SPONTANEOUS AWAKENING AND BREATHING TRIAL ASSESSMENT
Performed DAILY at time of day with minimal distractions/interuptions

Perform Spontaneous Awakening Trial (SAT) Safety Assessment
Are ANY ONE of the following listed below, MET?

Receiving sedation for active seizures or alcohol withdrawal or agitation?
Receiving neuromuscular blocker agents?
Evidence of myocardial ischemia within past 24 hours?
Evidence of increased intracranial pressure (ICP)?

IF YES, STOP!Repeat Daily SAT/SBT assessment next day;
IF NONE of above MET, proceed to box below

SAT Safety Assessment Continued
If sedation held for 4 hours, are any ONE of the following listed below present/MET?

Anxiety/Agitation/Pain
Respiratory rate 35 bpm or SpO₂ <88% for 5 minutes
Acute onset cardiac arrhythmia
Two or more signs of respiratory distress:

Tachy/bradycardia, use of accessory muscles abdominal paradox, diaphoresis, nasal flaring

Tachy/bradycardia, use of accessory muscles abdominal paradox, diaphoresis, nasal flaring

IF YES, STOP! Restart sedation at 50% reduce dose and titrate for pain/sedation; Repeat Daily SAT/SBT assessment next day
^*IF NONE of above MET, proceed to SBT

Perform Spontaneous Breathing Trial (SBT) Safety Assessment
Are any ONE of the following listed below, NOT MET?

Adequate oxygenation (e.g., PEEP 8 cm H₂O; SpO₂ 88% with FiO₂ <0.50);
Spontaneous inspiratory effort in a 5 minute period
No agitation; No evidence of increased ICP
No evidence of myocardial ischemia
Hemodynamically stable; no vasopressor or inotropic agents or only stable minimal doses

IF YES, STOP! Repeat Daily SAT/SBT assessment next day and continue to treat causes of respiratory failure
IF ALL of above MET, proceed to box below

Proceed with spontaneous breathing trial using CPAP (5 cm H₂O), PSV (<7 cm H₂O) or T-tube technique for 30-120 minutes and observe closely.
Move to box below.

SBT Tolerance Assessment
Are any ONE of the following listed below, MET?

Respiratory rate >35 or <8 bpm for 5 minutes or longer
SpO₂ <88% for at least 5 minutes;
SBP <80 or >180 mm Hg or >20% change from baseline
Heart rate >140 bpm or variability >20% from baseline
Abrupt change in mental status, anxiety, agitation
Acute onset cardia arrhythmia(s)
Two or more signs of respiratory distress:

Tachyacardia, bradycardia, use of accessory muscles abdominal paradox, diaphoresis, agitation, nasal flaring

Tachyacardia, bradycardia, use of accessory muscles abdominal paradox, diaphoresis, agitation, nasal flaring

IF YES, STOP! Repeat Daily SAT/SBT assessment next day and consider causes for weaning failure;
^**IF NONE of above MET, contact Provider to considerextubation.

End

FIRST STEP:Is the Patient Responsive to Verbal Stimuli?

NO

YES

^* SBT assessment with minimal sedation, optimal

^** Prior to extubation, conduct cuff leak test if high risk for post extubation stridor (PES). If test failed, consider steroid administration 4 hours prior to extubation.

NOTE: If ventilated >24 hours and pass SBT, but high risk for respiratory failure after extubation, consider immediate non-invasive ventilation (NIV).