Comparison of SAT and SBT Conduct During the ABC Trial and PILOT Trial

Tuqa Alkhateeb; Matthew W Semler; Timothy D Girard; E Wesley Ely; Joanna L Stollings

doi:10.1177/08850666231213337

Comparison of SAT and SBT Conduct During the ABC Trial and PILOT Trial

J Intensive Care Med. 2023 Nov 19:8850666231213337. doi: 10.1177/08850666231213337. Online ahead of print.

Authors

Tuqa Alkhateeb¹, Matthew W Semler², Timothy D Girard³, E Wesley Ely^{1

2

4}, Joanna L Stollings^{1

5}

Affiliations

¹ The Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
² Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
³ Center for Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁴ Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center Tennessee Valley Healthcare System, Vanderbilt University Medical Center, Nashville, TN, USA.
⁵ Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA.

PMID: 37981753
DOI: 10.1177/08850666231213337

Abstract

Background: Implementation of the "B" element-both spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs)-of the ABCDEF bundle improves the outcomes for mechanically ventilated patients. In 2021, the Pragmatic Investigation of optimal Oxygen Targets (PILOT) trial investigating optimal oxygenation targets in patients on mechanical ventilation was completed.

Objectives: To compare SAT and SBT conduct between a randomized controlled trial and current clinical care.

Methods: The 2008 Awakening and Breathing Controlled (ABC) Trial (2003-2006) randomized mechanically ventilated patients to paired SATs and SBTs versus sedation per usual care plus SBTs. The PILOT trial (2018-2021) enrolled patients years later where SAT + SBT conduct was observed. We compared SAT and SBT conduct in ABC's interventional group (SAT + SBT; n = 167, 1140 patient days) to that in PILOT (n = 2083, 8355 patient days).

Results: Spontaneous awakening trial safety screens were done in all 1140 ABC patient-days on sedation and/or analgesia and in 3889 of 4228 (92%) in PILOT. Spontaneous awakening trial safety screens were passed in 939 of 1140 (82%) instances in ABC versus only 1897 of 3889 (49%) in PILOT. Interestingly, SAT was performed in ≥95% of passed SAT safety screens in both trials and was passed in 837 of 895 (94%) in ABC versus 1145 of 1867 (61%) in PILOT. SBT safety screens were performed in all 983 ABC instances and 8031 of 8370 (96%) in PILOT. SBT safety screens were passed in 647 of 983 (66%) in ABC versus 4475 of 8031 (56%) in PILOT. Spontaneous breathing trial was performed in ≥93% of passed SBT safety screens in both trials and was passed in 319 of 603 (53%) in ABC versus 3337 of 4454 (75%) in PILOT.

Conclusion: This study compared SAT/SBT conduction in an ideal setting to real-world practice, 13 years later. Performance of SAT/SBT safety screens, SATs, and SBTs between a definitive clinical trial (ABC) as compared to current clinical care (PILOT) remained high.

Keywords: analgesia; mechanical ventilation; sedation; spontaneous awakening trials; spontaneous breathing trials.