Sedation Vacations and Spontaneous Breathing Trials
A “sedation vacation” or “spontaneous awakening trial (SAT)” is a period of sedation cessation during which a patient can be assessed to ensure they are receiving the proper level of sedation. The patient is first screened to ensure they meet the criteria for a SAT. If they meet the criteria for an SAT, sedation will be interrupted and the patient will be evaluated. If the patient tolerates the interruption in sedation, they will then proceed to a spontaneous breathing trial (SBT) safety screen and possibly a SBT. Upon passing a SBT, extubation may be considered.
According to Balas et. al. (2011), performing SATs and SBTs on a daily basis led to “significant decreases in the duration of mechanical ventilation, shorter ICU stays, … and significantly fewer overall complications (eg, ventilator-associated pneumonia, upper gastrointestinal hemorrhage, bacteremia, barotrauma).” During my clinicals at Cottage Hospital I have only cared for one patient on a ventilator. I did not see a SAT and/or SBT performed on this patient, however looking at this patient retrospectively, I do not think they were hemodynamically stable enough to pass the safety screening. I have yet to have a clinical rotation in the MICU or SICU so I am looking forward to learning more about the hospital’s use of SATs and SBTs during that rotation.
I was able to access and review Cottage Hospital’s policy for their daily awakening trial/weaning protocol. The safety screening parameters and guidelines for SATs and SBTs very closely followed the parameters cited by Balas et. al. (2011) but were slightly more conservative. One thing Balas et. al. (2011) mentioned that I found interesting was “use of the ABCDE bundle should not depend on an individual physician’s order but rather should be structured as a daily part of care with clearly defined safety guidelines (e.g. an “opt-out” rather than “opt-in” approach to care delivery)”. In both the SAT and SBT safety screening policies Balas et. al. (2011) cited, the provider was prompted to include every patient unless they met an “opt out” parameter. Looking at the safety screening protocol for Cottage Hospital, the policy for SATs is written to include all patients unless contraindicated, but the policy for SBTs was written to include only those patients that meet specific parameters. I am curious to know if the language used in the policy affects the amount of patients that are appropriately screened. Using “opt-out” safety parameters may more effectively include patients that are eligible to be screened. It will be interesting to see the culture and practice surrounding SATs and SBTs when on the unit.
References:
Balas, M. C., Vasilevskis, E. E., Burke, W. J., Boehm, L., Pun, B. T., Olsen, K. M., … Ely, E. W. (2012). Critical Care Nurses’ Role in Implementing the “ABCDE Bundle” into Practice. Critical Care Nurse, 32(2), 35–48. http://doi.org/10.4037/ccn2012229
Shynk, T. (2010). Daily Awakening trial/Weaning Protocol in Mechanically Ventilated Patients, Cottage Hospital
