Thread by @WesElyMD

1/ Do data support pt trial off sedation for “SAT” when pt is comfortable on current dose? Yes
 
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“Dr. Ely, yesterday our ICU #nurses went over #A2Fbundle in Epic for implementation. Do you recommend SAT at RASS Goal of RASS -1 to +1?
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2/ Excellent #Nurse added:

“We are currently not doing SAT (Spontaneous Awakening Trial) but keeping pt’s RASS -1 to +1.  Just want to make sure we are interpreting #A2Fbundle correctly.”
 
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3/ my Answers:

Great questions. I don’t think +1 (anxiety) is ever a good goal but 0 to -1 is a 👍 default target RASS if we acknowledge there are times when sedation target should acceptably be set as deep as -3/-4 in bad #ARDS or -5 transiently when pt requires paralytics.

4/ Some HCPs use philosophy that if pt is already “at goal” why shut drugs off? 

Well...what if target is wrong? Also, if a drug isn’t needed, it may be hurting a person & costing $$ unnecessarily. Bottom line: you won’t know if it’s needed until you stop it EVERY DAY w SAT.

5/ Data say stop sedation once a day even if at target. Restart as needed at half previous dose. That’s how we designed our Girard T 2008 ABC study in @TheLancet, which showed BIG survival advantage to SATs.

6/…it’s a gamble with someone else’s #recovery & #life not to do the SAT. What happened yesterday for your pt is NOT proof of how she/he will react today. When the sun comes up it’s a new opportunity to liberate this person! We act in anticipation of progress in #healing.

7/fin
Committing pts to more drug doesn’t make sense data-wise or to me as a doc since I can safely test need via an SAT. Assuming pts need more sedation is a sentence in favor of more immobilization, #delirium, ultimately more #dementia & #death.
 
#A2Fbundle = #humanization

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