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for Medical Professionals — ABCDEFs of Prevention and Safety

Both Spontaneous Awakening Trials (SAT) & Spontaneous Breathing Trials (SBT)

Spontaneous Awakening Trials (SATs), also known as daily sedative interruptions, are one of the recommended titration methods in the recent Pain, Agitation and Delirium (PAD) guidelines for managing sedatives in critically ill patients and achieving light sedation. Daily SATs are the stopping of narcotics (as long as pain is controlled) and sedatives every day and, if needed, restarting either narcotics or sedatives at half the previous dose and titrating as needed. The ABC study, also known as the Wake Up and Breathe study, showed that pairing together daily SATs with daily Spontaneous Breathing Trials (SBTs) in a protocol that included safety screens and failure criteria resulted in improved patients outcomes (i.e., decreased time on the ventilator, reduced time spent in the ICU and hospital, and improved one-year survival).

This coordination of SATs and SBTs (awakening and breathing trials) emphasizes that narcotic and sedation titration alongside timely removal of mechanical ventilation play a pivotal role in liberating patients from the ICU and are thus core features of the ABCDEF bundle.

Both SAT & SBT Resources


Wake Up and Breathe Flowchart

Spontaneous Awakening Trials (SATs) + Spontaneous Breathing Trials (SBTs)


2013 PAD SCCM/ACCP Guidelines (formerly known as sedation guidelines)
ABC Study
The Preventability of Ventilator-Associated Events: The CDC Prevention Epicenters' Wake Up and Breathe Collaborative
Pharmacist Leadership in ICU Quality Improvement: Coordinating Spontaneous Awakening and Breathing Trials

Choice of Sedation