Joan's journey: Walking Through and Away From ARDS

As Joan shares in episode 17 of the podcast, “Walking Home From the ICU”, she is deeply grateful for the exceptional care she received in the Awake and Walking ICU.?

In September 2018, she was a 38 year old with a history of tobacco use hospitalized in a rural hospital for acute respiratory failure secondary to influenza. When she continued to decline, she was intubated, sedated, and sent to the Awake and Walking ICU.?

During transport, Joan describes being lost in a terrible alternative reality in which she believed all the voices she heard and hands she felt belonged to teenagers trying to saw her wrists off and kill her.?

She says she was so grateful to have sedation turned off immediately upon arrival to the Awake and Walking ICU. In her interview she stated,

“If I had those meds running for weeks and was left in that place in my mind, I would be in a looney bin today.”?

Shortly after arriving, Joan’s blood gas revealed a P/F ratio of 67 while on a PEEP 16 and Fi02 100%. Nonetheless, she was able to oxygenate with movement, so the team kept sedation off and allowed her to connect with her husband and communicate via texting to the staff.?

In most other ICUs, Joan would have been deeply sedated and potentially paralyzed just for her low P/F ratio. Yet, this team saw Joan as more than a pair of sick lungs. They knew that the rest of her organ systems and quality of life were at stake. They knew that especially early on, the ABCDEF Bundle was applicable and imperative to Joan’s care.?

She was at a crossroads and how they protected her from delirium and ICU-acquired weakness while also supporting her during ARDS would greatly determine her survival as well as the trajectory of her life.?

The following table will walk you through Joan’s journey in the ICU day by day. Each column represents an approach to care by compliance with the ABCDEF Bundle.

?The pink column displays Joan’s treatment if she had been in an ICU that provided the protocols and treatment from the Morris 2008 early mobility study with <25% compliance with the ABCDEF Bundle.?

The middle peach column represents the care that would have been provided per the protocols employed in the 2022 TEAM Study which was <50% compliance with ABCDEF Bundle.?

The green column describes the care she actually received in the Awake and Walking ICU with 100% compliance with the ABCDEF Bundle.

“I am so glad I was able to be awake, walking, texting, showering, and communicating with my family while intubated with ARDS.”

This approach to care prevented pressure injuries, falls, hospital-acquired infections, tracheostomy, days to weeks extra in the ICU, LTACH placement, and life-long disability (Post-ICU Syndrome) for Joan.

By keeping her awake and mobile, this team saved Joan's life, cognitive function, psychological stability, physical independence, financial future, motherhood, relationships, substantial workload for her care team, and tens of thousands (if not more) in healthcare costs.

Our patients, clinicians, and hospital systems cannot afford to persist in antiquated automatic sedation and immobility practices. Now that we know better it is time to do better.

-Kali Dayton, DNP, AGACNP

www.DaytonICUConsulting.com

www.ABCDEFBundle.com