Episode #14: Different Treatment Different Outcomes
Now we have heard plenty of testimonials and evidence to be convinced that our practices must change. If we know that sedation and immobility causes harm, then what are the other options?
This next section of the podcast will be led by survivors that have contrasting outcomes. They too were critically ill and at a crossroads in their lives. Yet they were given the opportunity to be awake and walking from the moment they rolled in the ICU.
We will hear practices that perhaps only this awake and walking ICU dares to do. Patients walk on high ventilator settings and almost all throughout the worst of their respiratory failure, and then walk out the hospital doors and go back to work.
If we want different outcomes, then we must provide different treatment.
References:
Bailey, P., Thomsen, G., Spuhler, V., Blair, R., Jewkes, J., Bezdjian, L., Veale, K., Rodriguez, L., & Hopkins, R. (2007). Early activity is feasible and safe in respiratory failure patients. Critical Care Medicine. http://www0.sun.ac.za/Physiotherapy_ICU_algorithm/Documentation/Rehabilitation/References/Baily_07.pdf
Coles, S., Erdogan, M., Higgins, S., & Green, R. (2020). Impact of an early mobilization protocol on outcomes in trauma patients admitted to the intensive care unit. Journal of Trauma and Acute Care Surgery. https://www.ncbi.nlm.nih.gov/pubmed/31972758
George, B., Vakkalanka, J,. Harland, K., Faine, B., Rewitzer, S., Zepeski, A., Fuller, B., Mohr, N., & Ahmed, A. (2020). Sedation depth is associated with increased hospital length of stay in mechanically ventilated air medical transport patients: a cohort study. Prehospital Emergency Care, 23. https://www.ncbi.nlm.nih.gov/pubmed/?term=).+Sedation+depth+is+associated+with+increased+hospital+length+of+stay+in+mechanically+ventilated+air+medical+transport+patients%3A+a+cohort+study
Hanne, O., Helene, N., Strom, T., Oxlund, J., Wian, K., Ytrebo, L., Kroken B., Chew, M., Korkmaz, S., Lauridsen, J., & Toft, P. (2020). Nonsedation or light sedation in critically ill, mechanically ventilated patients. The New England Journal of Medicine. https://www.ncbi.nlm.nih.gov/pubmed/32068366
Hodgson, C., Stiller, Needham, D., Tipping, C., Harrold, M., Baldwin, C., Bradley, S., Berney, S., Caruana, L., Elliott, D., Green, M., Haines, K., Higgings, A., Kaukonen, K., Leditschke, I., Nickels, M., Paratz, J., Patman, S., Skinner, E., Young, P., Zanni, J., Denehy, L., & Webb, S. (2014). Expert consensus and recommendations on safety critera for active mobilization of mechanically ventilated critically ill adults. Critical Care Medicine, 18(658). https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0658-y
Morris, P., Berry, M., Files, D., Thompson, J., Hauser, J., Flores, L., Dhar, S., Chmelo, E., Lovato, J., Case L., Bakhru, R., Sarwal, A., Parry, S., Campbell, P., Mote, A., Winkelman, C., Hite, R., Nicklas, B., Chatterjee, A., & Young, M. (2016) Standardized rehabilitation and hospital length of stay among patient with acute respiratory failure: a randomized clinical trial. Journal of American Medical Association, 315(24), 2694–702. https://www.ncbi.nlm.nih.gov/pubmed/?term=Standardized+rehabilitation+and+hospital+length+of+stay+among+patient+with+acute+respiratory+failure%3A+a+randomized+clinical+trial
Moss, M., Nordon-Craft, Malone, D., Van Pelt, D., Frankel, S., Warner, M., Kriekels, W., McNulty, M., Fairclough, D., & Schenkman, M. (2016) A randomized trial of an intensive physical therapy program for patients with acute respiratory failure. American Journal of Respiratory Critical Care Medicine, 193(10). https://www.ncbi.nlm.nih.gov/pubmed/26651376
Pun, B., Balas, M., Barnes, M., Thompson, J., Aldrich, J, Barr, J., Byrum, D., Carson, S., Devlin, J., Engel, H., Esbrook, C., Hargett, K., Harmon, L., Hielsberg, C., Jackson, J., Kelly, T,. Kumar, V., Millner, L., Morse, A., Perme, C., Posa, P., Puntillo, K., Schweickert, W., Stollings, J., Tan, A., D’Agostino, M., & Ely, W. (2019). Caring for critically ill patients with the abcdef bundle: results of the icu liberation collaborative in over 15,000 adults. Critical Care Medicine, 47(1). https://www.ncbi.nlm.nih.gov/pubmed/30339549
Schaller, S., Anstey, M., Blobner, M., Edrich, T., Grabitz, S., Gradwohl-Matis, I., Heim, M., Houle, T., Kurth, T., Latronico, N., Lee, J., Meyer, M., Peponis, T., Talmor, D., Velmahos, G., Waak, K., Walz, J., Zafonte, R., & Eikermann, M. (2016). Early, goal directed mobilization in the surgical intensive care unit: a randomized controlled trial. Lancet, 388(10052), 1377–1388. https://www-sciencedirect-com.ezproxy.lib.utah.edu/science/article/pii/S0140673616316373#sec1
Shehabi, Y., Howe, B., Bellomo, R., Arabi, Y., Bailey, M., Bass, F., Kadiman, B., McArthur, C., Murray, L., Reade, M., Seppelt, I., Takala, J., Wise, M., & Webb, S. (2019). Early sedation with dexmedatomidine in critically ill patients. The New England Journal of Medicine, 380: 2506–2517. https://www.ncbi.nlm.nih.gov/pubmed/31112380
Shehabi, Y., Bellomo, R., Reade, M., Bailey, M., Bass, F., Howe, B., McArthur, C., Seppelt, I., Webb, S., & Weisbrodt, L. (2012). Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. American Journal of Respiratory Care Medicine, 186(8). https://www.ncbi.nlm.nih.gov/pubmed/?term=Early+intensive+care+sedation+predicts+long-term+mortality+in+ventilated+critically+ill+patients
Shehabi, Y., Chan, L., Kadiman, S., Alias, A., Wan, I., Mohd, A., Ismail, T., Tien, K., Saedah, B., Mat, S., Shaltut, A., Cheng, T., Cow, Y., & Bailey, M. (2013). Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicenter cohort study. Intensive Care Medicine, 39(5). https://www.ncbi.nlm.nih.gov/pubmed/?term=Sedation+depth+and+long-term+mortality+in+mechanically+ventilated+critically+ill+adults%3A+a+prospective+longitudinal+multicenter+cohort+study
Shahabi, Y., Riker, R., Bokesch, P., Wisemandle, W., Shintani, A., & Ely, W. (2010). Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients. Critical Care Medicine, 38(12). https://www.ncbi.nlm.nih.gov/pubmed/?term=Delirium+duration+and+mortality+in+lightly+sedated%2C+mechanically+ventilated+intensive+care+patients
Schweickert, W., Pohlman, M., Pohlman, A., Migos, C., Pawlik, A., Esbrooke, C., Spears, L., Miller, M., Franczk, M., Deprizio, D., Schmidt, G., Bowman, A., Barr, A., McCallister, K., Hall, J., & Kress, J. (2009) Early physical and occupational therapy in mechanically ventilated critically ill patients: a randomized controlled trial. Lancet, 373(9678), 1874–82. https://www-sciencedirect-com.ezproxy.lib.utah.edu/science/article/pii/S0140673609606589
