Mastering Intensive Care 033 with Wes Ely

Do you spend time finding out what the “why” is for your patient? Have you considered it’s not what is the matter with the patient but what matters to the patient? What the patient thinks their purpose is? Or at the very least, what they wish for during the next part of life, however short that may be? In this episode American intensivist, Dr Wes Ely, tells us how he deeply cares about the whole patient – the body, the mind and the spirit. He is passionate about really getting to know his patients. And to do that he thinks we need to be heavily focused on both ICU liberation and good listening.

The ICU liberation bit sounds easy. It’s removing the patient from the sedatives, the ventilator and whatever other harmful interventions are no longer needed when their situation is improving. But it’s harder than we think. And to help with this, he has led the development of the ABCDEF bundle. With the assistance of many colleagues, and based on high quality science, he has progressively developed a simple 6 factor approach that has been shown to speed up ICU liberation and improve patient outcomes. And in this podcast he describes how he uses it, and how you can too.

Listening to our patients also sounds easy. But how many of us spend the time required, and really be there for that person with grace and humility, so we can truly find out what matters to them, and respect their spiritual faith.

Wes will be well known to many of you. He is a Pulmonary and Critical Care specialist who conducts patient-oriented, health services research as a Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University School of Medicine, in Tennessee, USA. He is also a practicing intensivist with a focus on Geriatric ICU Care, as the Associate Director for Research for the VA Tennessee Valley Geriatric Research and Education Clinical Center. His research has focused on improving the care and outcomes of critically ill patients with ICU-acquired brain disease. Wes has built the ICU Delirium and Cognitive Impairment Study Group and his team have developed the primary tool by which delirium and health-related quality of life outcomes are measured, the CAM-ICU. He has over 350 peer-reviewed publications and over 50 published book chapters and editorials.

In this conversation, Wes and I cover many other topics including:

• How he chose medicine after observing family illness as he grew up
• The enjoyment he receives from holding the hands of and looking into the eyes of patients
• How good doctors are not distracted by technology
• A Wall St journal and a CNN.com article he has penned which display his ability to find out what really mattered to 2 of his patients
• The importance of reading – and the 3 types of reading we should do
• How his ICU ward round is patient-centric and heavily nurse-focused
• The need to understand our unconscious biases and to have humility
• The concept of becoming the best version of our selves
• That life balance requires exercise, sleep and healthy eating
• His passion for triathlons, including the ironman
• How he balances family and work
• How his spiritual faith helps him to minimize stress
• His understanding that there is something bigger than us happening around us
• How burnout is simply an imbalance in the fundamentals of life
• The Nietzsche quote “He who has a why to live can bear any how”
• His appreciation of the work of the 3 Wishes Project (links below)
• What happened when he read the Jabberwocky poem (link below) to one of his patients
• His advice that young clinicians should be patient and truthful
• What the mnemonic DR-DRE means to him

Wes Ely is a genuine leader of our specialty and is a wise, philosophical and compassionate doctor with a refreshing spiritual perspective. Please enjoy listening to the podcast.

Show notes

• Ely W. Every deep drawn breath. A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU. 2021
• Ely EW. ‘A Swimming Pool in the ICU?’ Wall St journal
• Ely EW. Swimming pool in the ICU. Intensive Care Med. 2016 Sep;42(9):1502-3 [PMID 27515156]
• Ely EW. What happens when a patient says, ‘Doc, help me die’ CNN 2018
• The ABCDEF bundle. ICU Liberation.
• Strøm T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010 Feb 6;375(9713):475-80. [PMID 20116842]
• Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000 May 18;342(20):1471-7. [PMID 10816184]
• Ely EW et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996 Dec 19;335(25):1864-9. [PMID 8948561]
• Girard TD et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008 Jan 12;371(9607):126-34 [PMID 18191684]
• Schweickert WD et al.  Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009 May 30;373(9678):1874-82. [PMID 19446324]
• Ely EW. The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families. Crit Care Med. 2017 Feb; 45(2): 321–330.  [PMC5830123]
• Balas MC et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014 May;42(5):1024-36. [PMC4105208]
• Barnes-Daly MA, Phillips G, Ely EW. Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients. Crit Care Med. 2017 Feb;45(2):171-178. [PMID 27861180]
• Sir William Osler
• Dalai Lama
• Matthew Kelly
• Fulton Sheen
• David Bennett
• The Merton prayer
• Friedrich Nietzsche
• Viktor Frankl
• Cook D et al. Personalizing death in the intensive care unit: the 3 Wishes Project: a mixed-methods study. Ann Intern Med. 2015 Aug 18;163(4):271-9 [PMID 26167721]
• Swinton M et al. Experiences and Expressions of Spirituality at the End of Life in the Intensive Care Unit. Am J Respir Crit Care Med. 2017 Jan 15;195(2):198-204. [PMID 27525361]
• Poem “Jabberwocky” by Lewis Carroll
• Mother Teresa

My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to the ICU by listening to the perspectives of such thought-provoking guests as Wes Ely. I passionately believe we can all get better, both as carers and as people, so we can do our absolute best for those patients whose lives are truly in our hands.

Feel free to leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on Twitter using #masteringintensivecare, or by sending me an email at andrewATmasteringintensivecare.com.

Further reading and listening

• Full podcast collection on LITFL and Libsyn
• More conversation on Twitter (@andrewdavies66) and Facebook