ICU Liberation with Kali Dayton, NP and Heidi Engel, DPT
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Why have ICU patients traditionally been kept sedated and immobile?
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I'm Emily Silverman and this is the Nocturne's Conversations. For years, staff in the ICU believed that we needed sedation to keep ventilated patients calm. The idea was that the sedation was protecting patients from the discomfort, from the trauma of being critically ill. just a push of propofol, a dose of benzose, and the patient would drift off into what looked like a peaceful sleep. But they weren't sleeping. Not even close. What we didn't realize was that these patients in the ICU were still aware. Their minds, suppressed by medication, were spiraling into terrifying hallucinations. Their breathing tube became an instrument of torture. A routine catheter change felt like sexual assault. Some saw strange figures hovering in the air, people, animals, bizarre visions.
Others thought they were in an airport, a spaceship, somewhere, anywhere, but the ICU. And it wasn't Just the nightmares. Prolonged sedation damaged the brain. Patients woke up weeks later, not just physically weak, but mentally changed, living with symptoms of dementia, PTSD, and a kind of deep existential loss. Many couldn't return to work. Some lost their sense of purpose. We saved their lives in the ICU, but at what cost? Today's guests, Kaylee Dayton and Heidi Engel are leading a movement to change all this. They're fighting to restore consciousness, dignity, and mobility to ICU patients so that they don't just survive, but actually recover. Heidi is a physical therapist with nearly four decades of experience and has spent much of her career pioneering early mobility programs in the ICU.
She's an award-winning leader in the field and a founding member of the Society of Critical Care Medicine's ICU Liberation Campaign. Kaylee, an ICU nurse practitioner, trained in a unique awake and walking ICU under a woman named Polly Bailey, who you will hear more about later in this episode. In the Awakened Walking ICU, patients were kept alert and moving even while on ventilators.
Who was Polly Bailey and how did she change ICU sedation practices?
And when Kaylee later worked as a travel nurse, she was shocked to see how sedation was being overused, leaving patients with devastating long-term effects. She now works with ICUs around the world to shift their approach and hosts the amazing Walking Home from the ICU podcast, which takes a deep dive into this issue and features over 150 episodes with the voices of clinicians, survivors, and other experts. Together, Heidi and Kaylee are here to talk about the culture of sedation in the ICU, why it needs to change, how we can start treating ICU patients in a way that's more humanizing, connecting, and healing, and how Kaylee's work with her podcast and storytelling has helped her understand the issue better and spread the word about ICU revolutionism.
But before we dive in, let's take a listen to this excerpt from Kaylee's podcast, Walking Home from the ICU.
Suddenly she interrupted my thoughts with, You were so mean. You made me walk when I was tired and scared, and I thought I hated you. Yeah, I couldn't deny that. And I didn't know how to smooth that conversation over when suddenly she reached over her walker and had me in a bear hug and said, You saved my life, and I love you. That moment penetrated me. I remembered that her main goal and focus was to get home. What she meant by you saved my life was not that I just kept her on the ventilator. She got back to what her life meant to her. She had the value. She went home to her partner and her dogs. She taught me that that is what it means to save a life. This survivor friend understood before I did that saving lives in the ICU is done by preserving function and allowing a full restoration of their lives as a whole.
That is what this podcast. is all about. It is about how to save lives, not just specific organs.
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Chapters
8 chapters
1
Why have ICU patients traditionally been kept sedated and immobile?
0:00–2:36
2
Who was Polly Bailey and how did she change ICU sedation practices?
2:36–10:48
3
What is the Bailey method of an awake‑and‑walking ICU?
10:48–22:16
4
How does early mobility affect patient outcomes and delirium?
22:16–32:31
5
What challenges do clinicians face when trying to reduce sedation in the ICU?
32:31–43:38
6
How did COVID‑19 reshape sedation practices and ICU culture?
43:38–54:15
7
What role does the ‘Walking Home from the ICU’ podcast play in the liberation movement?
54:15–1:03:27
8
How can hospitals nationwide adopt the awake‑and‑walking ICU model?
1:03:27–1:07:11