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Published on: September 16, 2019
Pairing Spontaneous Awakening and Breathing Trials to Improve Weaning of Intensive Care Unit Patients: A Systematic
Fatma Refaat Ahmed1, Nabeel Al-Yateem, Aram Halimi
1Author Affiliations: Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, UAE (Dr Refaat Ahmed, Prof Al-Yateem, and Dr Maria Dias); Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Mr Halimi); Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Halimi and Prof Hashemi Nazari); Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Ms Salimi Akinabadi); Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Ms Hadavandsiri, Prof Mosavi Jarrahi; Department of Health Care Management, College of Health Sciences, University of Sharjah, Sharjah, UAE (Dr Azizur Rahman, Dr Al-Marzouqi); Maternal and Children Health Nursing Department, Faculty of Nursing, Applied Science Private University, 21 Al Arab St, Amman, Jordan (Dr Momani); Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Dr Zandi); Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt (Dr Gamil); Critical Care, Cardiovascular Nursing, College of Nursing and Midwifery, MBRU, Dubai Health, Dubai, UAE (Prof Eid Aburuz).
Objective:
This systematic review evaluates the clinical effectiveness of the spontaneous awakening trial (SAT)-spontaneous breathing trial (SBT) protocol in mechanically ventilated sedated patients (MVSPs) within intensive care units (ICUs). Methods: A comprehensive search identified 18 studies involving 12 284 patients from 11 countries. Outcomes included weaning success, mechanical ventilation (MV) duration, sedation time, complications, cognitive impairment, ICU stay length, and mortality. Results: Implementing the ABCDE bundle, particularly the paired SAT-SBT protocol, significantly reduced ventilation and sedation time by nearly 50%. The intervention was associated with decreased medication use, improved patient wakefulness, and higher extubation success rates. The intervention group showed shorter durations of MV, ICU, and hospital stays. Cognitive impairment was less frequent in the intervention group at the 3-month follow-up. Nurse workload was unaffected, and 1-year mortality was lower in the SAT-SBT group. Conclusion: The systematic review supports the clinical effectiveness of the paired SAT-SBT protocol within the ABCDE bundle for MVSPs in ICUs. The protocol improved weaning outcomes, reduced ventilation and sedation time, decreased complications, and shortened durations of MV and ICU stay. The findings underscore the benefits of a comprehensive approach integrating SAT and SBT in managing MVSPs. Further research is needed to optimize intervention timing, address implementation challenges, assess cost-effectiveness, and determine generalizability across diverse patient populations and healthcare settings.
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