Episode 219: Rethinking ICU Sedation with Dr. Wes Ely

Dr. Ely, thanks for joining us.

Do you mind introducing yourself to us?

I'd be happy to introduce myself, and I first wanna thank all of you who were there at the meeting for caring so much about our patients and about improving the way that we care for patients who are critically ill, and by extension, patients we will never even meet because what you do today will affect the culture of how your patients in your institutions are cared for.

And then down the line, even when you finish, if you help create that new and healthy culture of critical care, when you're done and gone, future patients will get better care as well.

My name is Wes Ely.

You can see I'm an older, gray-haired physician.

I am, I'm, I've been practicing medicine for 30 years.

I'm 62, and I'm a critical care professor at Vanderbilt University and at the VA here.

So I work in both of the institutions here.

And we've been doing research for around 30 years in the area of delirium, sedation, mechanical ventilation, protocolization for patients who have severe sepsis, ARDS, or any need for critical care.

And over my years as an investigator, both as, uh, as a scientist and a physician, it's been a privilege to be part of some of the instrumental clinical trials and observational cohort studies which have helped us to understand how do you measure delirium.

How do you predict whether or not somebody is going to have long-term cognitive or functional impairment after the ICU, what we now refer to as the post-intensive care syndrome.

And how do we make changes that improve upon what had become a malignant normality.

Let's use a term that actually adequately describes how far off course we got.

When, when ICUs were founded in the 1950s and '60s, for the next 40 years, it evolved using what we thought were benevolent ways of caring for human beings, but it wasn't actually benevolent.

We proved through thousands and thousands of patients and hundreds of clinical trials that we were being malevolent.

We were creating injury in human beings who were being cared for in the critical care units.

And I refer to what I even did myself as a malignant normality, accepting the status quo as good enough.

And let's be clear what that status quo had become.

Deep sedation, prolonged immobilization, treating patients as if they were inanimate objects in the ICU and leaving them with an acquired brain injury and acquired muscle and nerve disease that affected them for many years to come, maybe even for the rest of their lives.

And I remember I had a young woman who was a mother of three who pointed her finger at me and said, "Dr.

Ely, you didn't do your job." I can't care for my children anymore.

I've had to retire early, and I'm in my late 30s, and I can't care for my family anymore.

You didn't do your job." And I felt very convicted because I knew that I had contributed to her ongoing injury in life.

And there is a better way, my friends, and you're learning about it at this course.

Dr. Ely, thanks for joining us.

Do you mind introducing yourself to us?

I'd be happy to introduce myself, and I first wanna thank all of you who were there at the meeting for caring so much about our patients and about improving the way that we care for patients who are critically ill, and by extension, patients we will never even meet because what you do today will affect the culture of how your patients in your institutions are cared for.

And then down the line, even when you finish, if you help create that new and healthy culture of critical care, when you're done and gone, future patients will get better care as well.

My name is Wes Ely.

You can see I'm an older, gray-haired physician.

I am, I'm, I've been practicing medicine for 30 years.

I'm 62, and I'm a critical care professor at Vanderbilt University and at the VA here.

So I work in both of the institutions here.

And we've been doing research for around 30 years in the area of delirium, sedation, mechanical ventilation, protocolization for patients who have severe sepsis, ARDS, or any need for critical care.

And over my years as an investigator, both as, uh, as a scientist and a physician, it's been a privilege to be part of some of the instrumental clinical trials and observational cohort studies which have helped us to understand how do you measure delirium.

How do you predict whether or not somebody is going to have long-term cognitive or functional impairment after the ICU, what we now refer to as the post-intensive care syndrome.

And how do we make changes that improve upon what had become a malignant normality.

Let's use a term that actually adequately describes how far off course we got.

When, when ICUs were founded in the 1950s and '60s, for the next 40 years, it evolved using what we thought were benevolent ways of caring for human beings, but it wasn't actually benevolent.

We proved through thousands and thousands of patients and hundreds of clinical trials that we were being malevolent.

We were creating injury in human beings who were being cared for in the critical care units.

And I refer to what I even did myself as a malignant normality, accepting the status quo as good enough.

And let's be clear what that status quo had become.

Deep sedation, prolonged immobilization, treating patients as if they were inanimate objects in the ICU and leaving them with an acquired brain injury and acquired muscle and nerve disease that affected them for many years to come, maybe even for the rest of their lives.

And I remember I had a young woman who was a mother of three who pointed her finger at me and said, "Dr.

Ely, you didn't do your job." I can't care for my children anymore.

I've had to retire early, and I'm in my late 30s, and I can't care for my family anymore.

You didn't do your job." And I felt very convicted because I knew that I had contributed to her ongoing injury in life.

And there is a better way, my friends, and you're learning about it at this course.