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Every Deep-Drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine i...

Wes Ely

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Dec 29, 2023 Nic rated it really liked it

Shelves: nonfiction, medical, science, catholic, icu-care

It is important to stop treating family as visitors to the ICU and to include them as part of the care team, as essential workers, especially during unprecedented times. They are not a luxury but are part of the treatment plan. p 222

If someone had asked me when I was a young doctor about the most important aspects of critical care, I would eagerly have talked about ventilators and vasopressors, and moving patients out of shock and onto life support. I would never have imagined that one day I mig It is important to stop treating family as visitors to the ICU and to include them as part of the care team, as essential workers, especially during unprecedented times. They are not a luxury but are part of the treatment plan. p 222

If someone had asked me when I was a young doctor about the most important aspects of critical care, I would eagerly have talked about ventilators and vasopressors, and moving patients out of shock and onto life support. I would never have imagined that one day I might answer figs, or honey on a spoon, or a bar of music. 245

The more I study and read about all things medical, the more I'm humbled by the vastness of the information; there's so much to know. It's no wonder providers specialize, to focus intensely on a specific area of medicine. Wes Ely focuses on the pulmonary and ICU patients. He's humble, patient, and constantly seeking for the best path, the evidence based, best practice. This book represents his great work and contribution in this arena.
Four stars as transitions are sometimes abrupt and therefore momentarily confusing. Also, the quotes sometimes feel excessive and can become distracting. Although, the quotes do also serve to describe Wes Ely's foundational love of literature and English, contributed to his mother.
Wes Ely, thankfully, has shown how sedation, immobilization, delirium, and isolation of ICU ventilated patients leads to post-intensive care syndrome (PICS). His life's work has been dedicated to avoiding PICS and possible long term cognitive issues, similar to dementia. He faced resistance to change, with the new protocols he proved worked, to prevent and minimize PICS. Here is a clip demonstrating some of Ely's initiatives: Ely's work
Other amazing tidbits:
Gill slits!! The COVID patients suffer so many unexpected complications...As if that weren't enough, several developed an unusual pattern of air leaking inside their besieged bodies. It's something I've rarely seen to such an extent. Our three current patients with this subcutaneous emphysema are deformed by air seeping throughout their chest, abdomen, and even their face, their eyelids and genitalia puffed up with air, beyond recognition...The amount of air escaping through trapdoors is at a dangerous level, misshaping their bodies with every whoosh from their ventilators...We consulted with thoracic surgeon Dr. Matthew Bacchetta....He'd used a technique called gill slits...Learning from him, that's what we do now. Two incisions in the patient's skin, above the nipples, to allow just enough of the leaking air to escape slowly back into the atmosphere. pp 29-30

On the importance of early mobility: "If you do not make her walk, she's going to die. But if you get her up, she's going to live. It's that simple." 150

His work had helped reveal that for every day spent inactive in the ICU, two or more weeks of activity were needed to rebuild that muscle...Only once the patient moved again did the body begin to replenish that store of muscle. p 151

In her thoughtful and urgent book Elderhood, geriatrician Dr. Louise Aronson highlights the negative effects of loneliness on well-being, especially among older people, and cites a paper that proves the impact of social isolation on our health is equivalent to smoking fifteen cigarettes a day. When all else is medically equal, loneliness increases mortality by 26 percent. p 222 Which leads me to wonder how much loneliness should be factored into the mortality rate of Covid.

Early in the pandemic, we studied more than two thousand COVID-ICU patients in fourteen countries, and the science showed that overuse of benzodiazepines and underuse of families at the bedside were contributing to delirium and death. 236

I could go on and on. This good read should be required reading for all those working in ICUs. ...more

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Aug 05, 2023 Billie Dion rated it really liked it

Nov 02, 2023 Richie rated it really liked it

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