Walking Home from the ICU PodcastTranslating the ICU with Stephen Ramsey — Series 1, Episode 1

Episode Summary

Kali Dayton officially welcomes Stephen Ramsey — CVICU physical therapist, creator of the Ramsey Protocol, and lead author of the ELSO guidelines — as the newest member of the Dayton ICU Consulting team. In this kickoff episode of Translating the ICU, Kali and Stephen explore why physical therapists and occupational therapists are often rotating generalists in the ICU rather than dedicated specialists, and what needs to change to elevate rehab's impact on critically ill patients.

Key Topics Covered

• ​Introducing "Translating the ICU" — a new podcast series focused on physiology, pathophysiology, and critical thinking applied to real and theoretical ICU case studies
• ​CSM 2024 recap — Stephen’s talks on redefining PT's role in the ICU and point-of-care ultrasound; Kali's panel on what early mobility should actually look like
• ​The case for dedicated ICU rehab staffing — why rotating therapists undermine momentum, relationships, and patient outcomes
• ​PT/OT education gaps in critical care — invasive hemodynamics, pharmacology, diagnostic imaging, and ventilator management are largely absent from training
• ​Competency vs. potential — why redefining practice standards matters more than questioning individual intelligence or capability
• ​Mobility as a physiology test — Steven's framework for PT as "physiology tester," using mobilization to generate clinical data and drive medical decision-making
• ​Johnson 2019 data — dedicated CVICU PT/OT staffing increased from 2 to 4 clinicians → ICU length of stay decreased by 3.6 days
• ​The 2025 meta-analysis (60+ RCTs, ~8,500 patients) — timing matters more than intensity in early mobility
• ​Ventilator management and SBTs — why PTs need to understand spontaneous breathing trials and provide physiologic feedback before extubation decisions
• ​Building trust on the ICU team — demonstrating competency through relationships, not just credentials
• ​Barriers facing revolutionists — fear of mistakes, leadership pressure, staffing rotations, and how to push forward anyway

Resources & People Mentioned

- Steven Ramsey — @ThePOCUSPT | The Ramsey Protocol | ELSO Guidelines

• ​Kali Dayton — DaytonICUConsulting.com
• ​Christina Perme's ICU Rehab Course
• ​Heidi Engel & Jenna Hightower
• ​Johnson 2019 CVICU staffing study
• ​2025 early mobility meta-analysis (60+ RCTs)

Connect & Work With Us

• ​Consult with Kali on transforming your ICU's sedation and mobility practices → DaytonICUConsulting.com
• ​Coaching with Stephen Ramsey — one-on-one or team sessions for ICU rehab staff → www.DaytonICUConsulting.com and @ThepocusPT
• ​Online courses — coming soon from both Kali and Stephen
• ​Critical care ultrasound course for ICU clinicians — available now at ThePocusPT.com

Follow Kali on Instagram for open discussion, anonymous Q&A, and cross-disciplinary ICU conversations.

We know that the ABCDEF Bundle gives patients the best chance to survive and thrive. Yet, persistent hesitation regarding "increased RN workload and burden" remain significant barriers.

Is this belief true? Are sedation and immobility better, easier, and safer for nurses? Let's dive into Awake and Walking ICUs and what's in it for nurses.

Listen to more nurses share their comparison in workload and burden in episodes 76, 114, and 185!

Nursing Video  https://youtu.be/5zBdDVo2pyY?si=eDJxid0A5aWLwc0y

Interested in consulting, training, online courses and/or symposiums in your ICU? Check out www.DaytonICUConsulting.com!

Critical illness impacts not only the patient in the bed but also their entire family during and after the ICU. Eli and Cathy Garrison join us to share their young family's course of twists and turns of an amniotic fluid embolism to long-term disability.

Check out Cathy's podcast at: Birth Trauma Stories

www.DaytonICUConsulting.com

In this groundbreaking episode, Dr. Paul Wischmeyer returns to share the incredible developments in ICU nutrition and rehabilitation that are transforming patient recovery. As both a critical care physician and ICU survivor, Dr. Wischmeyer brings unique insight into what it takes to truly help patients recover from critical illness.www.DaytonICUConsulting.com

Get your CE credits from listening to this episode here: SapienCE

What if we had an expert continually present in the ICU dedicated to caring for the mental and spiritual health of families, patients, and staff in the ICU?

How would this impact stress, grief, and trauma in the ICU?

How would this kind of support impact patient and family experiences, outcomes, and staff morale and burnout?

Stephanie Jacques, LMT, joins us now to share her expertise, experience, and pioneer legacy.

www.DaytonICUConsulting.com

Get CME for this episode at SapienCE!

Erika Breivogel's journey through the ICU as a patient forever changed her as a person as well as transformed the care she now gives as an ICU nurse. In this episode she inspires up with her reflections of ICU culture vs. patient reality and what moves her to keep fighting the ICU revolution.

www.DaytonICUConsulting.com

Get CE credit for listening to this episode and unlimited other learning experiences here: SapienCE Reflecting Learning | Unleash Your Inner Sage

What does verticalization therapy look like at the bedside?

What does it take to get the entire ICU team engaged in optimizing verticalization beds?

Jessica Cafferty, OTR/L and Jennifer Babb, PT, DPT join us to share case studies and insights into verticalization therapy in their ICUs!

Get CE for listening to this episode and more! SapienCE Reflecting Learning | Unleash Your Inner Sagewww.DaytonICUConsulting.com

With the complex mobility needs of patients in the neuro ICU, how did Dr. Tarek Dakakni standardize patient standing for 8 hrs a day?

As acting medical director, how did Dr. Dakakni bring all disciplines together to customize care and optimize outcomes for each patient as a person?

Dr. Dakakni joins us now to share how the ABCDEF bundle looks in his Neuro ICU.

Dr. Dakakni’s verticalization orderset: https://docs.google.com/document/d/1IbWAlHqEVTgHyH1tI7Kp5lVcJw-OSgWJ/edit?usp=drivesdk&ouid=100517257919214330248&rtpof=true&sd=true

Www.DaytonICUConsulting.com

As described in episode 158, verticalization therapy (VT) has vast and powerful benefits to patient care and outcomes.

Having technology to increases access to VT is a big first step towards giving all patient early and routine doses of gravity.

In this episode, Heather M. Fudala, PhD, RN, CCRP, Audrey Roberson, PhD, RN, CPAN, NPD-BC, Elisa Winn, MSN, RN, AMB-BC, CWON, and Alice Peay, DPT, PT, MS join us to share lessons learned during their verticalization therapy study.

Obtain your CE credits for this episodes and other learning experiences with SapienCE!

Www.DaytonICUConsulting.com

A key part of symptom management, agitation management, and humanizing care is communication. Throughout the podcast, we have discussed non-verbal communication during mechanical ventilation.

....but what about non-invasive ventilation? How does the inability to communicate impact care, patient experience, and outcomes for patient on BIPAP?

Dr. Ian Wong shares with us his research and innovation that is transforming communication during non-invasive ventilation.

Randomized Controlled Trial of a Novel Communication Device Assessed During Noninvasive Ventilation Therapy - PubMedAtaia Medical – Empowering Patients with the Freedom to Speakwww.DaytonICUConsulting.com