1. Talking Points for A & B
Pain
 Most critically ill patients will likely experience pain during their ICU stay and many
critically ill patients may be unable to self-report their pain. Patients may have
negative physiologic and psychologic consequences of unrelieved/untreated pain-
agitation and delirium. Also, imagine uncontrolled pain leading to respiratory
distress leading to intubation.
 Self- reporting is the gold standard for assessment of pain.
o Next best thing would be the non-verbal pain scale
 Vital signs should not be used alone for assessment of pain in patients
that are unable to communicate.
o Consider using the patient’s family members to help assess for pain
(American Society for Pain Management Nursing).
o But when patients are unable to use self-report or exhibit behaviors, then
assume pain is present
 Examples: patients who are vec’d, those who are unresponsive but
have underlying pathology thought to be painful, those undergoing
procedures known to be painful
SAT and SBT
 Prolonged mechanical ventilation can lead to undesirable outcomes; therefore,
reducing the duration of ventilation time is an important goal. Within the ABCDEF
bundle, the B element—Both Spontaneous Awakening Trials (SAT) and
Spontaneous Breathing Trials (SBT)—focuses on setting time(s) each day to stop
sedative medications, orient the patient to time and day, and conduct a spontaneous
breathing trial in an effort to liberate the patient from the ventilator.
o Doing these trials lead to decreased ventilator days, decreased ICU LOS &
overall hospital LOS
 See “Wake Up and Breathe Flowchart” with particular focus on the SAT Screen.
 SAT Screen
o If the patient meets these criteria, a SAT must be performed…. TURN OFF
THE SEDATION!
o If the patient fails SAT screen (see criteria on flowchart), then restart
sedation at ½ dose then titrate to meet RASS goal
 Coordinate with RT for SBT.