Creating a Culture of an Awake and Walking Intensive Care Unit: In-Hospital Strategies to Mitigate Post-Intensive Care Syndrome

Kali Dayton; Heidi Lindroth; Heidi J Engel; Mikita Fuchita; Phillip Gonzalez; Peter Nydahl; Joanna L Stollings; Leanne M Boehm

doi:10.1016/j.ccc.2024.08.002

Creating a Culture of an Awake and Walking Intensive Care Unit: In-Hospital Strategies to Mitigate Post-Intensive Care Syndrome

Crit Care Clin. 2025 Jan;41(1):121-140. doi: 10.1016/j.ccc.2024.08.002. Epub 2024 Sep 16.

Authors

Kali Dayton¹, Heidi Lindroth², Heidi J Engel³, Mikita Fuchita⁴, Phillip Gonzalez⁵, Peter Nydahl⁶, Joanna L Stollings⁷, Leanne M Boehm⁸

Affiliations

¹ Dayton ICU Consulting, 13816 East 41st Avenue, Spokane, Washington 99206, USA.
² Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA; Center for Innovation and Implementation Science and the Center for Aging Research, Regenstrief Institute, School of Medicine, Indiana University, 1101 West 10th Street, Indianapolis, IN 46202, USA.
³ University of California San Francisco Medical Center (UCSF), 400 Parnassus Avenue A68, San Francisco, CA 94143, USA. Electronic address: https://twitter.com/HeidiEngel4.
⁴ Department of Anesthesiology, Division of Critical Care, University of Colorado Anschutz Medical Campus, 12401 East 17th Avenue, 7th Floor, Aurora, CO 80045, USA. Electronic address: https://twitter.com/mikitafuchita.
⁵ VitalGo Systems, 3315 Commerce Parkway, Mirimar, FL 33025, USA.
⁶ Nursing Research, University Hospital of Schleswig-Holstein, Arnold-Heller-Str 3, 24105 Kiel, Germany; Institute of Nursing Science and Development, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria.
⁷ Department of Pharmaceutical Services, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA; Vanderbilt University School of Nursing, 461 21st Avenue South, 419 Godchaux Hall, Nashville, TN 37240, USA.
⁸ Vanderbilt University School of Nursing, 461 21st Avenue South, 419 Godchaux Hall, Nashville, TN 37240, USA; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center at Vanderbilt, Nashville, TN, USA. Electronic address: leanne.boehm@vanderbilt.edu.

PMID: 39547720
DOI: 10.1016/j.ccc.2024.08.002

Abstract

The ABCDEF bundle and Awake and Walking intensive care unit (ICU) approach aim to prevent the long-term consequences of critical illness (ie, post-intensive care syndrome) by promoting patient wakefulness, cognition, and mobility. Humanizing the ICU experience is the key, preserving patients' function and autonomy. Successful implementation requires cultivating an ICU culture focused on avoiding sedatives and initiating prompt mobilization, addressing organizational barriers through tailored strategies. Overall, these patient-centered, mobility-focused models offer a holistic solution to the complex challenge of preventing post-intensive care syndrome and supporting critical illness survivors.

Keywords: ABCDEF; Awake and walking; Bundle; Critical care; Intensive care unit; Post-intensive care syndrome.

Publication types

Review

MeSH terms

Critical Care / methods
Critical Illness* / therapy
Humans
Intensive Care Units* / organization & administration
Organizational Culture
Wakefulness
Walking*

Supplementary concepts

postintensive care syndrome