Introduction: Spontaneous Awakening Trials (SATs), daily interruptions of sedation in mechanically ventilated patients, are associated with reduced mortality and shorter duration of ventilation. At our academic medical center, ICU nurses document daily SAT safety screens to determine eligibility. Institutional data has revealed decreased SAT pass rates. To address potential barriers, three criteria—myocardial ischemia, alcohol withdrawal, and increased sedation requirements due to agitation—were removed from the screen. We evaluated the effect of this intervention on SAT screen and trial outcomes. Methods: We retrospectively analyzed data from ventilated adult patients between January 19, 2024, and February 21, 2025, using Epic electronic health record. The intervention took place on July 20, 2024. Outcomes were compared for 6 months before and after the intervention. Daily entries included sedation status, SAT screen results and reasons, and SAT trial outcomes. Multiple entries per day were considered a pass if at least one was successful. Analyses were performed using RStudio. Results: A total of 1,386 patients accounted for 3,868 ventilator-days, of which 2,088 ventilator-days involved continuous sedation. Among these, 79% (1,654) underwent screening, and 79% (1,301) passed. Screen pass rates increased from 68% pre-intervention to 92% post-intervention, an absolute difference of 24% (95% CI, 20%–27%; p< 0.001). Increased sedation needs due to agitation was the leading reason for screen failure (77%; 222). Among those who passed, 89% (1,151) underwent SATs, with overall trial pass rates of 79%. Trial pass rates decreased from 83% pre-intervention to 75% post-intervention, an absolute difference of -8% (95% CI, -12% to -3%; p=0.001). Agitation, anxiety, or pain accounted for most failures in both groups (82% vs. 86%). Conclusions: At a single academic medical center, removal of select exclusion criteria from the SAT safety screen increased screen pass rates and trial performance but was associated with a modest decline in trial pass rates. Agitation remained the predominant cause of SAT failure, without significant increase following intervention. These findings may inform future quality improvement strategies to optimize sedation management and enhance outcomes in mechanically ventilated patients.
Mai et al. (Sun,) studied this question.