Speaker 1: It's the big take from Bloomberg News and I Heart Radio.
Speaker 1: I'm West Cassova today. How COVID exposed the dangers of
Speaker 1: heavily sedating patients in the hospital. In the early days
Speaker 1: of the COVID pandemic. This is before vaccines, people with
Speaker 1: severe cases who went to the intensive care unit were
Speaker 1: often placed on ventilators to keep them alive. Doctors heavily
Speaker 1: sedated many of these patients so they could stay calm
Speaker 1: and rest, and that invasive treatment helped a lot of
Speaker 1: COVID patients survive, but it came at a cost. Being
Speaker 1: under it on heavy drugs for days or weeks has
Speaker 1: now left many of them with lasting physical and mental
Speaker 1: health impairments. I did not sleep well. I would get
Speaker 1: panic attacks during the day, and I didn't attribute them
Speaker 1: to PTSD or anything. I just figured I've been through
Speaker 1: this and now it's just sort of trailing off into
Speaker 1: the sunset. That's Kelly McCarthy. She spent weeks on a
Speaker 1: ventilator as a result of COVID and lived, but she
Speaker 1: now faces a very different life. We'll hear more of
Speaker 1: her story a bit later. First, a conversation with Dr
Speaker 1: Wes Ealie He's a pulmonologist and critical care physician at
Speaker 1: Vanderbilt University Medical School, and he's seen up close the
Speaker 1: effects of sedation on patients. He's also the author of
Speaker 1: the book Every Deep Drawn Breath, A Critical Care Doctor
Speaker 1: on Healing, Recovery, and Transforming Medicine in the i c U. Doctor.
Speaker 1: In the early days of COVID, very sick patients were
Speaker 1: going to the hospital and doctors were trying to figure
Speaker 1: out what to do. There weren't a lot of answers,
Speaker 1: and sometimes people were being very heavily sedated. You've spend
Speaker 1: decades studying the effects of sedation. Can you explain the
Speaker 1: difference between the proper use of sedation and when it's overused? Yes,
Speaker 1: you know, when you come in the i c U
Speaker 1: and you have to get life support like a ventilator.
Speaker 1: It makes sense that as a doctor, I would want
Speaker 1: to provide my patient with a level of comfort that
Speaker 1: sometimes comes with unconsciousness, and so a sedative drug. But
Speaker 1: what we've learned over thirty years of research west thousands
Speaker 1: and thousands of patients and NIH and federally funded studies
Speaker 1: is that we can really cause a lot of harm
Speaker 1: to our patients. By giving them too much sedation for
Speaker 1: too long. And so what we have done is randomized
Speaker 1: trials over the years where we've proven that people can
Speaker 1: actually be more likely to live on the back end
Speaker 1: of critically illness if we shorten the sedation, give them
Speaker 1: less and overall, don't burden them with drugs like benzo
Speaker 1: days appines, which were really common during COVID. Unfortunately, you
Speaker 1: worked as a critical care physician in those early days,
Speaker 1: kind of scary. They weren't vaccines yet. What sort of
Speaker 1: practices did you see that you've now learned weren't actually
Speaker 1: best practices. I'm gonna tell you through the story of
Speaker 1: a patient. I had a patient named Teresa Martin, and
Speaker 1: I have permission to use her name. In nineteen ninety
Speaker 1: I cared for her with a pattern of sedation which
Speaker 1: was heavy and mobilizing and put her in a coma
Speaker 1: for many days, And then for the next twenty five
Speaker 1: years I did research to try and figure out, with
Speaker 1: the rest of us around the world, how do we
Speaker 1: keep people more awake, more learned, more in communication with
Speaker 1: their family members, and earlier mobilized. And we had made
Speaker 1: all this progress until twenty nineteen, we had more people living,
Speaker 1: they were living with less disabilities, et cetera. And then
Speaker 1: COVID hit West. I'm standing in the ICU in the
Speaker 1: COVID I C you caring for a man named Fred
Speaker 1: Reyes also have permission to use his name, and he
Speaker 1: was on the ventilator, and I thought to myself, Oh
Speaker 1: my gosh, this is deja boo. I'm back in Teresa Martin.
Speaker 1: We have regressed thirty years in our practices, and that's
Speaker 1: exactly what happened globally. We proved in a study of
Speaker 1: two thousand one COVID I SEE patients that we were
Speaker 1: over using benzos and under using family and this was
Speaker 1: creating a massive amount of a cute brain dysfunction and
Speaker 1: accelerating death during COVID. You said you were over using benzos,
Speaker 1: these very powerful sedatives and under using families. What exactly
Speaker 1: do you mean by that? The best way to keep
Speaker 1: somebody's brain online or on track when they're critically ill
Speaker 1: is to give them a little bit of sedation at
Speaker 1: the beginning on the ventilator. We do need sedation at
Speaker 1: the beginning when we first put somebody on the ventilator,
Speaker 1: but it's on day two or day three or day
Speaker 1: four where we need to be waking people up every
Speaker 1: single day to allow them to look in the eyes
Speaker 1: of their wife, their spouse, their husband, whatever it may be,
Speaker 1: so they can remember, oh, I have a reason to live.
Speaker 1: And they're getting by with a very scary how in
Speaker 1: the I c U. They have lions and tubes and
Speaker 1: they can't talk and they need to see their family
Speaker 1: and they to be able to process that well. During
Speaker 1: COVID we pummeled them with benzod a zapines. There was
Speaker 1: a paper early on in the New England Journal of Medicine.
Speaker 1: They showed that eight six percent of COVID patients were
Speaker 1: getting benzoda zapines like at a van or medaisa LAMB.
Speaker 1: And just prior of COVID we had pretty much gotten
Speaker 1: rid of those drugs altogether. They caused a tremendous amount
Speaker 1: of delirium and harm and so we don't like to
Speaker 1: use those on people. And so why were they used
Speaker 1: so frequently in COVID. Why did they bring these drugs back?
Speaker 1: What was it about COVID care that sort of threw
Speaker 1: the rule book out the window. Just prior of COVID,
Speaker 1: we had a safety checklist in the I c U.
Speaker 1: It's called the A D C, D E F bundle.
Speaker 1: We called the A T F bundle. That essentially was
Speaker 1: waite people up, get them out of bed, and have
Speaker 1: their family there. Well. At the beginning of COVID, when
Speaker 1: I wasn't vaccinated and no one else was vaccinated, were
Speaker 1: afraid to have family members come in, so we kept
Speaker 1: family away. We kept the patient in the room, We
Speaker 1: shut the door, and we had the patient behind the glass.
Speaker 1: They had a tube down their throat, so to make
Speaker 1: them not able to pull that tube out and take
Speaker 1: themselves off of a ventilator, which we call self excavation,
Speaker 1: we snowed them with benzos because they are the deepest
Speaker 1: coma laden drug that we could give them, and also
Speaker 1: the drug probofall those were the drugs that we were
Speaker 1: using because we had to keep the person so deeply
Speaker 1: in a coma, since we weren't free to go in
Speaker 1: and out of the room as much as we wanted to.
Speaker 1: When that happened, family members weren't allowed in. Doctors and
Speaker 1: other members of the care team weren't able to check
Speaker 1: as frequently. What did we learn about what the effects
Speaker 1: were both for the treatment of COVID and after people recovered,
Speaker 1: we were doing the best we could with the light
Speaker 1: we had at the time. Now we know that vaccines
Speaker 1: work and that personal protective equipment PPE works. It was
Speaker 1: anti medicine. It was a time when we couldn't have
Speaker 1: the families there. But what we learned were two main things.
Speaker 1: When we put all those COVID patients deeply indetective coma
Speaker 1: like we had been back in the ninety nineties, it
Speaker 1: increased dementia. It increases a problem called post intensive care syndrome,
Speaker 1: which is p I c S or the so called PICKS.
Speaker 1: And on the back end of the ice use day,
Speaker 1: if somebody survives, what they land with in their life
Speaker 1: is big time cognitive impairment, memory impairment, the inability to
Speaker 1: do their job. They also have way more in the
Speaker 1: terms of muscle and nerve disease, and then more depression
Speaker 1: and post traumatic stress disorder our PTSD. So we were exacerbating,
Speaker 1: if you will, the likelihood of them getting post intensive
Speaker 1: care syndrome and having all these disabilities in the months
Speaker 1: and years after they tried to recover from their COVID.
Speaker 1: So for decades you have studied this. You actually wrote
Speaker 1: the rule book when it comes to how to properly
Speaker 1: sedate patients with other physicians you work with. Knowing what
Speaker 1: you know now from the experience treating and sedating COVID patients,
Speaker 1: have you changed the rules are added to them in
Speaker 1: a way using this experience to improve care in the future.
Speaker 1: We absolutely have. What we have done is we have said, Okay,
Speaker 1: we don't need to start from scratch. We have twenty
Speaker 1: five years of randomized control trials and Cowork studies. We
Speaker 1: don't have to start over. So what we've done is
Speaker 1: we've worked nationally and internationally with intensive care societies and
Speaker 1: we're taking the abc DF bundle, the hwo F bundle,
Speaker 1: and we're re implementing it on a large scale all
Speaker 1: over the world to say, the next time we have
Speaker 1: a pandemic like this, we are going to make sure
Speaker 1: that we do not abandon all of this data which
Speaker 1: we know saves lives, produces length of stay, cuts down
Speaker 1: cost of care, and helps people survive without an acquired dementia.
Speaker 1: And so that's what we're doing to move forward both
Speaker 1: currently in the Perry pandemic period of COVID, because there's
Speaker 1: still hundreds of people in the i c US with
Speaker 1: COVID right now, although the numbers are way down and
Speaker 1: we're gonna have another pandemic, we just need to make
Speaker 1: sure we do it more safely next time. So dr
Speaker 1: we're talking about COVID in a possible future pandemic, but
Speaker 1: just in normal life. If one of our listeners, a
Speaker 1: member of their family falls ill and requires sedation and
Speaker 1: they're in the hospital, what can people do to make
Speaker 1: sure that the sedation they're getting does follow these rules
Speaker 1: and that they're going down the right path instead of
Speaker 1: a less fortunate one. First of all, if you are
Speaker 1: with a loved one who is in the I c
Speaker 1: U and on a ventilator, then you are their advocate.
Speaker 1: And I want you to know that it is okay
Speaker 1: to be their advocate and to request to be present
Speaker 1: at the bedside. These days of limited visitation should be over,
Speaker 1: and they are wrong, and you should challenge that and
Speaker 1: say I need to be with my loved one because
Speaker 1: they need an advocate and they need to make eye
Speaker 1: contact with me so they can remember that they have
Speaker 1: a why to live. We aunt heal people West with
Speaker 1: just science. It's over. We know that we have to
Speaker 1: have humanism and science We need physical touch and that
Speaker 1: personal humanistic approach plus the science. That's how we completely
Speaker 1: heal human being. So that loved one should say, I
Speaker 1: want to be on rounds. Let me listen to what
Speaker 1: you're doing and give me a lay explanation of what's happening.
Speaker 1: I will tell you what my loved one needs. I
Speaker 1: know what matters to them, and I call this West
Speaker 1: flipping the preposition. It's not just about what's the matter
Speaker 1: with someone, it's what matters to someone. So I have
Speaker 1: to have the family members there with me to tell
Speaker 1: me what Mr Smith, what's important to him, and how
Speaker 1: far I should push different types of interventions, how aggressively
Speaker 1: I should make that wakes up every day. Should we
Speaker 1: try and get him hearing? His granddaughter today is she's
Speaker 1: the most important person who's gonna help him? Have you
Speaker 1: know the reason to live. We're gonna take this humanistic
Speaker 1: approach and put it alongside the science, and we need
Speaker 1: the family there to make that happen. Dr wessey Elie,
Speaker 1: thanks so much for talking to me today. My brother
Speaker 1: styke you travling after the break the widespread effects of
Speaker 1: heavy sedation on patients. Bloomberg Senior Editor and Biosecurity correspondent
Speaker 1: Jason Gale joins me now from Melbourne, Australia. You have
Speaker 1: written this very interesting story about what's really a side
Speaker 1: effect and very serious one of COVID treatment, especially in
Speaker 1: the early days before the vaccine, when people were sedated
Speaker 1: and often sedated to keep them on ventilators. You writing
Speaker 1: your story about a woman named Kelly McCarthy. Can you
Speaker 1: tell us about her? Kelly McCarthey is a woman now
Speaker 1: fifty two years old. She's a grandmother. She was previously
Speaker 1: working full time as an insurance claims adjusted just outside
Speaker 1: of Boston. She got sick with COVID in early one
Speaker 1: was actually around the peak of the pandemic, the pandemics
Speaker 1: first went away in the US. I remember I was
Speaker 1: feeling very crummy, you know, just like a regular bug
Speaker 1: or something, and so I went and I got soup
Speaker 1: and whatever's just I was going to nurse it on
Speaker 1: my own. Finally one day I'm just like I can't
Speaker 1: get out of bed, and my husband comes in. It
Speaker 1: goes you go into urgent care if I have to
Speaker 1: throw you over my shoulder. So we did, and my oxygen,
Speaker 1: I guess was like in the fifties somewhere it's supposed
Speaker 1: to not go blow ninety and um, yeah, and everyone
Speaker 1: in the room went, so I knew it was bad. Um.
Speaker 1: So then they took me to the hospital and I
Speaker 1: was in the ICU for like, I want to say,
Speaker 1: like three days. Very quickly they worked out that she
Speaker 1: had COVID and tried to give her a supplemental oxygen,
Speaker 1: but after a few days they realized that she needed
Speaker 1: to go into a mechanical ventilator. I was intubated twice,
Speaker 1: and they tried three times to excavate me, but I
Speaker 1: guess I started getting really agitated and swinging and trying
Speaker 1: to whatever. So then they decided to do a tricky
Speaker 1: as to me. Yeah, so my little bar fight scar.
Speaker 1: But the they just said, we can't keep doing this
Speaker 1: and her lungs won't work on their own. And that's
Speaker 1: when they started working on my family, saying she's going
Speaker 1: to be hooked up to something for the rest of
Speaker 1: her life. And the only thing I had was some
Speaker 1: extra oxygen when I got home, so that was nice.
Speaker 1: We think of people when they're sedated as being asleep,
Speaker 1: but what you describe that Kelly McCarthy and other patients
Speaker 1: experienced is this sort of sleeping wakefulness where they were
Speaker 1: aware they were having really bad dreams and they could
Speaker 1: feel themselves fighting the ventilator despite the sedation. So sedation
Speaker 1: isn't exactly sleep and the way we are sleep, It's
Speaker 1: really an altered state of consciousness. So in the case
Speaker 1: of Kelly McCarthy, she was given multiple different agents fastidation
Speaker 1: for pain relief and to essentially paralyze her. There were
Speaker 1: periods over the many weeks in which she was on
Speaker 1: a mechanical ventil later and which she was not asleep,
Speaker 1: and she was kind of conscious of things going on
Speaker 1: around her, and it fed into her consciousness, and she
Speaker 1: essentially studied hallucinating. All kinds are different, sometimes horrific things.
Speaker 1: While I was under, I had the most horrifying nightmares,
Speaker 1: but I wasn't like all the way under, so reality
Speaker 1: was working its way into into my dreams. Like I
Speaker 1: was in a room and like a hospital room, go figure,
Speaker 1: and the doctors like, hi, Kelly, do you know me?
Speaker 1: I just intibated you whatever. And I looked at her
Speaker 1: and she she said, um, okay, so I'm going to
Speaker 1: kill you in my drink. I've doubt she said that
Speaker 1: in I See You. One of the other ironies of
Speaker 1: this story is that these treatments, though some of them
Speaker 1: were very difficult for the patients, led to a higher
Speaker 1: survival rate than we've seen in previous pandemics, certainly influenza pandemic,
Speaker 1: and so the very thing that kept them alive is
Speaker 1: something that has pointed up big problems with people being
Speaker 1: heavily sedated. Yeah. Absolutely, we are now dealing with the
Speaker 1: after effects of so many people, at least a quarter
Speaker 1: of a million patients in the US, who survived their
Speaker 1: intensive care for COVID, and a majority of them will
Speaker 1: have some degree of impairment following that. I don't drive
Speaker 1: at this point because if my legs are kicking out
Speaker 1: from underneath me, I don't want them kicking out behind
Speaker 1: the wheel because that could be a real problem. I
Speaker 1: forget things, and so that's difficult because literally I'll be like, oh,
Speaker 1: I got to look that up on Google, pick up
Speaker 1: my phone. I have no idea. Apparently it was a
Speaker 1: terribly important But stuff like that, holding things without dropping them,
Speaker 1: that's that's fun. So but only if my hands get
Speaker 1: to like that. They gave me surgery. I had carpal
Speaker 1: tunnel in both hands from the fluid that they filled
Speaker 1: me with, and I guess it impinged the nerves and
Speaker 1: because of that I got I mean, my hands hurt
Speaker 1: so much at the time and it couldn't feel them.
Speaker 1: So the impairments really go from the head to the toes.
Speaker 1: It's all kinds of things. There's mental cognitive impairments to do. Obviously,
Speaker 1: with the brain, there is often long scarring, muscle weakness,
Speaker 1: dental issues. Often um patients it's hard to clean their teeth,
Speaker 1: for example, patients can get bed sores. They essentially get
Speaker 1: what's called post intensive care syndrome, and that is this
Speaker 1: sort of umbrella term for really a large raft of
Speaker 1: problems that can be quite enduring. My conversation with Jason
Speaker 1: Gale continues after the break. Jason, you write in your
Speaker 1: story that even though Kelly is grateful to be alive,
Speaker 1: her life is now entirely different than it was before.
Speaker 1: It really is. Her daughter Rachel mentioned that she was
Speaker 1: previously working multiple jobs, working sometimes seven ninety hours per week.
Speaker 1: She's now unable to work at all, and the outlook
Speaker 1: for her working isn't good. And this is a woman
Speaker 1: who isn't her early fifties. She didn't expect to have
Speaker 1: to retire so young. It's just the isolation. It's not
Speaker 1: even the financial you know, because we do all right,
Speaker 1: so that's fine. But it's like I would go to
Speaker 1: work every day and see my friends and enjoy them
Speaker 1: and chit chat and talk to people and do my
Speaker 1: work or whatever. I don't have that anymore. I don't
Speaker 1: go out really. I mean, I'll go out to see
Speaker 1: my my kids, my grandkids, whatever, um, run errands, but
Speaker 1: since I don't drive, and I've got to wait for right.
Speaker 1: So it's had a profound effect on her professionally, but
Speaker 1: even you know, socially and economically. Uh, and not just
Speaker 1: not just Kelly, but the rest of the family. Um,
Speaker 1: it has affected me. That's Kelly McCarthy's mother, Brenda Reid.
Speaker 1: I still get choked up. But what I find is
Speaker 1: I can be driving along in the car and you know,
Speaker 1: just listening to music that has nothing to do with anything,
Speaker 1: and all of a sudden it will hit me and
Speaker 1: I will feel very sad, only for a moment, but
Speaker 1: there's still those little flashes, and um, I suspect those
Speaker 1: will go on for a while. I don't know how long,
Speaker 1: but it says to me that if something like that
Speaker 1: is affecting me, I can't even begin to imagine how
Speaker 1: it must be for the child, the woman who went
Speaker 1: through all of this first person. And I think it's
Speaker 1: important to note that when a patient does spend a
Speaker 1: lot of time in the I c U, the flowing
Speaker 1: effects across families is quite profound. A study from France
Speaker 1: showed that about a third of relatives of I SEE
Speaker 1: COVID patients suffered PTSD as a result. And in the
Speaker 1: case of Kelly McCarthy, the woman you read about in
Speaker 1: your story, she was thought to be dying and the
Speaker 1: medical team called her family to say it may be
Speaker 1: time to say goodbye, and in fact her life was
Speaker 1: saved by reducing the amount of sedation she was on. Yes,
Speaker 1: so initially Kelly McCarthy was treated in a county hospital essentially,
Speaker 1: and her acute respiratory distress syndrome just got worse and
Speaker 1: worse to the point where it looked like her respiratory
Speaker 1: failure would become fatal, and so her family was called
Speaker 1: in to say goodbye. We did go and see her,
Speaker 1: we did say our goodbyes, but I told her to
Speaker 1: hang on because we were working on something that um
Speaker 1: would be beneficial to her, and she couldn't hear She
Speaker 1: couldn't hear us, so we didn't know if she could
Speaker 1: hear us. As I say, she was unconscious. Around the
Speaker 1: same time, Brenda, Kelly's mother, learned that double lung transplants
Speaker 1: were occurring and may offer some life saving benefit for Kelly,
Speaker 1: and so calls were made to the Brigham and Women's
Speaker 1: Hospittle in Boston to have Kelly transferred. I had seen
Speaker 1: a story where at Brighaman Women's they had a lung
Speaker 1: center and there was a man I believe it was
Speaker 1: from Nebraska, had come in. Both lungs were gone because
Speaker 1: of COVID that he had transplants. He survived. He was
Speaker 1: home in Nebraska doing quite well and recovering, and so
Speaker 1: we said to the doctor, we want to transfer it.
Speaker 1: I spoke to Daniella Lamas, an intensive care doctor who
Speaker 1: took over Kelly's care, and she realized that Kelly's lungs
Speaker 1: weren't the main problem. She just as Danielle Lamas said,
Speaker 1: needed to have her sedation turned off or turned down slowly,
Speaker 1: and over the course of the next week or two,
Speaker 1: they did tie trade down all her sedation and opioids
Speaker 1: and things, and eventually she was able to come off
Speaker 1: the mechanical ventilator. What do you take away from all
Speaker 1: this about the lessons that have been learned from this
Speaker 1: and how in the future the harm that can come
Speaker 1: from this sort of treatment the well intended can cause.
Speaker 1: So talking to a lot of folks working in i
Speaker 1: c u s in different capacities, it seems as though
Speaker 1: we can never not allow family he gives back into
Speaker 1: the i c u s. That we need to figure
Speaker 1: out a way of keeping that and very important component
Speaker 1: of intensive care back in the i c U. So
Speaker 1: that is something that we've really learned from this pandemic,
Speaker 1: that it's so important to keep family members there in
Speaker 1: the room with patients. She's just a funny person, but
Speaker 1: a sensitive person and a kind person. And I watch
Speaker 1: her now and I always know she was strong and brave,
Speaker 1: but I watch her now as recovery continues, but at
Speaker 1: a snail's pace, unfortunately, and the recovery in the end
Speaker 1: may not be exactly what she had hoped for. But
Speaker 1: she's doing better now than she was in the beginning,
Speaker 1: and her her sense of humor does bring her through,
Speaker 1: but she It's funny because there'll be days when I'll
Speaker 1: be talking to her and she's very bubbly and upbeat,
Speaker 1: and I'll say, Okay, you're having a bad day, aren't you.
Speaker 1: And she'd say, why, why do you think that? I said,
Speaker 1: I'm your mother, and when you're upset, you're extremely bubbly
Speaker 1: and outgoing. And she went, yes, I guess I'm having
Speaker 1: a bad day. So they are in there, but she's
Speaker 1: her coping mechanism is positively amazing. You can read Jason
Speaker 1: Gale's story about COVID and sedation at Bloomberg dot com.
Speaker 1: Jason Gale, thanks so much for taking the time talk
Speaker 1: to me. Thanks for having me West. It's good to
Speaker 1: talk to you. Thanks for listening to us here at
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