ADULT INTERRUPT SEDATION/ANALGESIC INFUSION and
WEANING OF MECHANICAL VENTILATION GUIDELINES
STEP 1: Daily Screening Criteria for Sedation Interruption (Sedation Vacation)
Interrupt sedation/analgesic infusion(s) daily between 0730 to 12 noon for neurological checks, pain assessment and
spontaneous breathing trial.
Assess criteria to begin sedation/analgesic interruption:
 Patient sedated on continuous sedative and /or analgesia medications(s)
 Ensure staff available for continuous presence during sedation interruption , spontaneous respiratory mechanics, and if a
rapid wean is planned
 On mechanical ventilation for not less than 12 hours
 Not on sedation for active seizure, alcohol withdrawal, or delirium tremens, or ventilator synchrony
 Not on neuromuscular blockade medication (paralytic)
 No evidence of active myocardial ischemia (NSTEMI/STEMI) in last 24 hours
 No evidence of increased intracranial pressure (ICP greater than 20 mmHg)

Proceed to Sedation Interruption (Sedation Vacation) step 2 if criteria MET

If criteria to begin sedation interruption are NOT MET: reassess criteria, evaluate need to optimize patient and to
begin sedation/analgesic interruption in 24 hours.
STEP 2: Sedation Interruption (Sedation Vacation)
 Perform sedation interruption
Assess Criteria for PASS of Interruption
 Open eye(s) to verbal stimuli or RASS of -1
 Respiratory rate less than 30 breaths per minute
 SpO2 greater than 88%
 No acute arrhythmias
 No sign/symptom of heart rate changes: greater than
130 or less than 50 beats per minute or change greater
than 20 beats per minutes
Assess Criteria for FAILURE of Interruption sedation/analgesic :
 If sustained anxiety, agitation, or pain for 5 minutes or longer:
o Restart all titratable sedation/analgesic infusions at
half of the last documented rate/dose prior to the
interrupt sedation /analgesic infusion. Revert to
titration orders to achieve target parameter.
o Restart all non-titratable sedation/analgesic infusions
at last documented ordered rate.
 If patient unarousable discuss with physician treatment plan
 Use of accessory muscles, abdominal paradox, diaphoresis,
If criteria for sedation interruption are MET:
marked dyspnea
Begin Assessment of Spontaneous Respiratory
 Respiratory rate greater than 30 breaths per minute for 5
Mechanics Step 3.
minutes or longer
 SpO2 less than 88% for 5 minutes or longer
 An acute arrhythmia
 Heart rate changes: greater than 130 or less than 50 beats per
minute or change greater than 20 beats per minutes
STEP 3: ASSESMENT OF SPONTANEOUS RESPIRATORY MECHANICS
In patients with PEEP less than or equal to 8 or FiO2 less than or equal to 60% that are not hemodynamically unstable an
Appointment will be set by RCP and RN between 0730 and 12 noon. Priority patients will be identified by provider and RCP/RN the
shift prior. Assessments will occur approximately every 30 minutes for the designated patients. SBAR handoff * must be
completed between RCP and RN prior to starting of the assessments.
The following must be completed before/during each assessment:
Nursing Cares:
 All sedation/analgesic infusion turned off for 10-15 minutes prior to weaning trial.
o Includes all sedative and narcotic drips
o Includes all IV boluses of narcotics
 Vital signs every 15 minutes during Weaning Trial, then resume previous vital sign orders
 Elevate head of bed 30-45 degrees if no other contraindication
 Apply restraint if needed if patient become anxious
 During evaluation of sedation interruption, assessment of spontaneous respiratory mechanics, and for rapid weaning
provision of in room supervision is preferred.
Revised 11/13/ 2013 *SBAR handoff = S (situation) B (background) A (assessment) R (recommendations)
ADULT INTERRUPT SEDATION/ANALGESIC INFUSION and
WEANING OF MECHANICAL VENTILATION GUIDELINES
Respiratory Care Provider (RCP) Cares:
 If nebulized medication is ordered, administer prior to starting assessment
 Ventilator Settings: Wean patient to CPAP or PS setting. Document spontaneous respiratory mechanics
 Arterial blood gases:
o Before start of Weaning Trial (unless results from today are available on the same settings)
o If patient progresses to weaning trial after assessment of spontaneous respiratory mechanics
o Provider may elect not to obtain post weaning trial ABG
Spontaneous Respiratory Mechanics PASS Criteria:
o SpO2 is greater than 88% on FiO2 of less than 60%
o Minute ventilation 5 to 15 L/min
o Spontaneous respiratory rate less than 30 breaths/min
o Spontaneous VT greater than 300 mL or greater than 5 mL/kg
o Rapid shallow breathing index (RSBI) 105 or less (RSBI = frequency/VT)
o PEEP equal to or less than 8 cmH2O
o Absence of :

sustained anxiety or agitation

accessory muscles usage, abdominal paradox, diaphoresis, and marked dyspnea

sign/symptom of heart rate changes: greater than 130 or less than 50 beats per minute or change greater
than 20 beats per minutes

acute MAP changes greater than 20mmHg
RCP Cares:
 Initiate Weaning Trial:
 If criteria met, wean patient to CPAP or Pressure Support (PS) ventilator setting
 If Criteria Not Met :
 Notify prescriber of failed spontaneous respiratory mechanics and confirm return to patient’s previous ventilator order
settings.
STEP 4: Weaning Trial
Weaning Trial PASS Criteria:
 When patient’s results post Weaning Trial are NOT within the
 Cough or gag reflex present with deflated cuff
“Weaning Trial PASS Criteria”:
 Audible air leak around ETT
Nursing Cares:
 Arterial blood gas results (as indicated):
o Restart all titratable sedation/analgesic infusions at
 pH 7.30 or greater
 PCO2 rise of no more than 10 or more
half of the last documented rate/dose prior to the
from baseline
interrupt sedation /analgesic infusion. Revert to
 PaO2 greater than 60 torr on 60% of FiO2
titration orders to achieve target parameter.
or less
o Restart all non-titratable sedation/analgesic infusions
at last documented ordered rate.
 Notify prescriber for extubation order when
the patient’s results after Weaning Trial are
RCP Cares:
met.
o Notify prescriber when weaning criteria are not met.
o Assess opportunity to optimize patient for next
 If weaning trial criteria MET Proceed to
weaning trial
Extubation Step 5
o Document time of failure, what criteria were not met
and any complication in nursing and RCP electronic
record
o RCP to place patient to previous ventilator order
setting
STEP 5: Extubation
Nursing preparation for extubation:
 Mouth Care with Chlorohexidine 0.12% 15 mL scrub the oral cavity prior to deflating cuff for extubation
Revised 11/13/ 2013 *SBAR handoff = S (situation) B (background) A (assessment) R (recommendations)