August 12
by Jonathan Downham
In this episode, I explore the origins and evolution of the daily sedation hold — also known as the spontaneous awakening trial (SAT) — one of the most influential shifts in ICU sedation practice.
I unpack the key trials that demonstrated SATs could safely reduce ventilation time and ICU stay, and examines how these findings became standard care. But it's not all straightforward — SATs come with implementation challenges, especially when protocols are already in place.
Key topics:
The evidence behind daily sedation interruption
How SATs reduce ventilation and improve survival
Why some ICUs still hesitate to adopt them
What makes implementation successful in real life
How SATs have reframed sedation from passive to purposeful
Kress et al. (2000). Daily interruption of sedative infusions in critically ill patients.
Girard et al. (2008). Awakening and breathing controlled trial.
Mehta et al. (2012). Daily sedation interruption in protocolized sedation: RCT.
Ferraioli et al. (2019). Quality improvement project on SAT compliance.
Schmidt et al. (2016). ATS/Chest guidelines on sedation minimization
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