Sedation Awakening Trial (SAT)

An SAT should be performed daily. If a patient has passed an SBT the SAT will be performed for intent to extubate. If the patient has not passed their SBT, the SAT should still be performed. The patient should have their sedation stopped and be allowed to wake-up. This is an ideal time to perform a complete physical exam. 

If the patient tolerates the SAT, attempts to control acute agitation with analgesic medications prior to the addition of Benzodiazepines should be made. If unsuccessful, sedation with bolus dosing moving forward should be the treatment of choice. If the patient fails the SAT due to agitation and bolus dosing of sedative medication is or certainly will be unsuccessful, the patient should be given a bolus dose of medication and restarted at one-half their previous drip rate. An attempt to control agitation with analgesic medications is preferred. This can then be titrated to the minimal effective dose. During titration, bolus dosing should be used to control acute agitation.

Extubation Process

1.      Titrate patient sedation to the patient is over-breathing the ventilator but comfortable with no signs of acute agitation.

2.      Place patient on spontaneous breathing mode with tube compensation

3.      The patient’s RSBI should be monitored during the SBT.

4.      Perform the SBT over 30 minutes.

5.      If the patient passes the SBT, place back on the ventilator and perform an SAT.  

6.      If the patient passes the SAT, the patient could be extubated if no other contraindications exists. 

from Dr. Shaun Daly

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