Hello and welcome back to ACRAC. I'm Jed Wolpa and I'm really thrilled to have back with me today of fantastic guest who has been on the show before.

I'm really excited to talk about her work with getting patients up and walking and mobilized in the ICU even when they are intubated and we had a really interesting discussion.

And over the past few years, even through COVID, she's done even more amazing work on this. And so I'm really happy that she agreed to come back to the show to talk about what she's doing and how she's helping ICUs really across the country to engage in this really important work.

I'm excited to talk about it. Callie, welcome back to the show. Thanks for having me. So let's start by talking about what kind of transition has happened in your work over the past, you know, few years since we talked last, you're really doing a ton of this and just tell us a little bit about how that evolution happened.

Well, I started my career 10 years ago as a brand new nurse in an awakened walking I see you and I thought that was completely normal to have patients awake shortly after innovation, you know what was patients, there were some exceptions, but the protocol there is you don't even hang probable fall after innovation and you just let them wake up and we mobilized them shortly after and I thought that was I thought that was critical care medicine.

Then after a few years, I became a travel nurse and I was shocked to find that that was the opposite and every other ICU I worked in and they couldn't even fathom what I was talking about as far as having patients awake and walk into the ventilator.

So that's when I really saw this huge gap in education, even within myself, I knew how to take care of patients that were awake and walking, but I didn't know why I didn't understand patient perspective.

So my experiences as a travel nurse in contrast to the awakened walking I see you really left me with this big question mark as to why our practice is so different and I could see the difference and outcomes as well.

And so I returned to the waking walking I see you during my doctorate studies and started working there as well as a nurse practitioner after and I really started to dive into the research and I kept thinking if the ICU community knew the research patient perspective,

I started talking to survivors, I just kept feeling like we would make these changes if we understood the why and understood how much easier it is to care for patients this way.

So I started the podcast in boy at the beginning of 2020, not knowing that the pandemic was coming and then it hit and it ended up just being mostly for the pandemic.

It was extremely relevant to have this discussion and to be exposing the research behind the ABCDF bundle minimize and sedation patient perspective to learn things like that during the pandemic, but it was obviously it was a hard time to adapt and to flip practices like that, though it would have been the most beneficial time to do it.

But as the pandemic has improved teams are suffering from the changes in practices that we experience during the pandemic, the deep sedation, the complete immobility and they're tired of it and there are systems broken in large part because of how we've treated patients and so now it's turned into the opportunity to help teams change their practices.

So now I work as a consultant and I try to help ICU teams understand the why and how to create a waking walking I see is.

That's great, really, really great work and important work, I want to touch on you mentioned the ABCDF bundle and we're going to talk about that, but maybe just define that for people so we can have that established up front.

It's a protocol and this acronym stands for a assess and manage pain, be both spontaneous and awakening trials, see choice of analgesia and sedation, e early mobility and F family engagement and we'll get into what the ultimate goal is, but it's just it's a protocol, but a very general outline to help us hopefully customize our approach to sedation and mobility management for each patient.

For the ultimate goal of having them and have the best chance to survive and thrive.

Great, now when you go around and you're doing this consulting, what do you see as kind of the spectrum of people using this bundle and kind of keeping to it?

Is it pretty widespread? Is it not? Is it very based on, you know, location? What do you see?

I see a huge spectrum of compliance with the ABCDF bundle.

Some teams are still running medallion drips on most anticipated patients and don't do awakening trials until weeks later, once they have a tracheostomy.

Some do awakening trials, only once the ventilator settings are minimal, some do awakening trials most of the time, some hardly ever sedate their patients and walk most their patients, there's just a huge spectrum, even within the same kind of patient population, even within the same area, for example.

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