Coordinating Spontaneous Awakening and Breathing Trials: Fact Sheet

Did You Know?

• Spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT) reduce the length of mechanical ventilation, thereby reducing the risk for developing ventilator-associated pneumonia (VAP).
• In 2012, Luetz’s review article focusing on 14 studies recommended that weaning should be considered as early as possible, using a daily screening for readiness to wean protocol (SAT) that includes SBT.¹
• The 2015 "Wake Up and Breathe" quality improvement collaborative from Klompas et al. showed that enhanced performance of paired, daily SATs and SBTs is associated with lower VAE rates.²
• When used in conjunction, SAT and SBT protocols result in faster extubation time and an earlier discharge.^2,3

What the Experts Say

Society for Healthcare Epidemiology of America

Recommends the interruption of sedation (SAT) and the assessment of readiness to wean (SBT) once a day. That SAT and SBT should be paired.⁴

American Thoracic Society

Recommends use of daily interruption (SAT) or lightening of sedation to avoid constant heavy sedation and to facilitate and accelerate weaning; does not address SBT.⁵

Centers for Disease Control and Prevention

Supports weaning but does not address SAT and SBT.⁶

References

1. Luetz A, Goldmann A, Weber-Carstens S, et al. Weaning from mechanical ventilation and sedation. Curr Opin Anesthesiol 2012 Apr;25(2):164-9. PMID: 22246460.
2. Klompas M, Anderson D, Trick W, et al. The preventability of ventilator-associated events. The CDC Prevention Epicenters Wake Up and Breathe Collaborative. Am J Respir Crit Care Med 2015 Feb 1;191(3):292-301. PMID: 25369558.
3. Girard TD, Kress JP, Fuchs BD, 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.
4. Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acutecare hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35(8):915-36.
5. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005 Feb 15;171(4):388-416. PMID: 15699079.
6. Tablan OC, Anderson LJ, Besser R, et al. Guidelines for preventing healthcare-associated pneumonia, 2003: Recommendations of CDC and the healthcare infection control practices advisory committee. MMWR Recomm Rep 2004;53:1-36.