Walking Home From The ICU
By Kali
Walking Home From The ICUJul 10, 2020
Episode 171: The Power of Autonomy and Human Connection During ECMO
Episode 170: A Timeline Through the History of ABCDEF Bundle- Building the Future of Awake and Walking ICUs
It has been claimed that ICU early mobility is a "new and temporary fad". Is walking intubated patients really that new?
Let's start in 1970 and work our way through decades of research that continues to reaffirm that true mastery of the ABCDEF bundle gives patients the best chance to survive and thrive in and after the ICU.
Episode citations and transcript at www.daytonicuconsulting.com
Episode 169: Intubated in Your Own ICU
Episode 168: I Was Reported to the Board of Nursing!
What happened when I was reported to the board of nursing for advocating for early mobility in the ICU?
What are the roots of these concerns and this report?
How does social media impact culture and practices in the ICU?
Jess Hren, BSN, RN, Jenna Hightower, DPT, CCS, Phillip Gonzalez, MOT, OTR/L, BCPR discuss why I was reported to the board of nursing.
Episode transcript and citations: www.daytonicuconsulting.com
Episode 167: Breaking Barriers with Walking with Trans-Femoral IABP/Devices- The Ramsey Protocol with Stephen Ramsey
Is it save to mobilize patients with trans-formal devices such as balloon pumps, impellas, and ECMO?
Who was the first person to dare to ask, "Why can't we mobilize patients with trans-femoral balloon pumps?"
Stephen Ramsey, PT, DPT, CCS shares with us his journey to developing the Ramsey protocol and revolutionizing mobility in the CVICU.
Episode transcript and citations at:
Episode 166: The Struggle of an ICU Revolutionist to Save Lives
What it is like for them to try to implement interventions like awakening trials that have been supported by decades of research?
How does lack of support and success increase moral injury, burnout, and the loss of expert and compassionate clinicians?
"Kara" joins us to share her journey as an ICU pharmacist and revolutionist.
Podcast episode transcripts and citations:
www.daytonicuconsulting.com
Episode 165: "Don't Turn Me Off" - A Survivor's Perspective Of a Medically-Induced Coma
Are patients sleeping during medically-induced comas?
Are they more comfortable and free of trauma while sedated?
Can patients hear, feel, and understand their surroundings while in a medically-induced coma?
Do patients know when sedation is turn up higher? Do they know which providers will let them wake up and which ones will try to "turn you off"?
Drew Brophy is a world-renown artist that found himself intubated with COVID19. Drew and Maria Brophy share their astounding journey through critical illness and post-ICU syndrome.
***Early Mobility Conference April 14-16th in Orlando, FL***
https://www.earlymobility.com/2024conference
Podcast episode transcripts and citations at:
Episode 164: Antipsychotics in the ICU with Dr. Marie Rueve
Antipsychotics have been a hot topic in the ICU. Do they treat delirium? Can they be used to replace continuous sedation? When and how can we utilize antipsychotics to optimize care and outcomes? Dr. Marie Rueve from episode 160 joins us again to clear the air on antipsychotics in the ICU.
***Early Mobility Conference April 14-16th in Orlando, FL***
https://www.earlymobility.com/2024conference
Podcast episode transcripts and citations at:
Episode 163: Early Mobility During COVID19 in Switzerland with Sabrina Eggmann
Sabrina Eggmann is a PhD physiotherapist with 17 years of experience. She shares with us how her team utilized their years of expertise in early mobility to preserve their practices for COVID19 patients in Switzerland.
https://pubmed.ncbi.nlm.nih.gov/33492400/
Check out Sabrina's latest article in the Lancet Journal: https://www.thelancet.com/pdfs/journals/eclinm/PIIS2589-5370(24)00018-X.pdf
Episode citations and transcriptions found at www.daytonicuconsulting.com
Episode 162: Standardizing ICU Diaries
In episode 132, David Richards shared with us the life-saving impact of his ICU diary.
In this episode, Seth van der Meer from Post-ICU shares with us exciting technological advancements that can help make ICU diaries standardized and accessible for all patients.
Episode transcriptions and citations at: www.daytonicuconsulting.com
Episode 161: The Mad Hatter's Tea Party: A Nurse's Journey Through a Medically-Induced Coma
As a nurse of 22 years, Lynn had been taught that patients were comfortably sleeping while sedated in medically-induced comas. She shares the horrific realities she suffered while intubated and sedated and the months of playing "Truth or Propofol?" after discharge. Episode transcript and citations found at www.daytonicuconsulting.com
***Early Mobility Conference April 14-16th in Orlando, FL*** https://www.earlymobility.com/2024conference
Episode 160: Psychiatrists in the ICU
How can inpatient psychiatrists help ICU teams prevent and treat delirium? How can their expertise help ICU teams minimize sedation, prevent trauma, and treat the psychiatric needs of ICU patients? Dr. Marie Rueve shares with us the role psychiatrists can play in transforming patient care and outcomes in the ICU. www.daytonicuconsulting.com
***Early Mobility Conference April 14-16th in Orlando, FL*** https://www.earlymobility.com/2024conference
Episode 159: Building a Dream Team
How does adequate staffing, interdisciplinary team dynamics, and quality protocols impact patient outcomes and financial benefits?
What is the "secret sauce" of successfully weaning patients from the ventilator?
Sam Nimah and Phillip Morris share with us the exemplary work happening at Trivent Healthcare.
Episode transcriptions and citations found at: www.daytonicuconsulting.com
***Early Mobility Conference April 14-16th in Orlando, FL***
www.earlymobility.com/2024conference
Episode 158: Keeping "Up" With the Times. A Deep Dive Into the Benefits of Verticalization Therapy
What happens to the body at the cellular, neurological, pulmonary, musculoskeletal, and cardiovascular levels when it remains supine for days to weeks?
What is verticalization therapy and what does current research reveal about its benefits during critical illness?
Verticalization experts, Phillip Gonzalez, MOT, OTR/L, BCPR, Nikki Stephens, DNP, APRN, FNP-C, and Jenna Hightower, PT, DPT, CCS dive deep into the science and beauty of verticalization therapy.
Episode 157: Sedation is Sleep-Deprivation
Research has proven that sedation makes true restorative sleep impossible and real recall of the reality of the ICU is protective against post-ICU PTSD.
So what is really happening under sedation? If patients are not in sweet oblivion and restful slumber, what is their reality?
Chuck Evans joins us to share his startling story of being sedated and sleepless for weeks in the ICU.
www.daytonicuconsulting.com
***Early Mobility Conference April 14-16th in Orlando, FL***
www.earlymobility.com/2024conference
Episode 156: Nurses Are Willing, but Unsupported and Untrained in Practicing the ABCDEF Bundle
After decades of research and effort, why is there a persistent struggle to truly practice the ABCDEF bundle?
Are antiquated sedation practices because nurses are unwilling to change, or is it because they are unsupported and untrained in the risks and realities of sedation?
Even when training is provided in the classroom, what do nurses learn at the bedside? How does poor leadership impact sedation and mobility practices at the bedside?
Are nurses safe to question long-held habits and beliefs?
"April" joins us now to share her experiences entering the ICU and how the ABCDEF bundle is really being practiced.
***Early Mobility Conference April 14-16th in Orlando, FL***
https://www.earlymobility.com/2024conference
Episode 155: F- Family Engagement and Empowerment with Lito Rama
How do families impact patient outcomes in the ICU?
What does it really mean to engage and empower families in the ICU?
Have our teams truly recovered from the strict visitation restrictions from COVID?
How does an ABCDEF Bundle culture influence our visitation policies?
Lito Rama, RN, MBA joins us now to share with us the vast evidence supporting families in the ICU.
Podcast episode transcript and citations at:
***Early Mobility Conference April 14-16th in Orlando, FL***
Episode 154: E- EARLY Mobility with Heidi Engel
What is EARLY mobility? Why is it so vital that the ICU community advance past passive range of motion for intubated patients? What are the main barriers that prevent us from mastering the E of the ABCDEF bundle? If we're not doing highest level of mobility for most of our patients, are we truly practicing the ABCDEF bundle? Heidi Engel, DPT, joins us now to clear the air about early mobility. Podcast citations and transcripts found at www.daytonicuconsulting.com
***Early Mobility Conference April 14-16th in Orlando, FL***
https://www.earlymobility.com/2024conference
Episode 153: D- Assess, Prevent, and Treat Delirium with Dr. Adrian Austin
What does it really mean to "assess, prevent, and treat delirium"?
Are we treating a positive CAM score with the same urgency as a positive tropinin?
If we are automatically starting deliriogenic medications on every patient immediately upon intubation, are we truly practicing the "D" of the ABCDEF Bundle?
Dr. Adrian Austin shares with us the full picture of the "D" of the ABCDEF bundle.
Citations and transcriptions for all episodes found at www.daytonicuconsulting.com
***Early Mobility Conference April 14-16th in Orlando, FL***
www.earlymobility.com/2024conference
Episode 152: C- Choice of Sedation and Analgesia with John Devlin, PharmD
Is the C of the ABCDEF bundle only for avoiding benzodiazepines? How do we fully practice the "C" of the bundle and how does this impact patient care and outcomes? If we are automatically starting sedation without evaluation, are we truly practicing the ABCDEF bundle?
John W. Devlin, PharmD, BCCCP, MCCM, FCCP joins us in this episode to share his expertise on best sedation and analgesia practices in the ICU.
Episode citations and transcriptions found at: www.daytonicuconsulting.com
Episode 151: B- Spontaneous Breathing Trials with Karsten Roberts
How do we set patients up for successful breathing trials to minimize time on the ventilator?
What role do sedation and mobility play in prompt liberation from mechanical ventilation?
Karsten Roberts, MSc, RRT, FAARC joins us now to dive deep into spontaneous breathing trials in the ABCDEF Bundle.
www.daytonicuconsulting.com
***Early Mobility Conference April 14-16th in Orlando, FL***
www.earlymobility.com/2024conference
Episode 150: B- Awakening Trials- "Rehumanization of the Patient"- With Dr. Wes Ely
What is the purpose of awakening “trials”? When should awakening “trials” be done? How can we have successful awakening “trials”? Dr. Wes Ely joins us in this episode to crack the code on sedation cessation. Transcriptions and citations at: www.daytonicuconsulting.com ***Early Mobility Conference April 14-16th in Orlando, FL*** https://www.earlymobility.com/2024conference
Episode 149: A- Assess, Prevent, and Treat Pain with Joanna Stollings, PharmD
The A of the ABCDEF Bundle is for "Assess, Prevent, and Treat Pain".
How do we truly master this tool and how does this impact patient outcomes?
Can we assess, prevent, and treat pain while simultaneously striving to have all possible patients awake, autonomous, and even mobile?
Joanna Stollings, PharmD, shares what the A of the ABCDEF Bundle really means and how to master it for each patient.
www.DaytonICUConsulting.com
***Financial Benefits of the ABCDEF Bundle Webinar***
October 18th, 2022 at 12pm EST
Register here:
https://us02web.zoom.us/j/4173781755?pwd=RHFhYml0Vlc2ZTNJcEJiVURIS1hrQT09
***Early Mobility Conference April 14-16th in Orlando, FL***
https://www.earlymobility.com/2024conference
Episode 148: The History and True Mission of the ABCDEF Bundle with Michele Balas
This episode kicks of our 8-episode series dedicated to each element of the ABCDEF bundle. We're going to be going back to the basics and diving deep into how to truly practice the ABCDEF bundle in our ICUs.
www.DaytonICUConsulting.com
Episode 147: The Big Picture of Hospital-Acquired Pressure Injuries with Wound Care Karen
How do hospital-acquired pressure injuries (HAPIs) occur in the ICU and why is the ABCDEF bundle such a powerful tool to prevent HAPIs? How do HAPIs impact healthcare costs, staff workload, patient quality of life, and overall survival? Wound Care Karen joins us in this episode to explore the crisis of hospital-acquired pressure injuries in the ICU. Check out the Wound Care Karen Podcast here! Episode transcript and citations found at www.daytonicuconsulting.com
Episode 146: Success Stories from ICU Revolutionists
Individuals and teams are transforming patient outcomes through the adaptation of the ABCDEF bundle. Hear a compilation of their inspiring successes in this episode!
www.daytonicuconsulting.com
***Don't miss the upcoming free webinar, "Financial Benefits of the ABCDEF Bundle", on October 18th at 12pm EST. Register here:
https://us02web.zoom.us/meeting/register/tZIufuGsrTwjE9Lg_pK5i_Fslap7KYHuw63o
Episode 145: The Trauma of Sedation and Immobility in Families in the ICU
Family members also suffer the isolation, burden, trauma, and loss from sedation and immobility in and after the ICU.
Families are also at risk of developing post-ICU syndrome themselves.
Nonetheless, they are left unprepared to care for their loved ones who are suffering the damage of sedation, delirium, and ICU-acquired weakness while struggling through their own personal trauma.
Stefan Becker, a professional psychotherapist, shares intimate insight into the journey he and his wife have suffered in the ICU.
Episode transcription and citations at:
www.daytonicuconsulting.com
Episode 144: Living With a "Sedation-Induced Brain Injury" and PICS
What if we were as worried about "brain-protective strategies" as "lung-protective strategies" in the ICU? Such an approach will never be standardized until the ICU community truly recognizes the brain injuries survivors are left with after sedation and immobility. Until post-ICU syndrome is widely known and the impact is deeply appreciated, we will continue to fall short of evidence-based sedation and mobility practices. Only true experts can help us understand.
The real experts on post-ICU syndrome (PICS) are those that live with it. Carol Billian joins us now to share her personal expertise.
www.daytonicuconsulting.com
Episode 143: The Impact of Delirium on Stroke Survivors
We know that stroke patients are at high risk of poor cognitive, physical, and psychological outcomes. How does delirium impact their outcomes and how can we better protect patients from additional brain injury from delirium?
Rosa Hart, BSN, RN, SCRN from the "Stronger After Stroke" joins us now to explore the struggles, barriers, and importance of the ABCDEF bundle for stroke patients in the neuro ICU.
Check out the "Stronger After Stroke Podcast" here!
Episode transcription and citations found at: www.daytonicuconsulting.com
Episode 142: Treating Post-ICU PTSD
Dr. Brian Peach shares with us his exciting developments and research. Contact information for Dr. Brian Peach found with the transcription for this podcast episode at:
www.daytonicuconsulting.com
Episode 141: Fighting For Your Life With Your Eyes Open
Critical illness in the ICU is a battle.
It is a fight for life.
Sedation is often given with the hopes of sparing patients the discomfort and awareness of the struggles of the ICU.
Yet, does that ultimately prevent harm and suffering?
Antonette Montalvo, APRN shares with us what it meant to her to be able to fight for her life with her eyes open.
www.daytonicuconsulting.com
Episode 140: Early Mobility in the Burn ICU
Is early mobility safe and feasible in the burn ICU?
Considering the significant barriers such as pain, dressing changes, variable device securement, delicate position needs, etc., how can an ICU team continue to practice early mobility?
Physical therapist, Audrey O'neill, DPT, shares with us her recent publication and years of expertise.
Vapotherm webinar: https://vtherm.com/0803
Ebook and newsletter: www.daytonicuconsulting.com
Sign-up for ICU Revolutionists Meetings: https://ka8j42zmhi0.typeform.com/to/oVstW9jU
Episode 139: The Power of RN "Soft-Skills" to Change Outcomes
It goes without saying that nurses are the gatekeepers of patient outcomes in the ICU.
Do ICU nurses *really* aspire to care for unresponsive and atrophying bodies?
How does the ABCDEF Bundle impact the nursing role, skillset, and job fulfillment?
James Fletcher, BSN, RN seems to fit the mold of a nurse that would thrive solely with the flashy skills of an ICU RN. He shares with us the impact nurses can make by using "soft-skills" and human touch in the ICU. He is brining joy back to nursing with the ABCDEF bundle.
www.daytonicuconsulting.com
Episode 138: EARLY Mobility in the ICU Improves Cognitive Function 1 Year After Discharge
We know that early mobility is a potent tool to prevent and treat ICU delirium. How does it impact cognitive function 1 year after discharge? What do "Early" and "Mobility" REALLY mean? How has drastic variation in methodology in the research led to the confusion and conflict we now see in early mobility practices? How can we optimize early mobility in the ICU? Is it safe and feasible to mobilize most patients within 48 hrs after intubation? Is there evidence to support restrictive mobility parameters by ventilator settings, vasopressors, etc.? How can intensivists lead and support their teams to master the full ABCDEF bundle? Dr. Bhakti Patel shares with us her recent research and invaluable insights. See transcript and citations for this episode at: www.daytonicuconsulting.com
Episode 137: Physical and Occupational Therapists in the ICU: Working Together But Not Together
Occupational and Physical Therapists save lives in the ICU with their unique and complementary expertise. Bryan Lohse, DPT, CCS and Paul Arnold, OTR/L, CLT share with us how their Awake and Walking CVICU has developed their therapy teams. They address the question of PT & OT cotreatments in the ICU.
PESI Critical Care Rehab Summit:
Episode 136: Mastering the ABCDEF Bundle with the ICU Liberation Master, Dr. Juli Barr
The mission to create Awake and Walking ICUs is not a brand new endeavor. Dr. Juli Barr, an early PAD and ICU liberation founder, shares with us the tools needed to master the ABCDEF bundle.
www.daytonicuconsulting.com
Episode 135: The Contrast Between Awake and Sedated
The cultural assumption that everyone would rather be sedated is based on the myth that sedation is "sleep". Very few survivors can give us a comparison of being sedated vs. being awake while intubated. Lara, like Susan in episode 3, Caleigh in episode 117, and Mark in episode 87, has had it both ways and shares with us the contrast.
www.daytonicuconsulting.com
Episode 134: Are We Sedating Them to Death?
www.daytonicuconsulting.com
Episode 133: "SOAR: Sedation Off Awake and Rehabilitate" with Dr. Fuchita
www.daytonicuconsulting.com
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?"