Tyler’s Story: How Two Awake and Walking ICUs Helped Him Survive and Thrive Through ARDS

Most patients who are admitted to the ICU in need of mechanical ventilation have to suffer through days or even weeks of deep sedation, immobility, and all the ill effects of these practices.

Patients with acute respiratory distress syndrome (ARDS), can especially fall victim to these antiquated practices leading to the death of their quality of life, as many of them end up dealing with horrendous repercussions.

• 83% of ARDS survivors are readmitted within the first two years after discharge.
• 25% of them are readmitted within the first 30 days after discharge.
• 70-100% of ARDS survivors have cognitive impairments upon discharge from the hospital.
• 46-80% of ARDS survivors still have cognitive impairments (post-ICU dementia) one year after discharge.
• 48-96% of survivors still have myopathy (muscle weakness, cramps, stiffness, or spasms) two years after discharge.
• Only 68% of ICU survivors ever return to work.
• Of that 68%, 43% end up working reduced hours, 27% report having reduced capacity, and 24% will eventually lose their jobs.

One of the best way to beats these odds is to optimize the ABCDEF Bundle to keep even ARDS patients as awake, communicate, autonomous, and mobile as possible.

Tyler Lintz's story is a powerful demonstrate of how an Awake and Walking ICU approach protected him from death and post-ICU syndrome even during severe ARDS.

How Evidence-Based Practices Saved Tyler’s Quality of Life

In 2019, Tyler Lintz was a 32-year-old firefighter when he was admitted to the ICU for septic shock secondary to group A streptococcus pneumonia.

He was intubated in an outside facility and then transferred to the Awake and Walking ICU.

Upon arrival at the Awake and Walking ICU, he was liberated from sedation and continued to require vasopressor support for his septic shock.

He recalls experiencing intensely vivid hallucinations while he was sedated.

Tyler, being a firefighter, explained that in one of these “dreams” he was on a search and rescue team during a big storm in New York, but then got into a severe accident in the fire engine and ended up breaking his neck.

The next thing Tyler knew, he was waking up strapped to a hospital bed with tubes sticking out of his body, and he could have sworn he was in the hospital being treated for that broken neck.

Waking up like this without any context was quite scary for Tyler, who said he was in a state of “complete confusion” at the time and was “very anxious.” He also made a point of saying that even while he was sedated, he could still feel the anxiety.

In any case, despite being delirious from the sepsis, he was promptly ambulated and was able to walk about 75 feet.

The videos above shows Tyler being ambulated on maximum ventilator settings, vasopressors, and in delirium. Tyler developed acute respiratory distress syndrome (ARDS) but continued to be awake and mobile.

Unfortunately, about 48 hours after admission, Tyler did reach the point of being unable to oxygenate with movement and did require deep sedation, paralysis, and pronation.

After a few days of sedation and immobility, he was cannulated for extracorporeal membrane oxygenation (ECMO) and sent to a CVICU. Fortunately for Tyler, he had been sent to an Awake and Walking CVICU.

Even as someone who was very physically fit before being admitted to the hospital, Tyler remembers how difficult it was to quickly lose 35 pounds and struggle to sit up in bed or even squeeze a stress ball.

Shortly after being placed on ECMO, sedation weaning began.

“There were times where I would come off the sedation, and then whatever we were doing the bike or trying to sit up or just something, and then all of a sudden, they’d be like, I remember, ‘We’ve got to sedate him again’ and I’d just go back into delirium mode, hallucinations. I remember being awake, semi-consciously, but I would see things in my room. You know, it wasn’t comforting.”

Nonetheless, after the first few days in the CVICU, Tyler was up and mobilizing again.

“It was very depressing. I literally had to learn to walk again. I couldn’t remember how to walk. You know, there was, ‘Put your right foot out, put your left foot out, your gait is too linear, spread, spread your hips,’ and it’s just so frustrating, you know?

“I started thinking, Holy crap, I’m going to stroke out – just with the ECMO and everything else. Are they pushing me too hard? You know because I’ll keep going. But should I not keep going? It’s just a mind game,” he said.

As someone who experienced being in the ICU with sedation and without, Tyler said he would much rather be awake, and described being sedated as

“very anxiety-ridden depression.”

Tyler’s wife Amber was also very grateful that he was given the chance to remain awake in the ICU. The ability to communicate his wants, needs, and love to his family had inexpressible value to everyone involved.

Had he been sedated, he couldn't have written love notes to Amber like this:

“I much preferred him awake,” she said. “Because he was showing me that he was making steps to get out of there. And I needed those small little things to show me that he was progressing. Even like, you know, squeezing my hand, or opening his eyes, things that small were huge to me, because it was just like, okay, he’s doing something.”

Having Tyler awake allowed him to see his children and friends and preserve his will to live and fight for his own life.

All told, Tyler spent about three weeks on ECMO and walked on ECMO for about two weeks.

After this, he spent an additional three weeks in rehabilitation and was then able to discharge home.

If you want to learn more about Tyler’s story, from him and his wife, Amber, you can check out Episode 18 and Episode 19 of my Walking Home From The ICU podcast.

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How Tyler’s Doing Now Versus How Things Tend to Go for ARDS Survivors

If Tyler had been in most other ICUs, he would have remained sedated and immobilized for days to weeks. This would have significantly increased his risks dying and led to life-long disability at least.

Thanks to being awake and mobilized as much as possible, about two months after his discharge, Tyler was able to start working as a firefighter once again, and a few months after that, he was promoted to chief of his department.

He is free of post-ICU PTSD and post-ICU dementia and is currently leading a fulfilling life with a successful career.

The Awake and Walking ICUs that preserved his function by avoiding sedation and immobility during his critical illness truly saved not only his life, but sent him back to the full life he wanted to live.