Both Spontaneous Awakening Trials and Spontaneous Breathing Trials

Reducing the duration of ventilation time is an important goal because prolonged mechanical ventilation can lead to undesirable outcomes.

Within the ABCDEF bundle, the B component, Both Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT), focuses on setting a time(s) each day to stop sedative medications, orient the patient to time and day, and conduct an SBT in an effort to liberate the patient from the ventilator.

ICU sedation can help reduce anxiety and agitation for patients, facilitate mechanical ventilation, and decrease traumatic memories. But deep sedation has been found to reduce six-month survival and increase hospital mortality, ICU lengths of stay, ventilator duration and physiologic stress.

Studies have shown that using SAT and SBT synergistically helps decrease mechanical ventilation days, hospital lengths of stay and delirium.

Implementation Tools
Implementing the B component of the ABCDEF Bundle
Wake Up and Breath Protocol

Both SATs and SBTs are incorporated into the Wake Up and Breathe Protocol, a two-step process that focuses on creating a synergy between SAT and SBT protocols. These protocols typically incorporate safety screens and failure criteria.

The SAT safety screen includes the absences of seizures, alcohol withdrawal, paralysis and increased intracranial pressure. SAT failure criteria focus attention on the signs of pain, agitation and delirium (PAD), along with signs common to respiratory distress in aroused patients.

The SBT safety screen includes evaluation of the need for ventilator support; this helps facilitate ventilation weaning and decreases reintubation rates.

To enable successful implementation of SATs and SBTs, it is important to create an interprofessonal team. The ABCDEF bundle is most effective when implemented by a team that includes a physician, a nurse, a respiratory therapist, and a physical therapist at all levels of care.

The PAD guidelines recommend that:

  • Depth and quality of sedation should be routinely assessed in all ICU patients.
  • The Richmond Agitation-Sedation Scale (RASS) and the Sedation-Agitation Scale (SAS) are the most valid and reliable scales for assessing quality and depth of sedation in ICU patients.
  • Objective measures of brain function should be used adjunctively to monitor sedation in patients receiving neuromuscular blocking agents.
  • EEG monitoring should be used to either monitor nonconvulsive seizure activity in ICU patients at risk for seizures or titrate electrosuppressive medication to achieve burst suppression in ICU patients with elevated intracranial pressure.

 Additional Reading


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