hey, if you’re choosing now, if you want, you’re going to be on a ventilator. If you want to be in a medically induced coma, this may cause post ICU dementia, this may prolong your time on the ventilator for at least four to six days, if not weeks and months. This can mean be discharged home versus to an L tack. So how much would that change your field, your job? And the community as a whole? If we gave people a choice in education right away? Yeah.

Patrik Hutzel 22:57
Yeah, now look, it could be a huge change in paradigm, you know, a business like intensive care hotline as well as intensive care at home probably shouldn’t exist in the first place. Right, I witnessed fill a need that is there. Because of you know, again, quote, unquote, the mess that critical care is creating, you know that those businesses shouldn’t exist in the first place.

Kali Dayton 23:22
And when you and I talked about collaborating, I, that was my disclaimer, if you let if I got to do what I want to do. I might take away your business. Yeah, you and you were happy with that.

Patrik Hutzel 23:35
I’m happy with that, because we’re just feeling I believe we’re just feeling yeah, we’re just feeling the need for the mess that’s being created in the first place, unfortunately.

Kali Dayton 23:46
I interviewed a nurse practitioner that had gone to an LTACH after the ICU, she’d been in an “Awake and Walking ICU”, she was really aggressive with mobility. She went to an LTACH, and they did not share her values. And she even got in trouble for discharging people getting people discharged before the 30 days of reimbursement was up. So then they’ll tax weren’t making as much money, she was getting in trouble for getting people off sedation moving to cannulated too quick. And so she went elsewhere, she went to a nursing home and started a respiratory unit there.

And these are the very long term stuck forever, quote unquote, patients. And she took them to cannulation rate from 13% to somewhere in the 60s. Because she hustled them, she was aggressive. And I thought about doing that. Like I would love to do that because there is a need. Yet it still always bothered me that that need exists because of something that we could reverse.

Patrik Hutzel 24:42
Yep. Oh, absolutely. And part of the problem as well is like you just talked about, you know, funding for LTACHs. You know, part of the problem is also where is the funding going? How is funding be distributed? You know, that’s all part of the problem. The other big problem that I see in critical care is this and You would probably know that as well. ICUs are not having enough senior staff. So you have this huge staff turnover, you have junior staff coming in, they need to be brought up to speed.

From my experience, it takes years to become really proficient in intensive care whether it’s doctors, nurses, artists doesn’t matter. So you’ve got this huge staff turnover in ICU, and you’ve got all these junior nurses in ICU, and it takes years to bring them up to speed. So how do you deal with this high acuity and ICU with predominantly junior staff? You know, how can you get them to learn? How do you win a patient off the ventilator efficiently? How you know, there’s all these issues, ICU is so complex, you know, we’re just scratching the surface here.

Kali Dayton 25:48
It’s true. I think staffing is a huge part of when you run it on bare bones, you have time and resources for us to put out fires instead of looking at the big picture, seeing the end from the beginning, being proactive and preventing these complications. And I think that they hired even more techs to do all the things that nurses get consumed with nurses could step back and start seeing things we can gauge in the research more and do things. But now we run by bare bones, and then the pandemic hits, and we’re left with our pants down. It’s been really awkward.

Patrik Hutzel 26:20
Yeah, and it’s not only that, it’s you know, the other issue that I can see is, again, doctors, nurses, artists, you can’t become a critical, you know, you need to do a three year Bachelor of Nursing, and then you go into critical care, then you do a postgraduate course, or whatever it is. So the amount of training that goes for people to even go into as the barriers of entry are high. And then you’ve managed to overcome those barriers of entry. You’re just starting. You know, I mean, you and I were talking here, we’re talking with decades of ICU experience between the two of us, right? So we have probably the bigger picture. So imagine, and I remember this from my early days, I was so overwhelmed.

Kali Dayton 27:05
Yeah. You know, you’re just trying to figure out how to work an IV pump.

Patrik Hutzel 27:09
Exactly. Exactly, exactly.

Kali Dayton 27:13
In the “Awake and Walking ICU”, they hire a lot of new grads, a lot of people straight out or very new to critical care, because they have a fresh perspective. They’re not going to jump to sedation right away, because they never would have done it. So it’s easier to build a culture when it’s starting from scratch rather than trying to race years and decades of poor practice.

Patrik Hutzel 27:31
So do you think that your unit is the only unit worldwide that’s doing what you’re doing? Where do you sit in all of this?

Kali Dayton 27:40
There’s a spectrum of compliance with this approach. So you have the ATF bundle, which I think a lot of places are really trying to implement, where it’s trying to wean back the sedation sooner, gifts, vacations and breaks. And I think that’s really a good transition. I think the “Awake and Walking ICU” in Salt Lake City, Utah, is the only ICU in the whole world that does not start sedation right away and walks people hours after intubation as a standard.

Any kind of sedation, any kind of immobility is a very rare exception. And in my years there, I probably have only seen, I don’t know somewhere between five to eight tricky ostomies for very specific exceptions, such as like muscular dystrophy, severe ILD, things like that, but they’re very rare exceptions, not for your normal respiratory failure.

Patrik Hutzel 28:29
So you’ve you’ve got enough data under your belt to go out really to anyone and say, Look, this is working. Yeah.

Kali Dayton 28:36
And even there’s so much research, not from our hospital showing that decreasing sedation changes outcomes. Mobilizing early mobility is very subjective, you know, early might be eight days after intubation mobility might be passive range of motion, but even those show that there’s improvement, so we don’t have all the data on all of our patients.

But we know through the other research that these things improve it, all the outcomes. Yet, it still doesn’t quite capture the magnitude of difference in our ICU makes. COVID has been very telling, because even within our own system and a multi hospital system, the length of stay in this hospital is at least six days shorter than all the other ICUs that are caring for COVID patients.

So this is a unique situation where we have all the same diagnoses, all the same disease, and in place geographically close to each other. We’re taking care of a lot of the same patients, as far as comorbidities and health status at a baseline and our discharge disposition and our like the state is drastically different than our notes on the road.

Patrik Hutzel 29:42
Yeah, no, that’s great. And who started this, like, how did you come up with this? What was the driver?

Kali Dayton 29:49
It was Polly Bailey back in the 90s. So she’s coming from the same culture, the same environment that you were at and that we kind of are back in and she is in episode I’m gonna say 21…Yep, Episode 21. She tells her story where she was a nurse and she had followed a patient after discharge mother in her 30s. Six months to a year later struggling to get up the stairs still, after surviving ARDS. And she went back to her medical director, Dr. Clemmer who does episode two, and said, “We’re breaking people, we can’t do this. We can’t let them lay in bed and rot.” And he said, “Well, there’s what else can we do? I mean, they’re sick. They’re on a ventilator.”

She said,” Let me wake them up and move them.” And he said, “That’s crazy.” Yet, he trusted her and let her do it. And she has spent the last almost 30 years dedicating her whole career and really her life to preserving this culture that we established there. I’m just amazed that it’s not disseminated throughout the whole world. But this isn’t the standard because this is so groundbreaking. People often call it “cutting edge”- and it kind of made me cringe, because this has been going on for over 30 years. “Cutting edge” to me makes it sound like it’s new. It’s not new, but it is the best, and probably, to that degree, and throughout the whole world.

Patrik Hutzel 31:03
But what do you think stops this from becoming mainstream?

Kali Dayton 31:08
I think a lot of it’s education, I think we have these barriers, it’s really just mental barriers, we just have automatically married the ventilator with sedation. And it’s really hard to cut the ties. And I think even eight F mental has some difficulties because you start sedation, that when you wean it back, you’re exposing the delirium, which is really laborious to manage. And so it makes it really hard to implement, even the ABCDEF bundle.

And so I think the approach of not even certain sedation unless it’s absolutely necessary, like open abdomen, tenuous ICP, severe, severe alcohol withdrawal, you know, those exceptions. But as a whole, if you just don’t start sedation, they don’t get crazy, and they don’t know how to manage. But when you’ve never seen it, it’s hard to believe it. And so I guess that’s where my objective of the podcast comes in saying, anyone can do this. This is this is not just because this is such a special team. And these people are immortal. It is because they have the education and the support and the culture in place. But that can be developed anywhere. For sure. For sure. And I hope that your business goes out of business.

Patrik Hutzel 32:15
Yeah, no, absolutely. We are just look, we are just really filling in the gaps, again, because of the mess that ICU is creating.

Kali Dayton 32:24
You’re bringing a sense of humanity and to victims of this process. And I love it.

Patrik Hutzel 32:29
Very much so. And I do believe because you know, ICU is so fragmented as well, even though there’s a lot of similarities. ICUs are so fragmented, in the English speaking world as well. You know, I don’t think we’ll be going out of business anytime soon. Unfortunately, no, change, change. Change takes time.

Kali Dayton 32:50
But I’m determined to see it in my lifetime. But I think it will be a while but it’s not impossible. Patrick, anything else you would share with the ICU community?

Patrik Hutzel 32:58
Yes, I would like to share one more thing. It is, especially with what’s happening at the moment, please, ICU professionals. Don’t forget there’s a world outside of ICU areas. We are very poor in ICU at predicting what does a patient’s life look like? Six weeks down the line six months down the line, six years down the line, we are so poor.

And I think there’s very few people that have the perspective from ICU like, I believe I have, but also have the perspective of what does it look like after ICU without pre without prematurely saying, oh, this person won’t have any quality of life?

So let’s just stop everything. Because I wouldn’t want to live like that or in that situation. But who am I? Or who is the ICU community to judge? What does quality of life mean? What does it look like? What does it look like for the individual? Was it what does it look like for the family? And don’t just make these assumptions in that short window? When people are in ICU?

Kali Dayton 34:04
Thank you, I think I put a lot of quality, a lot of my definition of quality life on physical capacity. And then my daughter has a neuromuscular disorder and she may never walk. And yet she already is having such a rich quality of life that has changed my perspective. And I wonder if I would have approached some of those discussions differently. Thank you.

Patrik Hutzel 34:29
‘No, thank you. Thank you know, when such a pleasure to talk to you. And next week, I’ll invite you to my podcasts and I’m really curious to hear more about what you exactly do.

Kali Dayton 34:41
Excellent. Thank you so much, Patrick. Appreciate it.

Transcribed by https://otter.ai

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