Book SummaryEvery Deep-Drawn Breath, by Wes Ely

1-Page Summary1-Page Book Summary of Every Deep-Drawn Breath

Contemporary methods employed in Intensive Care Units, particularly the use of deep sedation and restraints, have resulted in unexpected adverse outcomes.

This segment of the narrative delves into the unintended negative impacts of progress in critical care technology on ICU patients, particularly stemming from the prevalent use of strong sedatives and physical restraints. Ely contrasts the rudimentary instruments and approaches once prevalent in critical care, such as the iron lungs employed during polio epidemics in Copenhagen, with the intricate procedures in contemporary intensive care units that, despite their advanced nature, have unintentionally given rise to a condition marked by confusion, referred to as Post-Intensive Care Syndrome (PICS).

Advancements in medical technology have markedly altered the procedures followed within Intensive Care Units.

The author delves into how critical care medicine has progressed and its importance. The narrative chronicles the evolution of mechanical respirators beginning with their use in combating polio, and it outlines the historical advancements, underscoring the emergence of positive-pressure breathing apparatus, the creation of devices to perform the function of kidneys, and the advent of pacemakers, as well as the early instances of transplanting a single organ, all to underscore the growing belief among medical professionals that their foremost obligation is to extend life, especially as a person approaches the conclusion of their earthly journey.

The introduction of technologies like renal replacement therapy and artificial breathing apparatus has revolutionized critical care medicine, with a primary focus on life preservation.

Ely notes a marked shift in the perspective of the medical profession, attributed to the prevalent deployment of sophisticated machinery designed to prolong life within intensive care settings. Healthcare providers had become exceptionally skilled at reducing the number of deaths. The fundamental aim of health care has shifted to align with the objectives of Intensive Care, focusing on preventing death. Maintaining the patient's stability over an adequate period can permit natural recovery processes to occur. Ely observes a crucial change in the focus of healthcare providers, who now prioritize the maintenance of life within the critical care units, even when faced with patients in extreme conditions and minimal chances of improvement. The introduction of these devices brought about a newfound hope that rapidly became widely embraced. As a budding physician, Ely fully embraced the traditional methods and standards associated with healthcare.

Context

• The ability to prolong life with machines has introduced complex ethical dilemmas, such as decisions about when to continue or withdraw life support, and how to balance quality of life with life extension.
• The development of new medications and therapies has expanded treatment options for critical illnesses, improving survival rates for conditions that were previously considered untreatable.
• Societal values and cultural attitudes towards death and dying influence how healthcare systems prioritize life preservation, affecting policy and practice in different regions.
• The concept of "adequate period" refers to the necessary time the body needs to initiate and sustain recovery processes, which can vary greatly depending on the individual’s condition and the severity of their illness.
• The widespread adoption of these devices necessitated new training and expertise among healthcare providers, leading to the development of specialized fields within medicine.
• For budding physicians, embracing traditional methods was part of forming a professional identity that aligned with the prevailing medical culture focused on technological proficiency and life-saving measures.

In critical care settings, it was routine to heavily sedate patients and use physical restraints to protect their health and prevent self-harm, despite a lack of solid evidence supporting the efficacy of such measures.

Ely's expertise in critical care provided him with a deep understanding of both the benefits and potential dangers of sophisticated medical devices, such as the utilization of positive end-expiratory pressure (PEEP) in ventilators and the application of inverse ratio ventilation (IRV) for patients with diminished oxygen levels. In the early stages of his career in medicine, Ely was a proponent of deep sedation and employing physical restraints for those in critical care. He discovered that this technique was highly successful in preserving patient well-being during mechanical ventilation and in protecting them from inadvertently detaching the breathing apparatus or causing self-harm. The machines took over breathing duties, enabling those who were critically ill to focus on healing. Ely observed that his patients often felt anxious and uncomfortable when reliant on mechanical breathing assistance, yet he was convinced that the benefits of administering sedatives outweighed any potential drawbacks.

Other Perspectives

• While Ely may understand the benefits and risks of using devices like PEEP and IRV, this does not necessarily mean that his application of these devices is optimal for every patient, as individual patient responses can vary widely.
• There are alternative methods to manage patient agitation and prevent self-harm, such as environmental modifications, non-pharmacological interventions, and the use of less invasive restraints.
• Mechanical ventilation, while taking over the work of breathing, does not necessarily allow all patients to focus on healing, as the experience can be stressful and may lead to complications such as ventilator-associated pneumonia.
• In some cases, patients may be able to participate in assisted ventilation strategies, such as synchronized intermittent mandatory ventilation (SIMV), which...

Every Deep-Drawn Breath Summary The enduring effects of delirium on the cognitive abilities and overall health of patients are a considerable concern.

In his narrative, Ely explores the possible negative impacts that deep sedation could inflict on patients receiving intensive medical treatment. He underscores the significant impact on those who once enjoyed vibrant careers, rich social lives, and hobbies, but saw their lives altered dramatically due to a single medical incident and the ensuing time spent in the hospital. Ely notes that knowledge about delirium and PICS has yet to reach a broad audience outside of those specializing in intensive care.

Delirium frequently escapes detection and is regularly disregarded within the confines of intensive care units.

Ely emphasizes the importance of recognizing delirium as a significant outcome of severe illnesses, not just an insignificant side effect.

A real health concern arises from harm inflicted upon the brain. Wes Ely notes that patients in critical care settings must contend with their primary medical conditions as well as further issues arising from a state of confusion that may cause physical, psychological, or cognitive difficulties. The writer prompts his audience to reflect on relatives who might have encountered such difficulties and to contemplate the potential...

Every Deep-Drawn Breath Summary The importance of prioritizing the patient's individual experiences and values within the realm of critical care.

In this segment, Ely advocates for a comprehensive approach to treating critically ill patients, emphasizing their overall well-being instead of just attending to a set of malfunctioning organs. He explains that adopting this method improves the recovery journey by combining scientific knowledge with advanced medical equipment, while still acknowledging their importance. Ely aspires to ensure that care focused on the individual is a fundamental aspect of bedside treatment. Wes Ely emphasizes the inescapable reality that either we or someone we hold dear will eventually be in the hands of an intensive care unit, and the caliber of treatment received in such situations will have a profound impact on both the immediate outcomes and the enduring well-being of the survivors. Ely champions a revolutionary shift in hospital treatment that places the patient at the forefront, a strategy supported by solid evidence. He also imparts to his audience a holistic approach that is demonstrated to diminish patient distress and improve their life expectancy and overall health after they are discharged from medical institutions.

Acknowledging the individual's entirety, not merely their...

Every Deep-Drawn Breath Summary The writer's individual experience and investigative work have significantly propelled progress within the sphere of intensive medical treatment, highlighting the enhancement of patient awareness and revolutionizing the methods employed by healthcare professionals in this field, particularly by addressing problems related to disorientation and confusion, and advocating for the initiation of physical movement at an earlier stage.

Ely concludes the book by sharing his journey to improve medical procedures in his Nashville intensive care unit and his ambition to expand these advancements worldwide. He emphasizes the importance of a united effort between critical care experts, patient advocates, relatives, and policymakers to ensure the sustained and effective implementation of care practices that are empathetic, tailored to the individual, and scientifically based.

The author's perspective evolved, leading him to adopt a holistic approach that prioritizes patient welfare over an exclusive reliance on advanced critical care techniques.

In this segment of the narrative, the author describes his transformation from a physician deeply engrossed in the complexities of sophisticated life-support machines to one who views each patient as a whole person.

Initially, the author focused on saving lives through advanced medical interventions, yet subsequently realized the unintended repercussions of extended periods of immobility and lack of consciousness.

During his initial years in medicine, Ely was enthralled by the opportunity to employ sophisticated medical technologies in critical care with the aim...