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. Author manuscript; available in PMC: 2012 Jun 14.
Published in final edited form as: Crit Care Nurse. 2012 Apr;32(2):35–48. doi: 10.4037/ccn2012229

Table 1.

Steps Involved in Awakening and Breathing Trial Coordination*@

Step 1 –SAT Safety Screen-RN Driven- The RN will determine if it is safe to interrupt sedation by responding to a set of predefined safety screen questions. For example,

  1. Is patient receiving a sedative infusion for active seizures?*

  2. Is patient receiving a sedative infusion for alcohol withdrawal?*

  3. Is patient receiving a paralytic agent (neuromuscular blockade)?*

  4. Is patient’s Richmond Agitation Sedation (RASS) score >2?*

  5. Is there documentation of myocardial ischemia in the past 24 hours?*

  6. Is patient’s intracranial pressure (ICP) > 20?*

  7. Is patient receiving sedative medications in an attempt to control intracranial pressure?@

  8. Is patient currently receiving Extracorporeal Membrane Oxygenation (ECMO)@

Step 2- Perform SAT-RN Driven- The RN will determine if the patient tolerated interruption of sedation by assessing if the patient demonstrates any predefined SAT failure criteria. For example,

  1. RASS score > 2 for 5 minutes or longer*

  2. Pulse oximetry reading of < 88 % for 5 minutes or longer*

  3. Respirations >35 breaths per minute for 5 minutes or longer*

  4. New Acute Cardiac Arrhythmia*

  5. ICP >20@

  6. 2 or more of the following symptoms of respiratory distress*

    • Heart rate increase 20 or more beats per minute, heart rate less than 55 beats per minute, use of accessory muscles, abdominal paradox, diaphoresis, dyspnea

Step 3- SBT Safety Screen- Respiratory Therapist (RT) Driven-The RT will determine if is safe to perform a SBT by responding to a set of predefined safety questions. For example,

  1. Is patient a chronic/ventilator dependent patient?#

  2. Is patient’s pulse oximetry reading <88%?*

  3. Is patient’s fraction of inspired oxygen (FiO2) >50%?*

  4. Is patient’s set positive end expiratory pressure (PEEP) >7?*#

  5. Is there documentation of myocardial ischemia in the past 24 hours?*

  6. Is patient’s ICP > 20?*

  7. Is patient receiving mechanical ventilation in an attempt to control ICP?#

  8. Is the patient currently on vasopressor medications?*#

  9. Does the patient lack inspiratory effort?*

Step 4-Perform SBT-RT Driven- The RT will determine if the patient tolerated the SBT by assessing if the patient demonstrates any predefined SBT failure criteria. For example,

  1. Respiratory rate >35 breaths per minute for 5 minutes or longer*

  2. Respiratory rate <8*

  3. Pulse oximetry reading of <88% for 5 minutes or longer*

  4. ICP >20#

  5. 2 or more of the following symptoms of respiratory distress*

    1. Use of accessory muscles

    2. Abdominal paradox

    3. Diaphoresis

    4. Dyspnea

  6. Abrupt mental status changes*

  7. Acute cardiac arrhythmia*

*

Criteria used in the Awakening and Breathing Controlled Trial (Evidence-based)31

#

Criteria added by example institution based on interdisciplinary discussion