The ABCDEF Bundle: Part 2
To navigate our future, we must first understand our past.
This picture is from 1970 at San Francisco General Hospital. It was not uncommon for intubated patients to be walking. In fact, medically-induced comas were not yet a thing.
Granted, these were not the same high-acuity and complex patients that fill our ICUs today. However, in the 1970's, a breathing tube did not equal sedated and lifeless.
It was ARDS experimentation in the 1990's that forever changed ICU culture. They suspected that ARDS patients needed MORE volume and MORE pressure from the ventilator and so patients received 12ml/kg of tidal volume. That is 2-3 times what we give now.
Understandably, patients could not be awake and compliant with their lungs blown up at such incredible levels with unsophisticated ventilators and the old stiff endotracheal tubes. So, we sedated them.
The assumption was that since patients have amnesia under sedation for a few HOURS in the OR, patients in the ICU would enjoy the same benefit for a few days-weeks. They were still with their eyes closed, so they must be "sleeping".
Without realizing the life-altering and life-ending harm of prolonged sedation, this practice spread like wildfire.
Once the research caught up, it was too late. The culture was set. Everyone expected every intubated to be comatose.
In the 1990's a visionary nurse, Polly Bailey, asked, "Why? Why not? What if?". She challenged the norm and founded the "Awake and Walking ICU" process.
As Wes Ely mentions in his book, "Every Deep Drawn Breath", Polly helped early mobility pioneers such as Dr. Ely and Dr. Dale Needham understand what was possible and best for patients on mechanical ventilation.
This inspired the creation of the ABCDEF Bundle.
Listen to episode 170 of the podcast, "Walking Home From the ICU" for a guided tour through the history of critical care medicine, 30 years of research, and the future of Awake and Walking ICUs.
Link to episode in the comments.
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Experienced Adult and Pediatric Cardiovascular Perfusionist and Consultant
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