Walking Home From The ICU
By Kali
Walking Home From The ICUSep 12, 2021
Episode 133: "SOAR: Sedation Off Awake and Rehabilitate" with Dr. Mikita Fuchita
When Dr. Mikita Fuchita heard about an Awake and Walking ICU, he had to see it with his own eyes. After visiting the Awake and Walking ICU, how did Dr. Fuchita embark on bringing his colleagues together to update their sedation and mobility practices? He shares his personal conversion and his team's journey with us in this episode.
Episode 132: The Power of ICU Diaries to Treat Post-ICU PTSD
Post-ICU PTSD is a life altering and life-threatening condition. ICU diaries have shown promising benefits to helping survivors navigate the trauma they carry with them from the ICU and especially delirium. David Richards shares with us his journey during and after the ICU and how his ICU diary has been a key part of his post-ICU survival.
www.daytonicuconsulting.com
Episode 131: Occupational Therapists as Leaders In the ICU
When Brenna's ICU set out to become an "Awake and Walking ICU", Brenna, OTR/L, accepted the challenge. She shares with us her journey to leading her team to have the skills and culture to optimize mobility during critical illness.
www.daytonicuconsulting.com
Episode 130: Becoming an Awake and Walking ICU With Dr. Bellucci
After visiting the original Awake and Walking ICU, how did Dr. Brian Bellucci help bring these changes to his ICU?
What is the physician's role in supporting a team's sedation and mobility practices?
How can we increase physician buy-in?
Dr. Bellucci shares with us his team's journey to becoming an Awake and Walking ICU.
www.daytonicuconsulting.com
Episode 129: Cognitive Rehabilitation After the ICU with Dr. Jim Jackson
Psychologist, Dr. Jim Jackson, from episode 51, returns to the podcast.
He shares with us his journey to writing his new book, "Clearing the Fog" as a roadmap to recovery for survivors.
www.daytonicuconsulting.com
Episode 128: Delirium Severity By ICU and Race
Let's talk about delirium severity. Does the severity of delirium vary by ICU specialties or by ICU treatment? What role does sedation play in delirium severity? What role does race play in delirium severity? Dr. Damaris Ortiz shares with us key findings from her important research. www.daytonicuconsulting.com
Episode 127: How to Save Lives and Over $1 Million
When the ICU at St. Joseph's Hospital in Colorado invested less than $100,000 into becoming an Awake and Walking ICU, what was their return on investment? How has supporting the training, education, and support of their team impacted their team dynamics, morale, and patient outcomes? Nancy Mcgann, PT, shares with us her team's exciting success! www.daytonicuconsulting.com
Episode 126: Delirium Podcrawl Episode
This week leading nursing podcasts are teaming up to confront delirium head-on.
Podcasts including Up My Nursing Game, Rapid Response RN, Good Nurse Bad Nurse, Cup of Nurses, and How to Not Kill Your Patient will dive deep into the reality and impact of delirium throughout the hospital from the ED to the acute care floor.
This episode, Tina from Good Nurse Bad Nurse co-hosts with Kali to explore how gaps in delirium education and support can turn lethal by a "Bad Nurse" and how a "Good Nurse" can change and save innumerable lives for generations to come.
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Episode 125: Responding to Agitation in the ICU
As Dr. Swamy said in episode 61, "You can't sedate away delirium".
Yet, when patients are delirious and agitated, how can we keep patients and clinicians safe?
How do we avoid and even discontinue sedation while keeping lines and tubes intact?
What role do restraints play in agitation and trauma for patients?
Are soft wrist restraints our best and only options?
Dr. Marie Pavini, intensivist, and innovator of Exersides shares with us more tools and insights for approaching sedation and delirium management in the ICU through updated restraint technology.
Episode 124: Alcohol Withdrawal and Phenobarbital
Alcohol withdrawal can send our patients into a spiral of delirium and downstream complications in the ICU. What are the risks of benzodiazepines for our patients even during alcohol withdrawal? How can we give our patients the best chance to walk away from ETOH withdrawal and critical illness? Dr. Obiajulu Anozie, MD joins us in this episode to explore the benefits of phenobarbital for alcohol withdrawal. www.daytonicuconsulting.com
Episode 123: Updating 50 Years of Perspective and Practices
Medicine is a field of evolution. Are we open to learning, changing, and progressing?
Dr. Peter Murphy has worked in critical care for nearly 50 years. As a seasoned expert in the field, he shares with us his own wake-up call to the reality of decades-old sedation practices. He provokes the question: "Am I leading or fighting evolution?"
Episodes 122: Caleigh’s Voice Through Critical Illness
Caleigh has had it both ways in the ICU. She has been sedated and immobilized which led to battling delirium and ICU acquired weakness. She has also been awake and mobile while intubated and walked out the doors. Listen to Caleigh share her insights and what meant to her to be communicative, connected, and autonomous during her fights for her life. Www.daytonicuconsulting.com
Episode 121: Tips and Tricks
Episode 121:
Having patients awake during mechanical ventilation can require a new skillset and approach to patient care. Let's talk about some of the tips and tricks for improving patient comfort and care. We'll hear it from an RN/podcast listener/ICU survivor and Louise Bezdjian, APRN from the original Awake and Walking ICU.
Citations and transcription: www.daytonicuconsulting.com
Episode 120: Walk Like Your Life Depends On It
What does being awake and mobile mean to current ECMO patient, Denise Bazalda? From her ICU room with a tracheostomy and connected to ECMO, @88deniseb, gives us incredible insight into how she is fighting for her life. Www.daytonicuconsulting.com
Episode 119: The Trauma of Delirium After a Traumatic Birth
Episode 119: How can delirium contribute to the trauma of a traumatic birthing experience? Midwife and ICU survivor, Amber, shares with us her personal journey through and after the ICU. Www.daytonicuconsulting.com
Epsiode 118: Mobility Saves Lives During ECMO
During the worst of the COVID pandemic, how did this Baylor Scott and White The Heart Hospital- Plano CVICU decrease their COVID mortality rates by 30%? Jenelle Sheasby, MSN, RN, tells us about the transformation in their mobility practices. Www.Daytonicuconsulting.com
Episode 117: Diving Deep Into the TEAMS Study
The ICU community is buzzing with talk about the recent NEJM "TEAMS Study". What do the methods and findings of the study tell us? The author of the study, Dr. Carol Hodgson as well as Dr. Wes Ely and Heidi Engel, DPT join us to dissect and discuss this study.
Episode 116: “In Shock” with Dr. Rana Awdish
How does a personal fight for life in the ICU impact a survivor-intensivist’s approach to patient care? Dr. Rana Awdish, author of “In Shock”, shares intimate experiences in and after her ICU stay. Episode transcripts and citations at www.daytonicuconsulting.com.
Episode 115: Sedation By Race
We know that deep sedation and immobility are lethal. We also know that outcomes in the ICU vary between races. How does race impact sedation practices? What role does sedation management play in the racial disparities seen in the ICU? Dr. Tom Valley shares with us his invaluable research into sedation by race. www.daytonicuconsulting.com
Episode 114: From the Eyes of a Travel Nurse
What was it like as a travel COVID ICU nurse to jump into an “Awake and Walking COVID ICU”? How does true mastery of the ABCDEF bundle impact RN workload, burnout, safety, and career fulfillment? Travel RN, Laurelai, shares with us her experiences and insights. Www.DaytonICUConsulting.com
Episode 113: Introducción a una “UCI Despierta y Caminando”
Introduction to an “Awake and Walking ICU” - An Episode in Spanish. Que experimentan a los pacientes durante sus comas inducidas? Porque y como debemos evitar a la sedation continua durante a la enfermedad crítica? Que es una “UCI Despierta y Caminando”? Este episodio cambiará a la perspectiva de nuestras prácticas en la UCI. Www.DaytonICUConsulting.com
Episode 112: Unplanned Extubations
What does research reveal about how and why do unplanned extubations occur? How dangerous are unplanned extubations? Does sedation really keep patients safer from unplanned extubations? We dive into it deep in this episode. Transcriptions and citations found at www.DaytonICUConsulting.com
Episode 111: Both Sides of the ICU Bed With Dr. Wischmeyer
What is like to be an ICU delirium survivor and intensivist? How did Dr. Wischmeyer’s own nutrition research transform his outcomes during his most critical ICU stay? He shares his journey with us in this episode. Www.DaytonICUConsulting.com
Episode 110: Occupational Therapy in the Trauma ICU
The trauma ICU has unique risks to agitation, delirium, and long-term impairments. How does occupational therapy help the trauma ICU team avoid sedation, maximize mobility, and radically transform patient outcomes? Phillip Gonzalez, OTR, MOT, shares with us his expertise and success as an occupational therapist in the trauma ICU and traumatic brain injuries. www.daytonicuconsulting.com
Episode 109: The ABCDEF Bundle for Traumatic Brain Injuries
Traumatic brain injuries can have distinct exceptions that necessitate deep sedation and immobility. How then can we apply the ABCDEF bundle to protect injured brains and restore lives? Charlotte Davis, BSN, RN, CCRN and Richard Rivera, BSN, RN-BC share their expertise and their team's incredible success with the ABCDEF bundle in the settings of TBI.
Episode 108: The ABCDEF Bundle in the Trauma ICU
The trauma ICU has a variety of high-acuity and difficult conditions that can cause obstacles and hesitation to change sedation and mobility practices. How does the ABCDEF bundle apply to the trauma ICU? Dr. Gregory Schaefer joins us now to discuss his expertise and team’s success in practicing the ABCDEF bundle in the trauma ICU.
Episode 107: Awake and Moving in the CVICU
Critically ill cardiovascular patients can be very high-risk and high-acuity patients with numerous devices and multiorgan failure. How and when can we safely initiate early mobility? What role should physical and occupational therapy play in the CVICU? Jenna Hightower, PT, DPT, CCS shares her incredible expertise and ground-breaking work in early mobility in the CVICU.
Episode 106: Early Mobility During ECMO
As ECMO programs have grown in demand and popularity during COVID19, what have we learned about the safety, feasibility, and benefit of early mobility? Why is there such a significant disparity in mobility practices between ECMO teams? Dr. Julian Macedo shares with us his expertise and insights into early mobilization during ECMO.
Episode 105: The ABCDEF Bundle in the CVICU
Episode 105: The ABCDEF Bundle in the CVICU
How does the ABCDEF bundle apply to the CVICU with a variety of diagnoses, acuities, and devices? Anna Dalton, DNP, ACANP, in an "Awake and Walking CVICU" shares with us the evolution their team has experienced in improving their mastery of the ABCDEF bundle.
www.daytonICUConsulting.com
Episode 104: ICU Rehabilitation
Episode 104: ICU Rehabilitation
When ICU-acquired weakness is not preventable, or we encounter a patient that has not received the ABCDEF bundle, how can we start the rehabilitation process? What approach can one lone clinician use for initiating recovery or preventing ICU-acquired weakness? Physiotherapist, Lucy Sutton, shares with us incredible insight into ICU rehabilitation.
Episode 103: Communication Is a Basic Human Right- Especially in the ICU
What impact does it have on patients to be lost in solitude while in medically-induced comas?
How does the inability to communicate impact patients' agitation, anxiety, and trauma?
How can providing communication tools ease the stress and burden of critical illness on clinicians, patients and families?
When patients are unable to verbalize, what tools are available to facilitate communication?
This episode explores the value of communication in the ICU and the impact of our sedation and immobility practices on the basic human right of communication.
www.daytonicuconsulting.com
Episode 102: Waking Up in the ED
102: Waking Up in the ED
When post-intubation wait times increased during the COVID19 crisis, Julie, an ED nurse, took "saving lives in the ED" to a whole new level. She shares with us what communication and patient autonomy mean to her and how she is applying that to how she cares for patients in the ED. One nurse can make a ripple effect throughout an entire hospital system.
Episode 101: The ABCDEF Bundle in the Neuro ICU
What does the ABCDEF bundle look like in neurocritical care? When patients suffer conditions such as intracranial hypertension that necessitate sedation and immobility, how does the ABCDEF bundle apply? Neurointensivist, Dr. Neha Dangayach, shares with us her team's strong ABCDEF culture and practices in the neuro ICU. @Drdangayach
Episode 100: Moving the Mission Forward
After 100 episodes of compelling stories, research, and testimonials, we know what can and should be for intensive care medicine. What is the next step? How do we lead our ICU teams into the future and standardize "Awake and Walking ICUs"? What resources are available to educate and support our teams in this transition? www.DaytonICUConsulting.com
Episode 99: How Physical Therapists Save Lives in the ICU
Episode 99: When physical therapists are allowed to work at the top of their licenses, how do they save lives? What barriers prevent them from fully contributing their expertise during critical illness? How is mobility a life-saving intervention? ICU Physical Therapist experts, Kenny Venere, PT, DPT, and Kyle Ridgeway, PT, DPT, CCS share with us their experiences and insights.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 98: Occupational Therapists Change Outcomes in the ICU
Occupational Therapists Change Outcomes in the ICU
How can occupational therapists help decrease time on the ventilator and time in the hospital? How can they preserve function and quality of life? What skills do they bring to preventing and treating delirium? Why should they be promptly utilized in a patient's journey? Corinne, Mallory, and Rachel share give us insight into the value occupational therapists bring into the ICU.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 97: How To Truly Prevent Ventilator-associated Pneumonias
How does ventilator-associated pneumonia occur?
How does the failure to practice the ABCDEF bundle increase the risks of prolonged time on the ventilator and mortality?
What do we know about the impact of early mobility on VAPs?
Let's dive deep into what we know about VAPs and how to drive down the rates in our ICUs.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 96: The Backstory of Ventilator-associated Pneumonia
Ventilator-Associated Pneumonia has significant lethal and financial repercussions for patients and our healthcare system. So why aren’t we panicking about it? Are hospitals really liable for the costs incurred from this ventilator-associated condition? Dr. Benjamin Wang, MD joins us to share the backstory behind VAPs in our US healthcare system and government.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 95: The Financial Cost of Sedation and Immobility
When healthcare systems say they don't have the resources to support proper practices, is that true? How much do deep sedation and immobility cost our ICU teams, hospitals, and healthcare systems? How can we use the research to support our plight for safe staffing ratios and evidence-based practices? Let's dive deep into the money talk.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 94: The ICU Deathtrap
Why are prolonged sedation and immobility lethal? How do our standard practices of automatically sedating every patient on a ventilator deprive them of the chance to survive and thrive? What systemic barriers stop us from implementing evidence-based practices that save lives and drastically change outcomes? Michelle, DNP, ACNP dives deep into powerful case studies that explore the "ICU deathtrap".
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 93: The Awake and Walking COVID ICU
Why is the mortality rate for COVID ICU patients in the Awake and Walking ICU less than half of the other COVID ICUs in the same hospital system in the same community? How have sedation and mobility practices impacted rates of central lines, vasopressor use, paralysis, tracheostomies, and LTACH admissions? How has this ICU continued to keep COVID patients awake and mobile during this pandemic? Dr. Joel Pittman shares with us valuable updates from the Awake and Walking ICU.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 92: Sedated Because She's Intubated and Intubated Because She's Sedated
Susanne was admitted to the ICU for ludwig's angina. When she required intubation only for airway protection, she was placed on the conveyor belt of ICU care. How did deep sedation and immobility impact her physical and psychological outcomes? How much more unnecessary time did she spent suffering in delirium on the ventilator? She tells us all in this episode.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 91: The Awake and Walking ICU in Denmark
Are there any other “Awake and Walking ICUs” outside of Salt Lake City, Utah? Dr. Thomas Strom shares with us his team’s success and research in Denmark. He provides powerful insight into the gaps and future of critical care medicine.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 90: Registered Dietitian Consultation STAT
What role do registered dietitians play in patient outcomes in the ICU? Why is malnutrition such an emergency? How can we better utilize the expertise of registered dietitians? What does the latest research show about our performance with nutrition in the ICU?
Megan Dockweiler, MS, RD, CNSC, and Amand Bakko, MS, RD CNSC share with us their expertise as ICU Registered Dietitians.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 89: Dropping the Grenade On the ICU
What role does the choice of sedation in the field or ED play in the delirium that unfolds in the ICU? How can inter-departmental collaboration improve sedation practices and patient outcomes? How can the ICU better understand delirium and respond appropriately to new admissions from the other facilities and the ED? Jeff Polland, BS, NRP, FP-C, shares with us his work to avoid benzodiazepine abuse to improve patient outcomes.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 88: Bring In Speech Language Pathology
How do speech-language pathologists save lives? How can we more fully utilize them in the ICU? How can PT, OT, AND SLP help, halt, or reverse pulmonary disease processes during acute and critical illness? Let’s discuss how they prevent harm and restore humanity in the ICU.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 87: Is Their Silence Worth Their Suffering?
Mark Hudson, an ICU survivor podcast host, is all too well acquainted with delirium. He has dedicated himself to advocating for fellow patients and survivors to prevent the torture of delirium. He tells it to us straight and guides us towards improvements. Mark Hudson's podcast: https://anchor.fm/icu-life-and-recovery
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 86: Ventilator Management in the Awake and Walking COVID19 Unit
How is the “Awake and Walking ICU” keeping their COVID19 patients mentally and physically functional during severe COVID19? Do they face constant ventilator asynchrony and how do they deal with it? Geoff shares with us his vast experience as a respiratory therapist in walking patients on mechanical ventilation during critical illness and now COVID19.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 85: RT Magic
Does sedation always improve ventilator dyssynchrony, or can it cause it? How does a lack of unity between disciplines impact patient care and outcomes? How can we better support and utilize the expertise of respiratory therapists to optimize care for patients on ventilators? Brady Scott, PhD, RRT shares his 20 years of experience and insights.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 84: Zentensive Care
How can we manage ventilators to decrease alarms, avoid misdiagnosing/mistreating asynchrony, and improve patient comfort and outcomes? Dr. Matt Siuba, MD, the “Zenintensivist”, shares with us his tools to decrease sedation and neuromuscular blockade use.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 83: Paralyze With Fear
As neuromuscular blockade agents have come back into vogue, let’s talk about the big picture. When we understand the repercussions of this intervention, we will paralyze with fear.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 82: Burnout
Episode 82: Burnout What role do constant poor patient outcomes play in the pandemic of ICU staff burnout? What if we had a system that supported staff to practice evidence-based medicine? Would a more humane environment and process of care improve our morale? Would improved patient outcomes support staff retention? Liz McQueen, BSN, RN, shares with us how her flame has been rekindled.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 81: Choose Wisely
How does the choice to automatically sedate every patient on a ventilator impact patients for the following weeks, months, and years? Let's dive deeper into how our favorite sedatives change the course of critical illness.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 80: Big Picture of Propofol
How does propofol affect muscles? The brain? Outcomes? ERRXpodcast host and critical care pharmacist, Adis Keric, BCPS, BCCP, shares with us the big picture of propofol.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 79: Step Up and Step Forward
Episode 79: Step Up and Step Forward
What can happen when a clinician wakes up to the reality of sedation and immobility?
ICU revolutionists around the world are stepping up and stepping forward to elevate sedation and mobility practices for their patients. It can take 1 person to make 1 decision and change a patient’s entire life. Hear their success stories!
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 78: “Never Really Over”
What is it really like to be in a medically-induced coma? As an experienced ICU physiotherapist and war veteran, Aron Welsh provides soul-shaking insight into the graphic trauma of ICU delirium during and after deep sedation. Warning: Mature Audiences Only.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 77: Start Where You Are
Are lung-protective strategies only implemented when patients are sedated? Is walking on the ventilator safe for the lungs? How do we transition from “sedating to keep patients safe” to “walking to keep patients safe”? Dr. Ali Fazili from the “Awake and Walking ICU” shares with us his expertise.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 76: Less Sedation = Less Work
Is it *really* easier to sedate patients? Ultimately, does giving patient delirium and ICU acquired weakness actually decrease staff workload? Travel nurse, Alex, gives us the real deal. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 75: Communicate. Don't Sedate.
When Jeff Sweat was about to be intubated, what was he told about what was to come? What information did his wife, Sunny Cannon, receive about the risks and reality of deep sedation? Was is it really like to "wake up" 3 weeks later? How have sedation, immobility, and tracheostomy impacted their family? Had they been allowed transparency and autonomy in Jeff's course, what would they have chosen? Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 74: Walk Them To Sleep
What are the main “treatments” or “tools” to prevent and treat delirium? How can we facilitate “quiet nights” without harming patients with sedation? Peter Nydahl, RN, MScN, PhD, teaches us how to walk them to sleep. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 73: Say It Again: Sedation is NOT Sleep
We habitually lie to ourselves and our patients' families when the word “sleep” leaves our tongues in reference to sedated patients. Why is sleep so vital to survival in the ICU? What prevents our patients from preserving their sanity and cognitive function? What has COVID taught us about the role of sleep in the ICU? Dr. Margaret Pisani, intensivist and sleep researcher, ties it all together for us. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 72: Military Veterans and Delirium
Why is baseline PTSD a risk factor for post-ICU PTSD? What does delirium look and feel like for war veterans? Why should the ICU community understand what veterans have experienced before and during the ICU? Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 71: What “Fight To Survive” Truly Means
When an ICU team started discussing end-of-life with 31-year-old Megan Wakley’s family, they fought to have her transferred to the “Awake and Walking ICU”. When research shows that the less sedation used and the more mobility performed the less likely patients are to die, what did that mean for Megan Wakely? She shares her story of surviving and thriving in the ICU. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 70: Rallying The Troops In The PICU
What specific approaches help rally the troops to bring change to the ICU? How have other PICU teams cultivated a rich culture of mobility? When an interdisciplinary approach becomes the culture of the PICU, what happens to patient outcomes? Erin Gates, DPT and Sara Eilerman, DPT share with us the PICU UP! culture and practices they have led their team to develop.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 69: Awake and Playing In The PICU
What does it take to inspire a PICU team to keep children on mechanical ventilation awake and playing? Who can bring the change? Hannah Child, a pediatric physiotherapist in the UK, shares with us her team’s evolution and successes. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 68: PICU UP!
We know that sedation causes and worsens ICU delirium, post-ICU PTSD, post-ICU dementia, and ICU-acquired weakness in adults. The research is vast and compelling. What does this mean for children? What does research reveal about the harm children suffer from drug-induced comas? Is there a different way to treat our children? Can we preserve their futures by changing our practices in the ICU? What will it take to protect our children? Dr. Kudchadkar shares her life-preserving research and practices. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 67: On to LTACH?
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. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 66: Trach and Peg
Why do tracheostomy rates fluctuate so drastically between ICUs? What is the true reason for so many tracheostomies? What are the long-term effects of tracheostomies? Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 65: "Create Survivors, Not Victims"
Jeroen Molinger, MSc brings the research to the bedside. He ties together the importance of muscle maintenance, nutrition, and how to create survivors not victims. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 64: Nutrition During Critical Illness
What role does nutrition play in improving outcomes in the ICU? How can we help preserve muscle through appropriate nutrition during critical illness? Jeroen Molinger, MSc continues to upgrade our approach to critical care through exercise physiology. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 63: Muscles Matter
Why is ICU-acquired weakness an independent predictor of mortality? What role does muscular atrophy play in multi-organ failure? When we unnecessarily sacrifice muscles for other organs, how badly do we damage patients’ chances to survive and thrive? Jereon Molinger, MSc, brings eye-opening information to the discussion. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 62: Patient and Families Have the Right to Know the Risks
We say we respect patient autonomy. We provide patients or families informed consent prior to intubation. Should patients and families be warned of the risks and repercussions of sedation and immobility? When sedation is nonessential, should patients be given the choice to be comatose or awake and moving? Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 61: "You Can't Sedate Away Delirium"
What barriers do we have in our ICU culture that prevent us from appropriately addressing delirium? What can we do to foster a better approach to helping delirious patients that are difficult to care for? Dr. Swamy gets real as we discuss the reality of delirium from our side of the bed. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 60: "Just Let Them Sleep"
For decades we have sedated patients with the belief that it is more humane to “sleep” through critical illness. Survivors have told us their experiences were not “sleep” to them. What do neurologists and researchers say about the quantity and quality of sleep during medically-induced comas? Dr. Williams Roberson shares with us her research and invaluable insights into sedation and sleep. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 59: One Nurse Bringing Change to a Hospital System
How can 1 nurse make bring the change? What can happen when a team catches the vision? How can a team transition their culture from deep sedation and immobility to awake and walking? Nora tells us about igniting her team's fire and the changes they are celebrating. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 58: Deadly Treatment for a Deadly Virus?
Louise, ACNP, has dedicated her career to preserving lives in the Awake and Walking ICU. So what was it like for her to have her own loved one die from sedation and immobility? She tells it like it is and gives us a sobering insight into both sides of the bedside during COVID19. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 57: The Shock of Working in a "Normal ICU"
When all you’ve ever known is walking patients on ventilators, what is it like to enter a time machine and go back to sedation and immobility? What did Tara learn taking care of COVID19 patients outside of her “Awake and Walking ICU”? She shares with us her reaffirmed empowerment to change patients’ outcomes through evidence-based practice.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 56: Minding Your Own Business
What does it mean to you to be able to toilet yourself? What happens to patient dignity when they are deprived of the capacity to “mind their own business”? Rachel shares with us what is happening to patients even when they are not on mechanical ventilation. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 55: Walking in ICUs Around the World
Where in the world do patients walk on ventilators and ECMO? Providers from 22 countries share with us their experiences with helping patients walk home from the ICU. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 54: Back To Harmful Practices From the 90's
After decades of research revealing the price patients pay from benzodiazepines, where are we now in the ICU? Dr. Wes Ely and Brenda Pun share with us the latest COVIDD study and how COVID19 patients are being cared for around the world. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 53: ICU Early Walking with Heidi Engel
How do we bring changes to the ICU? What barriers impede the progress of our culture? Heidi Engel, PT, DPT, shares with us her continuous journey to humanizing her ICU. Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 52: Haunted Beyond the ICU
What truly happens during delirium? When do the hallucinations and terror stop? Survivors give us a sobering reality check of what caused the deep psychological trauma during their ICU stays and how their lives are forever impacted.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 51: Post-ICU PTSD: Fact vs. Fallacy
What does research reveal about the most common contributing factors of post-ICU PTSD? Does sedation prevent or inflict trauma? Dr. Jackson shares with us his decades of research and experience with post-ICU PTSD.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 50: The Reality of Post-ICU PTSD
What causes Post-ICU PTSD? What is it like to live with this trauma? How does it impact life after the ICU? Spencer Freeman shares with us intimate insight into living with Post-ICU PTSD.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 49: The Cost of Rot
How do Hospital Acquired Pressure Injuries (HAPI) impact patient outcomes and quality of life? How can they be better prevented? Cami, our wound care specialist, shares with us penetrating insight into the reality of rotting in the ICU.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 48: What is An "Awake and Walking ICU" Q&A
What do you want to know about the Awake and Walking ICU? Join the facebook group, "Walking Home From the ICU Discussion Group".
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 47: Change Practices to Change Lives
What does an awake and walking ICU patient look like walking back into the pulmonology clinic? Dr. Shilling shares what this process has meant for his practice in the clinic.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 46: Waking Up After Decades of Sedation
What was it like for a seasoned ICU nurse with decades of valuable experience to completely change their sedation practices? What was it like to then re-enter a “normal” environment and strive to continue the best practice? Paula shares with us her personal shock and conversion.
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 45: Physical Therapy In the ICU During COVID19
What roles do physical and occupational play in helping COVID19 patients survive and thrive? How have they changed their approaches during the challenges of COVID19? Why should we never remove their therapies from ICU care?
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 44: Walking Home From the ICU after COVID19
When 69-year-old Dr. Ken Hurwitz was intubated for COVID19, how was his life saved and even preserved? After 3 weeks on the ventilator, why was he able to walk away and go straight home?
Photos, transcriptions, and citations at: www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 43: Trapped In My Body As An ARDS Survivor
Now that we know what happens to patients after sedation and immobility, do we know what it is really like? Do we understand what happens to patient dignity, autonomy, and identity when they lose control of their bodies? Eileen Rubin shares with us what it was like as a 33-year-old trial attorney to wake up and not be able to lift a finger.
www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 42: The Power of Nursing Care Against COVID19
When good nursing care is not possible during a pandemic, what happens to patient outcomes? Makenzie tells her tales as an ICU nurse in NY as we explore the role nursing care plays in saving and restoring lives. www.DaytonICUConsulting.com @DaytonICUConsulting
Trailer
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Episode 41: Crisis Culture During COVID19
What happens to our culture and practice when patient volumes and needs exceed our ICU capacity? How does this impact short and long-term outcomes? Dr. Dixie Harris shares with us the reality of ICU care in NY during the COVID19 pandemic.
www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 40: Cultural Revolution
What was it like in the early phases of the “Awake and Walking ICU?” How was the new practice introduced? How was the culture revolutionized in spite of opposition? Who rejected the change? How did nurse Patty go from incredulous to emphatic? www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 39: Ethical Turmoil
What is it like to be “born” into an awake and walking ICU and then be immersed in a different culture? Jim shares with us his culture shock and ethical turmoil as he strives to maintain his best practice in a new environment. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 38: “THEY’RE AWAKE?!?”
What is it like to jump into an awake and walking ICU as a travel nurse? Alex shares with us her first shock and impressions upon entering a different culture. She teaches us the changes and wisdom her practice has gained.
www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 37: Culture Shock
How much of our practice is driven by culture vs. evidence? What role does ICU culture play in our perspective, knowledge, and patient outcomes? How often do we dare to ask “Why?”, “What if?” or, “Why not?” www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 36: We Need To Talk
What if we expected to be able to communicate with all patients on mechanical ventilation? How would that impact our practices? What role does communication play in patient survival and outcomes? www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 35: Mobility is EVERYONE’S job
What happens after patients are sedated and immobilized for weeks? What will the rehabilitation process for COVID19 survivors be like? How long will it take for them to be able to sit, stand, and walk again? Christiane Perme, the post-ICU rehabilitation specialist, shares with us how to prevent such outcomes and help patients thrive in their lives again.
www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 34:Recommendations From a 4-Time Ventilator Survivor
Ann Bannon was intubated four times and awake on the endotracheal tube and ventilator for months. She gives us valuable insight into how to help the new flood of ventilated patients. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 33: COVID19- The Domino Effect
What can we do to improve mortality in the midst of a pandemic? As times have changed, our practices must change as well. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 32: Delirium Day
In commemoration of Delirium Day, it is most appropriate to hear from one of the leading delirium experts, Dr. Sharon Inouye! She shares with us her professional and personal experiences with delirium in all aspects of hospitalization.
www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 31: Nurse Manager
Nancy tells us about her transition to the awake and walking ICU as a nurse manager. She explains the nurse manager’s role in preserving a culture of humanity in the ICU. She shares with us how sedation cessation saved her own mother’s life.
www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 30: Speech Language Pathologists
Lydia, CCC-SLP, shares with us the vital role speech therapy plays in helping patients get back to their lives. She explains how awake and walking enables patients to resume eating sooner and preserves cognition. The utilization of speech therapy is explained and applied in ways that the ICU world has never understood before.
www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 29: Occupational Therapists
How does occupational therapy get to be utilized when patients are awake and walking on the ventilator? What role does occupational therapy play in preserving physical and cognitive function during critical illness? How has this enhanced role impacted the fulfillment Merrill, MOT, finds in his career?
www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 28: Pharmacists
Kathryn, BCCCP, tell us of her culture shock coming to the awake and walking ICU after years in units around the country. She tells about the role pharmacists play in delirium prevention and preservation of function in the ICU. She shares how this shift in focus has enhanced her job satisfaction.
www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 27: Physicians
Dr. Badke, MD, shares what it was like to shift perspective and culture as a new intensivist in the awake and walking ICU. He explains what role the physician plays in helping patients walking home after the ICU.
www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 26: Nurse Practitioners
What does it mean to be the steward of patient outcomes? Louise, ACNP, explains how nurse practitioners are guardians of delirium prevention and preservation of function for her patients in the ICU.
www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 25: Respiratory Therapists
Respiratory therapists are key to helping patients walk on the ventilator. Cash, RRT, shares his tips and secrets to walking and even showering patients on the ventilator. He reveals how having patients awake and walking has impacted his ICU career. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 24: Physical Therapists
What is it like for physical therapists that get to do more than a passive range of motion with patients on ventilators? Physical therapists in the awake and walking ICU save lives and enable patients to have their lives back after discharge. Angela Hallstrom, DPT tells us how they do it. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 23: Registered Nurses
What is it like as an RN to care for intubated patients on the ventilator that are AWAKE and WALKING? Brandy, RN shares with us why she is passionate about keeping brains and bodies strong during critical illness. She reveals how humanizing the ICU has impacted her career. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 22: Interdisciplinary Teamwork
Patients cannot walk out of the ICU without the efforts and expertise of each discipline. What role does each discipline play in returning patients to their lives? www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 21: What We've "Always Done" Isn't Always Right
How did this ICU get so off the grid? Decades before the research and in a generation of paralytics and benzodiazepines, a nurse saw a problem and had a vision. Polly Bailey, ACNP, shares with us her journey to building an awake and walking ICU. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 20: A Chance To Say Goodbye
Though avoiding sedation and mobility decreases mortality, death is not always avoidable. How does being awake and mobile during critical illness impact your last mortal moments? What does it look like to have a chance to say goodbye? www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 19: Walking On ECMO Part 2
Tyler Lintz was admitted for severe septic shock, pneumonia, and ARDS. He eventually needed ECMO but was still allowed to keep walking. Tyler and Amber tell us how he returned to being a firefighter 3 months after ECMO. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 18: Walking On ECMO Part 1
Tyler Lintz was admitted for severe septic shock, pneumonia, and ARDS. He eventually needed ECMO but was still allowed to keep walking. Tyler and Amber tell us how he returned to being a firefighter 3 months after ECMO. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 17: Walking On The Ventilator For 17 Days
Joan Johnston was admitted for ARDS and remained on the ventilator for 17 days. She shares with us what it was like to be awake, walking, and even showering while intubated. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 16: Defending the Defenseless
James was admitted for severe mycoplasma pneumonia that turned into mild ARDS. His downs syndrome and autism inspired the ICU team to get creative to keep him awake and walking on the ventilator. His journey straight home moves us to reconsider our standard practices. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 15: Walking Through Severe ARDS
Bryan Carter was admitted for severe pneumonia that became severe ARDS. He was allowed to be awake and walk on the ventilator until he was proned. When he was able to be supine he was right back on his feet. He shares with us his story and how his treatment impacted his outcomes. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 14: Different Treatment Different Outcomes
If we treated patients differently, would their outcomes be different? What if patients never stopped walking during critical illness? One ICU dared to ask. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 13: Loved Ones Are Survivors Too Part II
Caregivers also leave ICU with high rates of PTSD and long-term life impacts. Mike Maranhas shares his side of his wife's ICU stay and recovery. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 12: Loved Ones Are Survivors Too Part I
Caregivers also leave ICU with high rates of PTSD and long-term life impacts. Mike Maranhas shares his side of his wife's ICU stay and recovery. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 11: Rehabilitate Rehabilitation
When we send patients to LTAC or SNF to relearn how to walk, what is that like? Susi Rimkus, DNP, shares with us her experience with rehabilitating rehabilitation. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 10: I Can't Move
What is it like to wake up with less physical capacity than a newborn? What is it like to be sent to LTAC with no expectations of returning home? When patients have not moved for weeks+, what is the journey to recovery like? How long does it take? What are the psychological effects on survivors and loved ones? Jim and Cheryl Rettinger give us an inside look. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 9: The Big Picture of Immobility
What happens down the road to patients that are on bedrest during their time on the ventilator? Is there another way? Let's put it into the big picture. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 6: Broken Brains
Survivors tell us what "cognitive deficits" really look like and the impact they have on their function and lives. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 5: The Big Picture of ICU Delirium with Dr. Wes Ely
Dr. Wes Ely, the creator of the CAM scoring tool and the ACDEF Bundle, shares with us the realities and consequences of ICU delirium. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 4: Sedation is NOT Sleep
68% of nurses believe sedation is for patient comfort. Survivors of prolonged tell us the reality of how "sweet" their sedation dreams really were. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 3: DNS= Do NOT Sedate Me
Susan East is a three times survivor of ARDS. She tells us why she sought legal protection against sedation after her first experience with ARDS. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 2: How Did We Get Here??
Is sedation during mechanical ventilation in the ICU always a necessity or a habit with history? Dr. Terry Clemmer, one of the founders of critical care, shares the evolution of mechanical ventilation and sedation culture he witnessed during his 50 years of critical care medicine. www.DaytonICUConsulting.com @DaytonICUConsulting
Episode 1: Start Here
Kali shares the variation in sedation and mobility practices she witnesses in critical care throughout the USA. ICU survivors changed her perspective and belief in what is right and best for patients. www.DaytonICUConsulting.com @DaytonICUConsulting