How to 'Awake and walk' ICU patients?

[Dr-Junior]

Hello,

recently I'm getting more aware and frankly fascinated of the idea of walking patients while they are intubated. Now the question is how do you get patients tolerate their tubes without gagging and be agitated. I would love to hear about current practices. Maybe I can implement that one day on my ICU.

Thanks in advance.

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[deleted547339]

Hello,

recently I'm getting more aware and frankly fascinated of the idea of walking patients while they are intubated. Now the question is how do you get patients tolerate their tubes without gagging and be agitated. I would love to hear about current practices. Maybe I can implement that one day on my ICU.

Thanks in advance.

We don’t do it. We extubate most people so soon that they won’t be well enough to walk. Ecmo is usually the exception but I don’t work in a cticu anymore.

 

[deleted547339]

We do put intubated people in the chair all the time though. Nurses hate it.

 

[chessknt]

Covid ruined any progress made on that front. Half the time we barely have enough nurses to keep the unit functioning let alone do **** that requires 1:1 care that isn't urgent like a scan.

 

[Dr-Junior]

We do put intubated people in the chair all the time though. Nurses hate it.

What do you use usually for sedation when doing that?

 

[deleted547339]

What do you use usually for sedation when doing that?

You don’t. Some enteral analgesia should be adequate.

 

[SurfingDoctor]

While I like the idea... I think delirium is overrated and one ability to survive critical illness is more or less independent of how many step they can take intubated (other than that is a marker is severity of illness).

 

[Radetzky]

Extubate or tracheostomise

 

[Siggy]

I like the idea, but all of the issues has been mentioned

1. Rare is the patient who is intubated and tolerating no/minimal sedation who wouldn't be better served by extubation. It certianly happens, but its rare and they're generally poor rehab candidates at that stage anyways (either neuromuscular diseases with significant progression or some sort of airway issue in patients who tend to be fully functional anyways).

2. Most of the times I've seen pictures, there's a dedicated nurse, PT, PT assistant, and RT for the vent walk. Most community hospitals do not have the staffing for that.

 

[PTPoeny]

The one time it worked well for me was someone intubated for heart failure. They didn't need high settings and didn't have baseline anxiety both of which help.