Nowadays, ICU patients often experience unbearable sedation, cessation and inevitable fear, which are accompanied by the lack of groundless treatment.

Unfortunately, most of these patients could not survive, and even more people were deprived of the ability to thrive when they left the ICU and the ICU.

But when the ICU team members understand and apply the proven practice, even the most painful ICU will have a glimmer of hope for hospitalization.

Nevertheless, the cases I will record are disturbing and difficult to digest, but the practice of evidence shows how to significantly improve the prognosis of ICU patients.

This study involves the first woman to understand that managing the power grid in the ICU and implementing initial activities in the ICU can actually save lives.

Her name is Megan. This is her story.

The method of saving Megan’s life with fiber mesh therapy in ICU

Megan Wakley is a 32 year old female with a history of malnutrition, post-traumatic stress disorder, alcohol dependence, benzoic acid, marijuana and cigarette use.

He was admitted to an outdoor hospital due to alcoholic leukopenia pneumococcal septicemia(ALPS), and immediately intubated for mechanical ventilation.

She developed necrotic and comorbid pneumonia, septic shock, alcohol withdrawal, and ARDS(acute respiratory distress syndrome).

Then deep sedation and fixation were carried out within 7 days, and the condition continued to deteriorate.

The ICU team who treated her began to discuss various options, such as comfort care, with Megan’s family. So we decided to transfer Megan to the “Awakening and Walking ICU”

After reaching the “Awakening and Walking ICU”, Megan also used methazolam and fentanyl for sedation, and set the ventilator as a vasopressor for auxiliary control, with PEP of 14 and FIO2 of 60%.

Once the “Awakening and Walking ICU” team knew Megan’s current ventilator installation and vasopressin requirements, and her oxygenation and hemodynamics were stable, they immediately focused on the overall situation.

They recognized that Megan was in danger of septic shock and severe respiratory failure due to necrotic and concomitant pneumonia and ARDS, and recognized the need to treat this situation and prevent further complications.

In addition to acute infection, Megan also has important risk factors that lead to adverse outcomes such as weakness and fiber mesh in the acquired intensive care unit, which may reduce her survival probability.

Nevertheless, let’s see how Megan’s experience is related to the common diseases of ICU patients, and how the ICU team members who treat her can alleviate these problems by understanding the practices brought about by evidence.

ICU acquired weakness

Megan was malnourished at baseline, which may double his hospital stay and medical expenses. His chance to discharge as a nursing institution will further increase the risk of weakness and death in the ICU.

The development of sepsis and septic shock also significantly increased her risk of rapid muscular atrophy and acquired weakness in the ICU.

In addition, Megan stopped for 7 days under sedation, and her lost muscle mass and use may pose a threat to her survival.

Fortunately, the ICU team who treated her knew that the more muscles and functions Megan lost, the longer he stayed in the respiratory tract, the greater the possibility of death, and the more difficult it was to recover.

At the same time, his quality of life will be affected by physical defects in the coming years.

Nevertheless, they knew that they must immediately stop muscle atrophy and begin to rebuild muscle quality and function.

Fiber mesh

Megan developed septic shock after abstaining from alcohol and remained calm for 7 days.

Because of all these factors, the probability of her silently suffering from traumatic fibrillation during the sedation is incalculable.

The study showed that Megan’s baseline PTSD increased the risk of PTSD after ICU. Her ICU nursing team worried that although she seemed to be sleeping, she could vividly recall the traumatic events that led to the initial PTSD, which might worsen her mental function and mental health after the ICU.

The fear of Megan in the “Awakening and Walking ICU” group. It is worth mentioning that they consider that there is evidence every day that phobia increases her risk of death by 10%.

In addition, they also know that the research results show that the power grid will triple the risk of hospital death, and there is evidence that mental disorder within six months after discharge will triple the risk of death.

They also know the evidence, which frees her from calmness and fear, and is important for improving her chances of survival and growth.

Fortunately, Megan’s ICU nursing team realized that by applying the ABCDEF bundle to Megan’s care, the following could be achieved:

Her ICU readmission risk is halved

Network and coma days reduced by 25-50%

Reduce the use of body restraint by more than 60%

68% reduction in hospital death probability within 7 days

Sanatorium/rehabilitation facilities reduce discharge opportunities by 40%

Please help Mei Genzhen to walk.

Ultimately, their goal was to wake Megan up and get on the ventilator. So that she can finally get out of the ICU and resume her life.

The first step to achieve this goal is a real vacation.

Unfortunately, Megan’s painful overactivity lapses were exposed when they gradually reduced their intake of imidazolam and fentanyl.

She was excited and active. In order to reach out and pick up the endotracheal tube, she overcame the bondage and quickly bit off the endotracheal tube. So she finally had to re intubate urgently.

Induce sedation when changing the tube, and the group discussed their strategy.

They didn’t think it was a real vacation of failure, but they realized that Megan’s accident was an emergency.

They knew that continuous deep sedation could aggravate and prolong her cilia, realized that cilia were a life-threatening disease, and made plans to help Megan overcome cilia.

At this time, they realized that Megan had used benzoxazoles and midazolam at the baseline, and he needed benzoxazoles.

On the other hand, they knew that deep sedation with benzodiazepines such as imidazepam would increase his risk of death.

Therefore, they decided to give her chlorphene through the food tube to relieve anxiety and meet the requirements of benzodiazepine.

In addition, they decided to replace propofol with imiprazole diazepam and mate with umitopetine.

The ultimate goal is to ensure that Megan is fully awake and alert, including the following major interventions, to take major interventions on the grid.

mobility

Family participation

Real sleep(not real)

Drugs to avoid causing toads

The ICU nursing team realized that although her family was present, if she took a deep sedative, it would not help her return to reality. They know they can’t move and really sleep after using sedatives.

Taking these factors into account, they allowed her to wean after using propofol, take only the right medetomidine, and obtain a RASS score of 0 to+1.

As long as she is sober enough and stays within the target range of RASS, they will immediately let her stand up and walk.

Megan was clumsy and weak at first and needed support. Every time I walk, I am exhausted and go to bed immediately.

Fortunately, Umetomidine and fentanyl can be stopped. She was still unconscious, but her anxiety and insecurity began to improve.

The next day, she began to write on the blackboard. For example: “Where is my daughter?” “Where is my dog?” So her family brought her dog to ease her anxiety.

After a few days, her fear disappeared, she could not be restrained, and her anxiety was controlled by her family, behavior and low-dose of clonorphine.

She needs to install the chest tube on the common pneumonia and adjust the respiratory system settings, including the PEEP18 and FIO2 100% of the ARDS.

Somehow Megan got rid of his composure and fear and continued to walk.

If you want to know more about Megan, you can see my podcast of episode 71 of Going Home from the ICU.

What about Megan?

Megan spent more than a month mechanically passing through the air, which is a long time compared with most patients in the “awakening and walking ICU”.

Her lungs were severely damaged. She really needed bronchostomy for night rest(rare in “awake and walking ICU”).

She was sent to the Long term Acute Care Hospital(LTACH) because of her unknown fear of patients with novel coronavirus pneumonia who entered the ICU for the first time.

He left the intensive care unit and breathed independently through tracheostomy. He stayed in LTACH for only one week, pulled out the tube, and returned home to be reunited with his family.

Megan told me in my podcast “Walking Home from the ICU”: He thanked for being allowed to walk soberly during his stay in the ICU, and for being able to continue his life with his daughter.

She firmly believes that her life can be liberated from the fear of insanity, awakened from critical illness, and remain vigilant.

Do you want to know more about how ICU island network management can greatly improve patient outcomes and working conditions in the ICU? If you are ready to do the best for the patient, ICU team and your final route, we are ready to help. We will guide you through the whole process, please do not hesitate to contact us.