This is called a “wake up and breathe” strategy. In the first step of the protocol, the patient’s sedation is turned off, also known as a “spontaneous awakening trial.” “Almost all patients on a ventilator in the ICU receive sedating medications that keep them comfortable or even comatose,” says the study’s first author, Timothy Girard, M.D., M.S.C.I., of the Vanderbilt University School of Medicine in Nashville. “The spontaneous awakening trial (SAT) allows them to wake up, so we can find out if they are ready to proceed without sedation. If the patient is uncomfortable, we restart sedation, but a lot of patients are comfortable enough to proceed with the next step in the protocol.”

This second step involves allowing the patient to try breathing on their own without substantial help from the ventilator, called a “spontaneous breathing trial” (SBT). If the patient shows signs they are unable to breathe on their own, they are immediately placed back on full mechanical ventilation.

The multicenter study included 335 critically ill patients in four hospitals who were receiving mechanical ventilation. Patients managed with the combined “wake up and breathe” protocol (the SAT + SBT group) were compared with patients who were managed with daily spontaneous breathing trials and usual sedation practices (the SBT group). This group did not undergo formal awakening trials; their sedation was managed by their ICU doctors and nurses on a case-by-case basis.

The patients in the SAT+SBT group were able to breathe without the ventilator’s assistance an average of three days more and were discharged from the ICU and hospital an average of four days earlier than the SBT group. During the 28-day study, 47 patients in the SAT+SBT group died compared with 58 in the SBT group.; Source: American Thoracic Society