Walking Home From The ICU

Dr. Wes Ely, critical care professor at Vanderbilt University and the VA, sits down with Kali and Heidi Engel, DPT for a deep dive into the history and evolution of the ABCDEF bundle — the ICU care protocol that transformed how we treat critically ill patients.

In this conversation, Dr. Ely traces the origins of spontaneous breathing trials (SBTs) and spontaneous awakening trials (SATs) back to the 1990s, when every ICU patient was placed on benzodiazepine and opioid drips as a matter of course. He explains how standardizing the weaning process cut ventilator days by two, halved complication rates, and saved $5,000 per patient — and how the landmark ABC trial, published in *The Lancet*, became the first study to demonstrate a life-saving benefit from stopping sedatives entirely.

**Key topics:**

- The "malignant normality" of 40 years of deep sedation and prolonged immobilization in ICUs

- Why "sedation vacation" is the wrong term — and why sedation should be shut off completely, not weaned

- The number needed to treat of seven: one in every seven patients survived at one year thanks to the ABC protocol

- How CAM-ICU and ICDSC gave clinicians the tools to measure delirium starting in 2001

- Janet Keith's remarkable story: walking on a ventilator after 50% facial removal from necrotizing fasciitis

- A COVID-era story of a postpartum ARDS patient whose survival hinged on waking up to see her husband

- Why the full bundle must be implemented together — not "one letter at a time"

- The "holy trinity" of ICU recovery: remove sedation, mobilize the patient, and engage family

- Practical implementation advice using PDSA cycles: start with one bed, one nurse, one patient, and expand from there

- The ethical imperative of *primum non nocere* and the difference between benevolence and beneficence

Tidewater AACN Chapter Awake and Walking ICU Symposium: https://tidewateraacn.nursingnetwork.com/nursing-events/152356-tidewater-aacn-presents-all-hands-on-deck-2027-critical-care-symposium#!info

www.DaytonICUConsulting.com

Kali Dayton introduces the Walking Home From the ICU podcast’s focus on creating awake, mobile, humanized ICUs through high reliability systems, then interviews high reliability expert Alan Bennett, who shares how his work in patient and workforce safety became personal.

Alan describes seeing prior safety and mobility initiatives he helped implement—like CorTrac feeding tube guidance, pressure injury prevention devices, and cardiac chair use—directly support Nate’s care, and emphasizes that clinicians’ work leaves a legacy that may one day affect their own loved ones. He highlights empowering interdisciplinary rounds, family inclusion and overnight presence, delirium challenges, communication tools, early psychiatric evaluation leading to a bipolar I diagnosis and treatment, and end-of-life moments made meaningful through compassionate, reliable teamwork

Check out how Alan used Cartridge.com to share Nate's journey with his community during his time in the ICU: https://www.caringbridge.org/site/f42c9509-ffa7-11ef-84b9-27fb4887a222

www.DaytonICUConsulting.com

00:00 Welcome to the ICU Revolution

01:01 Why High Reliability Matters

03:14 Meet Alan Bennett

05:20 Nate’s ICU Journey

07:27 Legacy of Safety Work

10:08 Being a Family Teammate

19:58 Delirium and Sedation Tradeoffs

25:11 Communication and Connection

29:59 Faith Psychiatry and Meaning

38:16 Humanizing End of Life Care

43:25 High Reliability Explained

45:13 Culture Burnout and Retention

48:44 Tech Can’t Replace Nurses

52:09 Legacy Message and Closing

Revolution in sedation, delirium, and mobility culture in the ICU requires more than a memo, grand rounds, or a weekend symposium.

Leaders who provide minimal support without teaching teams the how and why but expect a drastic change in care and outcomes risk a mutiny.

Leadership and implementation strategy can inspire innovation, humanity, and transformation OR can leave clinicians bitter, burned out, and shut down.

Listen to the insights from revolutionist’s concerns about their leaders' current implementation attempts.

⁠www.DaytonICUConsulting.com ⁠

Posting a video about the role of communication for sedation management to help prevent post-ICU syndrome sparked important discussion and the sharing of valid concerns.

@pulmtoilet comes back to the podcast to address the cultural and educational roots of the the current state of affairs to dissect why communication prior to sedation is a hot topic in the ICU community.

Follow @pulmtoilet and check out Dr. Ghionni's YouTube channel with incredible content on ventilator management!

Find the agitation algorithm here!

www.DaytonICUConsulting.com

From 180 lbs at peak athleticism, intelligence, and financial prosperity — to 120 lbs, isolated and locked in his penthouse. Anjan Chatterjee tells the harrowing reality of life during and after prolonged sedation in the ICU.

Most people think surviving the ICU is the hard part. For Anjan, it was only the beginning.

On August 14th, 2022, a routine run ended with a slip, a fall, and a traumatic brain injury that left him clinically dead — resuscitated only because his dog, Kingston, wouldn't stop barking. What followed was two weeks in a medically induced coma, seizures, facial fractures, and a mind that couldn't tell dreams from reality.

He woke up convinced he'd been arrested, shot at by police, and sentenced to death. He burst through hand restraints. It took 14 nurses to hold him down. Then he was discharged — to a psychiatric ward — still hallucinating, still terrified, and completely alone.

"I sat in this lavish penthouse, and I was a prisoner. I didn't talk to a single soul for six months."

In this episode, Anjan opens up about the psychological and physical toll of post-ICU syndrome — the delirium, the 60-lb muscle loss, the cardiac deconditioning, the brain fog, and the crushing isolation that followed. No referrals. No support. No one who believed him. Just a man, his trauma, his dog, and four walls at the top of a building.

This is a story about what it really means to survive — and what it takes to actually come back.

Stay tuned for upcoming online courses!

www.DaytonICUConsulting.com

Walking Home from the ICU

Translating the ICU with Stephen Ramsey Part 2: ICU Case Study

Guest: Stephen Ramsey, PT

In Part 2 with Stephen Ramsey, physical therapist and ICU mobility expert, the discussion dives into a complex cardiothoracic ICU case Stephen presented at APTA's CSM conference.

Using the MENTOR framework, Stephen walks through how rehab clinicians should approach critically ill patients — from chart review to interdisciplinary communication to real-time clinical decision-making.

A structured approach for PT/OT clinical reasoning in the ICU:

• M – Map the Story: Thorough chart review and understanding the patient's full history
• E – Expose the Unknowns: Identify gaps and questions before entering the room
• N – Narrate Your Reasoning: Verbalize your clinical thinking to colleagues and the medical team
• T – Test the Theory: Treat PT/OT as an assessment, not just an intervention — mobilize to observe physiologic response
• O – Observe for Signals: Monitor real-time hemodynamic and respiratory responses
• R – Review with the Team: Debrief after every session, whether it went well or not

Stephen walks Kali and the audience through a real case study using the MENTOR framework.

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