 Hi guys, so one of you guys asked me to talk about spontaneous awakening trials in the ICU and I thought that that was a great topic, so here I am going to be talking a little bit about spontaneous awakening trials. So if you don't know what that is, basically in the ICU when you have patients that are intubated and sedated, spontaneous awakening trial is where you're waking them up to kind of see what their mentation is like and work on their level of sedation slash possibly doing a breathing trial to ex-debate them. So there's lots that go into that goes into spontaneous awakening trials and there's kind of this basic format that I'm pretty sure is standardized across most ICU's, but your every ICU is going to be a little different and also a little disclaimer like every patient is going to be different so you when you're doing a spontaneous awakening trial on you know different patients you may have to approach it a little bit differently, but I'm going to kind of just tell you the standard way that it is done. Spontaneous awakening trials in my ICU are done every single morning. I usually will do them during my first assessment because then you can get a really good idea for how a patient is doing neurologically. Now there's different criteria and this will be listed on your charting system or maybe you have a diagram or something and I have a link that I will link down below of this really helpful diagram that tells you like the criteria that would fail someone from a spontaneous awakening trial. But to give you a little idea, if you have a patient that's sedated and intubated and they're on a hundred percent FiO2, a peep of 15, and you have them paralyzed because they've been fighting the ventilator, you're not going to turn off all their sedation, especially if they're paralyzed, but you're not going to turn out their paralytic, you're not going to turn off their sedation because you're putting them more at risk because they're going to be fighting the ventilator and potentially like that could put them in a harmful situation if they're coughing, de-satting, not letting the ventilator do the work for them, so to speak. So there's different criteria where you're not going to wake someone up, but if it's just your typical maybe CLPD exacerbation, asthma exacerbation, pneumonia, the patient's doing better, they're on less FiO2, they're, you know, not requiring a ton of vanilla ventilator support. Then that is a good time to wake them up. Now, I'm not saying if your patient's requiring a lot of support that you can't lower their sedation or wake them up, but again, this is going to be kind of just a blank statement. So typically, if your patient doesn't meet any of those contraindications to wake them up, you're going to turn your sedation off at my hospital. It says to turn your sedation off and to leave your, like, what if they have pain medicine running, leave that on. I forget the timing. I think it says, if after two hours your patient hasn't woken up and cut the sedation in half. Now here's the thing, every patient is different. If you have someone who's maybe on 50 of propofol and you just suddenly turn it off, you may freak them out. You may need to be a little more gentle with turning the sedation down. I'm not saying you're not going to eventually get down to zero, but sometimes if you just suddenly, like, it's like a switch, you know, you tie the sedation on and then you just suddenly turn it off. You're going to potentially freak your patient out when they come out of sedation. So every patient's different. Again, just kind of a blank statement, but you're going to turn your sedation off or down and you're going to assess your patient's neuro status. So are they able to follow commands? Are they able to stay nice and calm? There's different criteria that a patient can pass or fail their spontaneous awakening trial. So if your patient's being nice and calm, they're breathing on their own, they're able to follow commands, then potentially they could proceed onto a spontaneous breathing trial. Now every hospital may have different criteria of when you can do this spontaneous breathing trial. So if you're interested in that, I could talk more about that, but look into your hospital policy. But if your patient's getting super agitated or suddenly they're breathing 40 times a minute or they're not able to follow commands, that's an indication that they're failing their spontaneous awakening trial. Now there may be different reasons that they're failing. Maybe they have a history of anxiety or maybe they have a psych history and you stop their psych myth. So they're totally disoriented. They're totally like, they have no idea what's going on. Or maybe they actually are struggling to breathe because their lungs aren't quite ready to do a breathing trial. So in that case, the blank policy that I'm talking about says to restart their sedation at half of what the original dose was and then titrate up to whatever your goal, RAS or order RAS is. You don't know what a RAS is. Basically it's a level of sedation and that's like a whole nother video I could get into. Now it's important to look into why your patient may be failing an awakening trial. Is it agitation? Are they in pain? Are they anxious? Do you need to get a different medication on board to maybe help them stay nice and calm but not interfere with their respiratory drive like Presidex? That's a common one that we use in the hospital on that is Presidex to keep them nice and calm but not interfere with their ability to follow commands and breathe on their own. Or are they failing because it's a respiratory issue? Are they becoming super tachycardic? Is their oxygen level dropping? Are they having lots of dysrhythmias? Those are all indications that your patient is failing their awakening trial. As a nurse, when you are doing these awakening trials, it's important that you are at the bedside or nearby so that way you can reorient your patients and explain to them as they come out of sedation what is going on. So I like to always tell my patients, like I introduce myself, I say that I'm their nurse, you're in the hospital, you have a breathing tube in, it's helping you breathe, you're waking up from sedation right now so you may feel a little foggy and I'm kind of just explaining to them what's going on because you can imagine if you've been totally blacked out for who knows how long and I just suddenly wake up and you've got a tube in your mouth, you're restrained down to the bed, you've got people eating over you, it can be a very scary thing. So giving your patients lots of reassurance and explaining to them what's going on can be helpful to help with their anxiety level. Also the biggest part about spontaneous awakening trials is that you're reducing patients risk of ICU delirium and if you study delirium or know anything about delirium you know that if a patient becomes delirious it increases their ICU stay, their hospitalization stay, their time on a ventilator, their risk of mortality, like there's a ton of different risks associated with delirium so it's important that we're waking our patients up and we're making sure they're on the appropriate amount of sedation if we have to resedate them. I think that kind of sums up spontaneous awakening trials. It's a lot of information and if you're not in the ICU or you're not familiar with a lot of these terms, I know this video probably could just like goes in one ear and out the other. But if you're interested in learning more about breathing trials or I don't know, different things associated with this topic, let me know in the comments below. But thank you guys for watching, give this video a thumbs up and subscribe to my channel and I'll see you guys next time. Bye.