1. MICU Sedation Vacation/SBT Decision Tree
SAT Safety Screen Criteria
No active seizures
No ETOH withdrawal
No agitation
No paralytics
No myocardial ischemia
Normal Intracranial pressure
Fail if:
any screen criteria not met
Step 1:
Perform Spontaneous Awakening Trial (SAT) Safety Screen
 Repeat Step 1 in 12 hours
 Assess mobility indicators
Pass
Nursing Action
If patient apneic, do not restart sedation or increase analgesia
Restart sedation based on RASS:
< -1 hold sedation, restart analgesic at 50% pre-SAT dose
+1 or +2, restart sedation & analgesia at 50% pre-SAT dose
+3 or +4, restart sedation & analgesia at 75% pre-SAT dose
Titrate sedation to goal RASS -1 to +1
Repeat Step 1 in 12 hours
SAT Failure Criteria
Extreme anxiety, agitation, or pain: RASS ≥ +2
Respiratory rate > 35/min X 2 min.
Oxygen saturation < 88% X 2 min.
Accessory muscle use
Acute cardiac arrhythmia
Bradycardia
Tachycardia (20 bpm over baseline)
Diaphoresis
Performance of SAT
Goal is RASS -1 to 0
Allow patient to be more awake during the day
High dose sedation is:
Propofol > 20 mcg/kg/min
Ativan > 4 m/hr
Versed > 10 mg/hr
Step 2:
Perform SAT while in room performing assessment:
Analgesics - ↓ dose by 50%
Low dose sedation - turn off
High dose sedation - ↓ dose by 50%
Fail if:
any failure criteria present
Pass
SBT Safety Screen Criteria
No agitation
Oxygen saturation ≥ 88%
FiO2 ≤ 50%
PEEP ≤ 7.5
No myocardial ischemia
No vasopressor increase in the last 4 hours
Inspiratory effort present
Fail if:
any screen criteria not met
Nursing Action
Continue full vent support
Restart sedatives & analgesics based on RASS and titrate according to same instructions above for SAT failure
Repeat Step 1 in 12 hours
Step 3:
Spontaneous Breathing Trial (SBT) Safety Screen
Pass
Fail if:
any failure criteria present
SBT Failure Criteria
Respiratory distress
Respiratory rate > 35/min X5 min.
Respiratory rate < 8/min
Oxygen saturation <88% X1 min.
Heart rate change > 20 bpm
Mental status change
Acute cardiac dysrhythmia
Significantly increased anxiety or diaphoresis X 5 min.
Nursing Action
Return to full vent support
Restart sedatives & analgesics based on RASS and titrate according to same instructions above for SAT failure
Repeat Step 1 in 12 hours
Step 4:
Perform SBT
Pass
Consider extubation
Note: Always use nursing judgment