Hi, it’s Patrik from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another intensivecarehotline.com Podcast and in the last episode, we published our first podcast interview with Kali.
You can check out the last podcast here.
Podcast: Interview with Kali Dayton from Dayton ICU Consulting
Patrik: Hello, and welcome to another intensivecarehotline.com podcast. At intensivecarehotline.com, we help families of critically ill patients in intensive care to get peace of mind, make informed decisions, and get them power, control and influence. Welcome to another episode of the intensivecarehotline.com podcast.
Today, I’ve got a special guest, Kali Dayton. Hi, Kali.
Kali Dayton: Hi. Thanks for having me on again.
Patrik: It’s a pleasure. We have recorded a podcast before, maybe a year or 18 months ago, I can’t quite remember. You’ve been a guest on the show before, which is great. And I will link to this episode in the transcript when the episode is live, but today, we want to dive even deeper into what Kali is doing at Kali Dayton Consulting. Kali, can you introduce yourself and what you do and how it links in with what we do at intensivecarehotline.com?
Kali Dayton: Absolutely. I am a nurse practitioner in the U.S. That’s nurses that have gone on to an additional two or three years of school. I have my doctorate in acute care nursing practice, and I was a nurse for about seven years in intensive care. I started my career in an ICU where almost every patient was allowed to wake up after intubation, after having a breathing tube placed. And we would get them up moving shortly after. And this was a pretty high acuity, meaning patients in this unit were pretty sick. It was a medical surgical ICU. We even continued that practice during COVID. We had COVID patients walking in their rooms and the death rates in that ICU were vastly different than the death rates in the other neighboring ICUs in that same community, even in the same hospital system. So, there’s a lot of research and science behind that, but I didn’t know any of that.
That was my first job as a new nurse. I just was used to almost everyone being awake. There are some very few exceptions in which patients have to be in a medically induced coma. Those exceptions include intracranial hypertension, like when there is a lot of pressure in the brain, if a patient’s having seizures, if they can’t oxygenate their body with movement. Those kinds of cases are when you have to stop the movement and you have to sedate a patient, otherwise patients can be awake. So that was what I thought. That’s what I knew of critical care medicine. After a few years, I became a travel nurse, which means that I went to different hospitals. Every three months, I’d jump around to a new hospital. And I was shocked to find that every patient that was intubated on the ventilator was deeply sedated in a medically induced coma.
And I remember even my first shift, I was so naive. I got my patient assignment, and my patient was on a ventilator and they were sedated. But I wanted to continue my routine. I wanted to know who my patient was, assess them, hopefully get them to a chair to get ready to go on a walk later. It was just that routine for me. There was nothing about the patient’s diagnosis, nothing about their acuity, nothing said that they were too sick or had one of these exceptions that would necessitate this sedation. I didn’t know why they needed to be in a coma. So I asked my orientee nurse, “Can I just take sedation off and get them up just to make sure I wasn’t missing anything?” And she just looked at me in absolute terror and said, “What? No, they’re intubated.”
Which was really confusing to me because having a breathing tube did not mean a patient had to be intubated. In my mind, I never heard that concept that you would just sedate someone because they had a breathing tube, because they had sick lungs. So, I innocently said, “I know that they’re intubated, but why are they sedated?” And she said, “Because they’re intubated.” And I said, “But why are they sedated?” And we went in circles, and we got nowhere. We could not speak each other’s language. And I realized that I was-
Patrik: And she probably questioned your credentials.
Kali Dayton: Oh, I’m sure. I’m sure she thought, okay, this nurse is not safe to treat patients. She’s never worked in an ICU because she obviously doesn’t know that patients have to be sedated on a ventilator. So, I was still a pretty new nurse. I had only been in intensive care medicine for two years, and I thought, okay, it’s a new experience. Maybe I’m confused. Maybe there is something about this. And everyone else thought it was normal, no one else questioned it. So, I kind of looked around and figured I don’t know what to do here other than just what I’m told. So, I did it for the next two years. I did what everyone else did, and I sedated patients because I didn’t know what happened to patients while they’re sedated and what happens to them after. No one told me that.
And I believe that my colleagues throughout those 11 other ICUs where we did sedate patients, I believe that my colleagues did not know what happens during and after sedation and what the risks are. What I did hear is they’re sleeping. This is more humane. They’re comfortable. So, I started to kind of believe those things too, because there’s no way to know because the patient doesn’t move a muscle and is not communicating.
But then I met a survivor a few years after doing travel nursing on an airplane ride, and he started to tell me what it was like to be sedated, what it was like for him to be in a medically induced coma. And he was crying to me as a complete stranger. It was over four years after his discharge. And he was sobbing to a stranger on the plane talking about having his limbs nailed to the ground in the middle of a forest while trees came crashing down on him. And he couldn’t get up. And demons came out of the sky. And I think there was a lot more that he still could not verbalize because it was too traumatizing. And that was the first time I had ever heard that, Patrik. I had no idea. So, I thought, well, obviously he had what we all know is ICU delirium. We hear that term. We use that term when someone’s confused, when they’re kind of agitated, we say, oh, they have delirium. They’re delirious. I didn’t realize how real it was that patients aren’t in their own reality and that it’s often gruesome and graphic and especially traumatizing. This man was psychologically scarred as if he had physically lived those experiences. So yes, he knows now that he was in ICU, but he didn’t know then. And his soul still thinks that he lived those things. So, I went to survivor groups hoping that they would validate my hope that that was a fluke, that he was extremely rare.
But if you go to any ICU survivor group, it’s full of those kinds of testimonials where they are deeply traumatized, PTSD (post-traumatic stress disorder), panic attacks. They have cognitive impairments, meaning a post ICU dementia. Their brains are scarred and injured from what they experienced under sedation. So that posed this big question mark as to why in my previous ICU, and then I went back to the ICU while I was in grad school, so why in my ICU do we have almost all patients awake and walking and why are they fine on the ventilator? But in every other ICU I worked in, throughout the entire community, everyone else automatically starts sedation and putting patients into medically induced comas the moment they are on a breathing machine. Why?
And there’s a whole backstory as far as the history of critical care medicine, but ultimately, it’s because clinicians don’t know the harm of sedation. They don’t know what happens to patients after the ICU, and they just do what they’ve been told and taught. And that’s why I think it’s really important for family members to understand the truth about medically induced comas and to be able to advocate for their loved ones.
Patrik: Absolutely. And look, the world that I grew up in ICU, I have never heard of people not being sedated when they need a breathing tube. The first time I came across was when I heard about your podcast and about what you are doing. This is a completely new world to me as well. What I have seen in some ICUs that I work in, and I’ve done a lot of travelling just like yourself, I have seen in some ICUs patients being mobilized on a breathing tube once they’re out of the induced coma, which from my experience, is quite advanced as well, because most ICUs don’t do that. Right? So yes, advancement on that end, but certainly not inducing them into a coma to begin with. Now, I was listening to one of your episodes the other day, and that really struck home with me, where you said, in discussions with doctors, I think on your podcast as well, where you said something like, the doctor said, well, what if he or she takes out her breathing tube and you said, well, what if she never walks again?
- Quick Tip for Families In ICU: 28 Days in A Medically Induced Coma & Breathing Tube Down the Throat, On The Ventilator. What’s Next?
Kali Dayton: Yeah. That was a quote from Dr. Wes Ely. He’s a researcher in the world of delirium. He was in Korea and presenting to a group of physicians, and they brought in a survivor, young woman in her twenties, she’d had bleeding in her lungs. So, it was just one organ, one part of her body that was affected. But she needed to be on a ventilator to support her lungs while they addressed the breathing or the bleeding in her lungs. But because they put on a ventilator, boom, she was automatically sedated, and she didn’t use her muscles. And what’s really important to realize is that sedatives are toxic to the muscles. So, during critical illness, you have a lot of inflammation, you have a lot of things that are attacking the muscles and causing them to waste away quickly. Your body is consuming your muscles. But then you’re in bed and on top of that, with sedation, you’re not even contracting your muscles, your brain’s not talking to the muscles, and you’re not using your muscles at all.
And then on top of that, you now have toxic medications going into the body that are attacking the muscles, which are the sedatives. So, this woman, this young woman in her twenties with just again, bleeding in the lungs, was sedated for, I can’t remember how many weeks or months, but she was sedated for prolonged periods of time. And so, she was in a wheelchair. She walked into the hospital with bleeding lungs and came out with a wheelchair and probably had a tracheostomy and still two years later was needing to be in a wheelchair. So, Dr. Ely talks about how he asked them, “Well, why did you keep her sedated for so long?” And they said, “Well, we were afraid that she would pull her tube out.”
And it was another physician that said, “Well, what if she never walks again?” He said that her legs were like a chicken bone. There was no meat on her legs, no muscle anymore, two years later. So, what happens is your muscles are obviously affected. They waste away, but your nerves can be affected as well. So, you come in for one thing and you can leave with a neuromuscular condition. You can leave with a brain injury because of these practices that we don’t even question in the ICU.
Patrik: Kali, I was talking to a client this morning and she has her mother in ICU on a ventilator with a tracheostomy now, and she’s already making progress of getting off the ventilator. And then I asked her, “Are they mobilizing her?” And she asked the ICU team, and they’re saying, “Oh, we don’t do mobilization.” And I just go like, this is madness. I mean, the world that I grew up in, yes, I didn’t know about the aspect of critical care medicine that you know about not needing sedation. But what I do know from ICUs is, well, once you have a trach mobilize, day one, mobilize.
Kali Dayton: And I’ll say to that as well, that’s kind of an old cultural myth. I hate to say it, Patrik, but it really is a myth. I cannot find anything in the research that validates this belief that patients cannot mobilize or can’t have sedation off until they have a tracheostomy. I think that’s rooted in the fear that patients will take out their breathing tube when the sedation’s off. So, the clinicians feel more secure once there’s a tracheostomy. But there’s nothing to say that patients cannot be off sedation, cannot mobilize until they have a tracheostomy. That’s for the clinician.
Patrik: I agree.
Kali Dayton: Tracheostomies aren’t benign. They come with risks. So, in my mind, if a patient is in a unit with a team that will not take off sedation, will not mobilize them until they have a tracheostomy, do a tracheostomy right away, whatever it takes, mobilize them, get those toxic medications off, that’s fine. But with my patients, I have no problem mobilizing them with a breathing tube because I know that that will prevent a tracheostomy. They will keep their muscles intact so that when the COVID, when the bleeding, when whatever’s going on is done, they will be strong enough and intact and ready to breathe on their own and walk out the doors.
Patrik: Yeah. So, in your unit that you worked at then, a tracheostomy was basically very rare?
Kali Dayton: Extremely rare. Even during COVID. I know in COVID, it was just trach/PEG, trach/PEG, everyone, but not in that unit. Very few. And those few that did have tracheostomies were like chronic lung conditions where they were never going to have the lung function to independently breathe. They were going to need the ventilator for a long time, if not forever, the rest of their lives. I know in neuro cases, like with strokes, they’re traumas. There’re certain things when the brain is so damaged that they can’t safely breathe on their own, that yes, then they need a trach. So, there are indications for traches, but when someone comes in for an infection or most of the problems that lead patients to be in the ICU, a tracheostomy can be an indication of a failure to keep the respiratory muscles strong.
Kali Dayton: Because they were not mobilized, because they received toxic medications to their muscles.
Patrik: And why do you think… Why is the approach in this particular ICU so different to any other ICU probably in the world? What’s the background there?
Kali Dayton: Yeah, this is one of my favorite stories to tell in my podcast. Walking home from the ICU, I interviewed Polly Bailey, she’s one of my mentors. She was a nurse back in the ’90s when they were really starting to treat really sick patients, especially with ARDS. So extremely sick lungs. But those were archaic ventilators where they just would pound air in, pull it out. They were not like our ventilators we have now where you can customize the settings, it can synchronize with the patient. You can make it much more comfortable for the patient. That’s now. Back then in the ’90s, they would pound air in and they were also giving… They were using a different approach to ventilating patients. Lots of air, lots of pressure, lots of things that would make it impossible for a patient to be awake and calm and compliant with the ventilator.
So that’s when they started bringing up these medications from the operating room, all of these heavy sedatives and use them for prolonged periods of time. And that was just for the ARDS (acute respiratory distress syndrome) patients, the certain kind of patients. They weren’t used to using that for other patients until they started to notice, wow, looks like patients are sleeping. They don’t use the call light. They look more comfortable. They oxygenate better for a little bit. So, they didn’t have the research to say, wow, that’s really lethal. That’s really deadly. They just saw that in the moment for that narrow window that they have into a patient’s course, they looked better. So, then they started using those medications on other patients in the ICU that were on the ventilator for other reasons. So, Polly Bailey was a nurse during that time, going along with that, didn’t know anything else until she followed a survivor out of her ICU.
And at that time, they didn’t have rehab. So, they basically just scooped people off the gurney, dumped them in their car and said, good luck, go live your life. She followed her home. She would go and visit her in her home. It was a mother in her thirties with little kids. I think throughout the next year, she struggled to build up the strength to get up the stairs. Her husband was helping her use a bed pan. She was psychologically and cognitively destroyed. And Polly was mortified. You don’t think if it’s a nurse, you’re there to help save lives. You hope that they go on to live fulfilling lives. And she’s realizing that that’s not the case for many of these patients. So, imagine a female nurse in the ’90s going to her medical director and saying, what if we didn’t do this to patients?
What if we got them up and mobilized them so that they didn’t become so weak? What if the sedation is causing all this trauma in the brain? And we just avoided it? And there was no research on this, Patrik, can you imagine? We are all about evidence-based medicine, but there was nothing about this out there. We didn’t know what happened to the patients. We didn’t have all the decades of studies to support this that we have now. But Polly, one nurse, proposed this idea. The medical director trusted her. She experimented with her patients and found that their outcomes were totally different, that they did really well, that they survived when no one else thought they would survive. They started doing it on more and more patients, but there was hard buy-in, it was a hard win.
Patrik: I bet. Can you talk about the average ventilation time in your ICU? Do you have any stats? And that would be a number. I mean, as you know, 10 to 14 days of mechanical ventilation with the breathing tube induced coma, that’s when you sort of trigger a tracheostomy. Would you go over 10 to 14 days of ventilation with the breathing tube?
Kali Dayton: Oh, yeah. Completely depends on the diagnosis, right?
- Podcast: Critically Ill Patients Need Not be Given Sedation Right Away. I Worked in an ICU Where Patients on Ventilators are Awake and Walking & I Believe This is Normal and Possible.
Patrik: Of course, of course.
Kali Dayton: We know that mobilizing patients and avoiding sedation decreases time in the ventilator for just about any patient on the ventilator for any reason. That’s just in general. So, this ICU also gets a lot of ARDS patients that even before COVID, even during COVID. So, I think in COVID, we prevented a lot of intubations by mobilizing patients even before being intubated, mobilized them on BiPAP, mobilizing them on high flow. But if they did have to be intubated… If they still kept their stats up that they were still oxygenating on the ventilator, there’s no reason to prone and paralyze them. Or we would prone them, I had patients texting while proned, while intubated. So, it just depended on the patient. But the timing of the tracheostomy, boy, I mean, I’ve had patients be intubated for three plus weeks, be successfully extubated and walk out the doors. I mean, they’re walking 500, 1000 feet, but still intubated for those few weeks because of just whatever’s going on with their lungs.
Patrik: And let’s just talk about ARDS in particular, some ICUs that I’ve worked in, you prone them, proning doesn’t work. Next thing is you put them on ECMO (extracorporeal membrane oxygenation). So, I don’t know whether you had ECMO in that unit, but if you didn’t, well, you probably had a pathway already to avoid ECMO.
Kali Dayton: I think so, yeah. I hope we get more studies in the future showing how much mobility prevents ECMO. I have anecdotal stories from ECMO units where people bring someone in for ECMO and then they mobilize them, and they don’t need ECMO. But that’s not always the case. So-
Kali Dayton: … that unit does not do ECMO, but they transfer to a unit that does.
Patrik: Of course, of course.
Kali Dayton: So, it’s like when they have ARDS and they’re to the point where they cough, they move a muscle, and they’re down in the seventies, we obviously can’t mobilize them anymore.
Patrik: Of course, of course.
Kali Dayton: They have to be proned, oftentimes paralyzed. But that’s the time when you quickly cannulate them, gets into an ECMO unit onto machine that provides that oxygen.
Patrik: Of course.
Kali Dayton: And then what’s the holdup? Get them up again. And there’s a big variation in ECMO units too. Some ECMO units are mobilizing almost everybody, and some ECMO units say, no way. Some ECMO units will say, we can mobilize some patients as long as they have the cannula going in from up top, but not if it’s in the groin. And other ECMO units will say, huh, we don’t care where the lines go in.
Patrik: Where the access is.
Kali Dayton: We’re going to mobilize everyone. So, there is so much culture behind this that I think that’s really important for families to understand is medicine should be evidence-based. We should be looking at the research and showing what is safe, what’s beneficial, how we should treat patients, but culture stops us from doing those things that are best for patients.
Patrik: Yeah. Kali, one of the things that I’m… When families come to us and they say, oh, should we do a trach, or should we not do a trach? Or should we give consent to it? Well, one of my first questions that I have for them is, well, has the ICU done everything beyond the shadow of a doubt to avoid the trach? And I have a checklist, but with your knowledge, this takes on another dimension, right? Because-
Kali Dayton: Yeah.
Patrik: Takes on a whole new dimension.
Kali Dayton: I have two podcasts. One is for clinicians, and one is for families. So, I have clinicians telling me about their implementation of these principles from the podcast. It’s amazing these moments where they’re at that crossroads like do we do a trach, do we not? And this isn’t always effective. Again, I think if a trach is going to help a team mobilize a patient, or at least get them to a rehab center that will mobilize the patient, then do that quicker. But if you are with a team that’s willing and able to mobilize a patient, give them some mobility before they do a trach. And so, one story I love is from a speech therapist where they were doing an awakening trial, which I can do a whole spiel on awakening trials, but when I learned awakening trials as a travel nurse, I was taught, you just turned sedation down enough to start to see them start to thrash, and then that’s how you know they can’t handle the ventilator, and you turn sedation back on.
So, when that approach is done, that’s how patients get stuck on the ventilator and on sedation for so long when they can’t work them through the agitation because… But they don’t understand that they’re experiencing delirium. They don’t know the root of that agitation. They just want to make it stop. They don’t understand that they don’t make agitation to stop. They don’t make that terror stop by turning sedation back on. They’re just masking it. They’re just stopping the movement. Survivors will tell you that they’re locked back into those hallucinations. I don’t even want to call them that, but they’re locked back into that delirium. So, the speech therapist was called in because they were having a hard time with a patient that was agitated during an awakening trial.
They turned on sedation and it was, I think a 15-year-old kid, and he’d come out swinging. So, she gave him a pen and paper, and he said… Where he wrote, “Dying?” He wanted to know if he was dying. And they said, okay, let’s talk about it. And they started talking about where he was and what’s going on. And just talking to him, having him connect with his family, letting him communicate. Boom, agitation was gone, but he was about to be trached before that. They were able to mobilize him because they calmed him down enough. And a few days later, he was extubated.
Patrik: I have another question here Kali, what do I see? We’re talking to ICUs worldwide all the time, and correct me if I’m wrong here, I’m probably an old-fashioned nurse having done my training in the ’90s, and we were brought up in ICU, mobilize, mobilize. I stopped seeing that.
Kali Dayton: Agitation?
Patrik: No, no. Not agitation, mobilization, what I’m basically saying, I stopped seeing it basically… Well, ICUs now say, well, we can’t do it. We don’t have the staff; we don’t have the resources. Ship them off to LTAC. And I just go, hang on. Where did good old nursing go about mobilization? Mobilization.
Kali Dayton: Yeah.
Patrik: I just go, is it complacency? Is it, I don’t know, lack of staff, lack of resources? Is it a different approach? But the approach clearly is not working. Right?
Kali Dayton: Yeah.
Patrik: The sooner you can mobilize… Where are we going in intensive care? What generations of doctors and nurses are coming through and forgetting about basic principles of rehabilitation, I believe. What do you see?
Kali Dayton: Yeah. Well, I’m also a consultant. So, my main focus is training ICU teams to do this best evidence-based practice that gives this kind of care that I’m talking about, right? But it requires me to dive into why are we where we are at, and the older nurses, I will have older nurses that have been doing this for 20, 30 years, say, oh yeah, I used to do this.
Patrik: I used to.
Kali Dayton: Yeah, I used to, and now it’s gone. So, I think comes down to, we were mobilizing patients up until we started using those big, deep sedatives during this ARDS experiment. Then those sedatives went into all the other patients, not just for ARDS. So then through the early 2000s and into the 2000-and-teens, we kept doing that, and those nurses that had been mobilizing patients retired, left, died down. So, we are left with these heavy sedatives, and they’re very tempting. But what especially happens, Patrik, is that when you start those type of sedatives, and maybe you’ve experienced this, when you later turn them off, it can be a complete nightmare.
Patrik: Oh, totally. Totally.
Kali Dayton: They come out thrashing, they’re agitated, they’re coughing, they’re gagging, they’re trying to pull out the tube. They have no idea what’s going on, and it can be a huge risk, so-
Patrik: Vicious cycle, vicious cycle.
Kali Dayton: Vicious cycle. So, this is where I’m trying to teach ICU teams just if you don’t have to, don’t even turn it on because you’re setting yourself up for more harm, more work, more risk. Get the family there. As someone wakes up, have them connect with them, give them a pen and paper, let them ask their questions, let them acclimate to the tube, and it’s going to be so much easier for days to weeks to come. So that happens. So, we automatically start sedation. When that started becoming the norm, that’s when mobility went away. How do you mobilize the patient if they’re sedated? And then how do you get sedation off when they come out that way? It seems like so many teams will keep sedating them, go through that process of taking it off, they come out thrashing, turn it back on until they’re too weak or too delirious.
Patrik: Correct, correct.
Kali Dayton: … and can’t thrash anymore, and they don’t have any fight left in them.
Kali Dayton: Now we can safely take off sedation, and that is dangerous. And then once they’re at that point, it is impossible, not impossible. It is very difficult to mobilize them. You’ve now got a large adult newborn that you’re trying to sit up at the side of the bed. That’s when it takes a whole army and equipment and extensive time and skill. What I’m realizing is that nurses especially, but even physical therapists, occupational therapists, unless they’ve been trained on those exact skills, they’re not comfortable with it. They’re scared. So, one, they do have short staffing ratios. Two, they have this huge barrier of sedation. They’ve made it harder for themselves. Patients come out much weaker in the backend. So, when they think it’s safe to mobilize, it’s now too hard to mobilize them, and they don’t have the skills for it. So, there’s a lot behind it.
Patrik: Why do you think, Kali… Obviously your unit has done enough research and done enough cases to verify the concept. Why do you think other units are not paying attention to that? Is it big pharma, is it… What is it?
Kali Dayton: We could say that, but without even getting to big pharma, there’s just so many conflicts. I would say to be candid that ICU that I’m coming from really should be publishing more data, but there’s so many politics in the hospital system.
Kali Dayton: So, it’s a multi-hospital system, and if they publish that and they use their other hospitals, let’s say for COVID, it’s all the same disease process. That’d be a great study to look back and say, how did their difference in sedation and mobility practices change the outcomes? Did patients survive longer? We know that they did, right? But we need to publish that study. But when you have higher ups that don’t want to expose the poor treatment on their other ICUs, it makes it really hard to get that data published.
Patrik: That’d very hard, makes it very-
Kali Dayton: That’s probably as much as I can say.
Patrik: Yeah, sure.
Kali Dayton: But I think nonetheless, even without their exemplary practices captured in studies, we have enough research to validate what they do, and it’s very well-known. We have large studies with over 15,000 patients in which we saw that the less sedation received, the more mobility given to patients, the more they survived, the quicker they got off the ventilator, the more likely they were to go home, the less likely they were to come back to the hospital. I mean, the more quality of life they had. I mean, there are so much research behind this, Patrik, but when you talk to a bedside clinician, they’re usually not aware of it. So, we haven’t brought the research to the bedside, so how can they be held accountable for it if they don’t know it?
Patrik: Yeah, yeah. No, absolutely. Kali, maybe we should wrap this up for today and probably record another episode, but how do you help families or ICUs? Tell us a little bit more. Where can people find you? How do you help them? What’s your approach to avoid those situations in the first place? Tell us more.
Kali Dayton: Well, my company is called daytonicuconsulting.com. It’s my website. On that website, under the resources tab, there are two different podcasts. One is Walking Home from the ICU. That one is for clinicians, but that one is organized by topics, and I have a lot of survivor testimonials, clinician testimonials. I think there’s a lot of resources there. But I also have a second podcast called Walking You Through the ICU, and that gives much more succinct step-by-step information for families that are in the ICU with their loved ones. Both of those podcasts have transcripts and citations. Here I am referencing all this research, but if you want to have that in your hands to bring to the bedside, go ahead and print that out. There’s also a free e-book on my website, Dayton ICU Consulting.
So, you’re welcome to print that out. That debunks six myths about medically induced comas. I’m really trying to just make this succinct so that you, as the family member, can bring it to the clinician and it’s applicable to both of you and can guide that discussion. You have a right to be asking, does my loved one have an indication for sedation? And just please be aware that mechanical ventilation, being on a ventilator is not an indication of sedation. There’s nothing in the research to validate that. So, you have a right to ask, does the research, does the evidence support this? You as a family member or part of the team. So, jump in there, bring the resources to the table and discuss it. And I’m happy to support anyone throughout that process because I feel like it’s important to have an ally and someone that has experience and all the tools under my belt to help you through that process.
Patrik: That is fantastic. This is a completely new world for me as well.
Kali Dayton: Yeah. It’s big. It’s a lot. And it’s scary to take this on. Even I, as a nurse practitioner, with all my experience, I was really scared to start my clinician podcast because it felt… It’s hard to challenge this big beast. So, I can only imagine as a family member how daunting it is to challenge these concepts and this treatment that everyone else accepts as norm. So please come to us, be prepared with the information to have those conversations and just know that your loved one’s life and quality of life depend on you acting right now at this moment.
Patrik: Yeah. But you are also working with ICU teams directly. You consult ICU teams directly as well.
Kali Dayton: That’s my main focus right now is giving them training. So, I do webinars and then I go on site. I see what’s going on with their teams, how they’re treating patients. We do simulation training. We practice, we pretend to be a patient. We go through case studies and scenarios, and I try to give teams the same tools that I want to give you as far as how to let a patient wake up and be comfortable in ventilator, how to communicate with them, how to prevent delirium, how to stop them from getting so weak, how to make it easier and safer for everyone so that hopefully your loved one walks out of the ICU doors and goes straight home. That’s the vision I’m trying to give to ICU teams and those exact tools, because this is a new concept for them. Please be patient with your ICU teams. They’ve been through a lot throughout the pandemic. There’s a staffing crisis throughout the world. These are new and can be very scary concepts. No one is trying to hurt their patients, but just know that everyone’s a victim of this gap in education.
Patrik: Yeah. Kali, thank you so much for sharing your wealth of knowledge about this topic. Much needed topic, much needed insights for families in ICU, but also for ICU teams. We’ve got to be open to new approaches because like we’ve discussed here, the harm that’s being done to patients and families is huge. It’s huge.
Kali Dayton: I will tell you, I reached out to a team a little bit ago saying, I am looking around at my unit, and I don’t really see ICU patients, they’re all LTAC patients. They’re trached, they’re pegged, but LTACs are too full to take them. But our team is not trained to rehabilitate them. So, we can’t get new patients in. We can’t get them out. They’re stuck. She didn’t say it, but they’re just rotting there. So just know that a lot of people are also aware that this is a crisis throughout our system.
Patrik: Absolutely. And the message, the take home message of this podcast that I got out of it is what we said earlier. You phrased it, what the doctor says, what if he or she takes out her breathing tube? Well, that’s not the question.
Kali Dayton: What if they never walk again? Yep.
Patrik: That’s the take home message for me.
Kali Dayton: I have an episode, I think it’s about 116 of my clinician podcasts, Walking Home from the ICU, about unplanned extubations. I can go on and on about it. If there’s a breathing tube in there, it’s in there for a reason. We want to make sure that stays in there safely, but making someone confused and delirious with sedation drastically increases the risks of pulling that out and making them so weak that they cannot breathe makes that scenario far more dangerous. So, if they pull out the breathing tube, but they’re strong enough to walk and breathe on their own, we can try BiPAP, high flow, we can try other things.
Kali Dayton: Oftentimes, patients don’t have to be re-intubated.
Patrik: Oh, no. And I can confirm that with all the self-extubations that I’ve seen over the years, there would’ve been the odd one where you think, yeah, let’s not re-intubate. Let’s just see how we go with high flow or with BiPAP, and lo and behold, they’re thriving.
Kali Dayton: Yeah. But that is a clinician or nurses’ worst fear. They think it’s completely lethal. It’s an absolute failure on their part. So just understand that is their perception. If I was a loved one and that was my nurse’s fear, I would say, fine. I will stake it out here. I will hold their hands for the next three weeks straight if it means that I can save them from having a brain injury or being unable to walk. Or if that’s what you need to feel safe, let me just be here. I will make sure that they do not pull their tube out. If that’s your biggest fear and hold up to letting sedation come off.
Patrik: Absolutely. All right. Look, what a great podcast, Kali. What a great message for clinicians, but obviously for families in ICU, for patients in ICU, because that is next level, I believe, and it’s much needed insight and a much needed approach to change a health system, a critical care system that is in dire straits.
Kali Dayton: I’m optimistic for the future. I think critical care medicine will change, but if you’re listening to this, it’s because your loved one is in there right now. So, you’ve got to bring that change for your loved one right now.
Patrik: Absolutely. Absolutely. Okay. Thank you, Kali. We probably should continue the conversation in another episode.
Kali Dayton: We will.
Patrik: So obviously, go to, where is it again? Kali Dayton Consulting?
Kali Dayton: Dayton ICU Consulting.
Patrik: That’s the one.
Kali Dayton: Yep.
Patrik: Go there and connect with Kali. You can also reach Kali if you contact us here at intensivecarehotline.com. If you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website, or simply send us an email to [email protected]. Also, have a look at our membership for families in intensive care at intensivecaresupport.org. There you have access to me and my team 24 hours a day in a membership area and via email, and we answer all questions intensive care related. We also can help you with medical record reviews for your loved one while they are in intensive care in real time.
Or we can help you review medical records after intensive care, if you have unanswered questions, if you need closure, or if you’re suspecting medical negligence. But we highly recommend that we review your loved one’s medical records in real time. Thanks for watching this podcast. Subscribe to my YouTube channel, share the podcast with your friends and families. Click the like button, click the notification bell, and comment below what your thoughts are about this episode or what questions you have, and then we can get back to you with your questions and answer them. Thanks again, Kali, for coming onto the show. We’ll talk next time.
Kali Dayton: Great.
Patrik: Thank you.
How can you become the best advocate for your critically ill loved one, make informed decisions, get peace of mind, control, power and influence quickly, whilst your loved one is critically ill in Intensive Care?
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- How to ask the doctors and the nurses the right questions
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- How you need to manage doctors and nurses in Intensive Care (it’s not what you think)
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
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