MICU SEDATION VACATIONSBT DECISION TREE SAT Safety Screen

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 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 1: Fail if: Perform Spontaneous Awakening Trial (SAT) Safety Screen any screen criteria not met Pass Step 2: Perform SAT while in room performing assessment: Analgesics - ↓ dose by 50% Low dose sedation - turn off High dose sedation - ↓ dose by 50% Nursing Action « If patient apneic, do not restart Fail if: any failure criteria present • • • No agitation Oxygen saturation ≥ 88% Fi. O 2 ≤ 50% PEEP ≤ 7. 5 No myocardial ischemia No vasopressor increase in the last 4 hours • Inspiratory effort present Step 3: Spontaneous Breathing Trial (SBT) Safety Screen Perform SBT Pass analgesic at 50% pre-SAT dose • +1 or +2, restart sedation & analgesia at 50% pre-SAT dose analgesia at 75% pre-SAT dose « Titrate sedation to goal RASS -1 to +1 « Repeat Step 1 in 12 hours Fail if: any screen criteria not met Pass Step 4: sedation or increase analgesia « Restart sedation based on RASS: • < -1 hold sedation, restart • +3 or +4, restart sedation & Pass SBT Safety Screen Criteria Repeat Step 1 in 12 hours Assess mobility indicators Fail if: any failure criteria present 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 « « « 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 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 SBT Failure Criteria « Respiratory distress « Respiratory rate > 35/min X 5 min. « Respiratory rate < 8/min « Oxygen saturation <88% X 1 min. « Heart rate change > 20 bpm « Mental status change « Acute cardiac dysrhythmia « Significantly increased anxiety or diaphoresis X 5 min. Consider extubation Note: Always use nursing judgment