A Review Study: Standardized, Respiratory Therapist-Initiated Spontaneous Awakening and Breathing Trial (SATSBT) Protocol Implementation and its Effect on Ventilator-Free Days in MICU Patients

Alshehri, Mohammed Ali; Al Mufarij, Faisal Mohammed; Almalki, Abdullah Hulail; AlFaleh, Khaled Osamah; Almahaily, Khalid Ali; Almalki, Maram Hulayyil; Aldossary, Faisal Johar; Aloknah, Abdulaziz Faisal; Almlaki, Abdulelah Hulail; Jazzaa, Wael Ali; Alonazi, Nouf Khalid; Yahya, Razan Yahya; Alsulami, Abeer Ibrahim

doi:10.21608/jmals.2025.461947

A Review Study: Standardized, Respiratory Therapist-Initiated Spontaneous Awakening and Breathing Trial (SATSBT) Protocol Implementation and its Effect on Ventilator-Free Days in MICU Patients

Document Type : Original Article

Authors

¹ Respiratory Therapist, King Abdulaziz Airbase Armed Forces Hospital – Dhahran, Saudi Arabia

² Respiratory Therapist, Armed Forces Hospital – Najran, Saudi Arabia

³ Emergency Medical Technician, King Abdulaziz Airbase Armed Forces Hospital – Dhahran, Saudi Arabia

⁴ Registered Nurse, King Abdulaziz Airbase Armed Forces Hospital – Dhahran, Saudi Arabia

10.21608/jmals.2025.461947

Abstract

Mechanical ventilation is a ubiquitous feature of life support in the MICU, yet it is also riddled with high iatrogenic morbidities like ventilator-associated pneumonia (VAP), diaphragmatic dysfunction, and prolonged sedation. Reduction of the duration of mechanical ventilation is a primary goal in critical care, and ventilator-free days (VFDs) have emerged as a robust, patient-important outcome measure that reconciles survival and weaning from the ventilator. The now-classic Awakening and Breathing Controlled (ABC) trial proved the utility of paired spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) in promoting improved outcomes in mechanically ventilated patients. However, translating this evidence into day-to-day practice in different MICU settings has been challenging. This review is a delving into the recent literature (2020-2025) focused on the use of a standard, respiratory therapist (RT)-directed SAT/SBT (SATSBT) protocol as a quality initiative and its specific impact on VFDs in MICU patients. It investigates why protocolization is justified, the central role of RTs in driving protocol, obstacles to effective implementation, and the resulting effect on clinical outcomes aside from VFDs, such as ICU LOS and mortality. The meta-analysis of existing evidence demonstrably indicates that a well-structured, RT-guided SATSBT protocol is a strong and effective QI intervention that significantly increases VFDs and thereby improves patient outcomes and optimizes resource allocation in the MICU.

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