Exploring Racial and Language Barriers to Spontaneous Awakening Trial Adherence

Monday, March 23, 2026

9:00 AM - 10:00 AM Central Time

Location: Connections Central - RST 17

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Vikram B. Gondhalekar, MD

Montefiore Medical Center, New York

Disclosure(s): No relevant financial relationship(s) to disclose.
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Ari Moskowitz, MD MPH

Associate Professor of Medicine and Director of Critical Care Research
Division of Critical Care Medicine, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx Center for Critical Care Outcomes and Resuscitation Research

Disclosure information not submitted.
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Samira Hayee, MBBS

Internal Medicine Resident
Department of Medicine, NYC Health & Hospital/Jacobi, Albert Einstein College of Medicine, Bronx Center for Critical Care Outcomes and Resuscitation Research

Disclosure information not submitted.
Michelle Ng Gong, MD, MS (she/her/hers)

Montefiore Medical Center, New York

Disclosure information not submitted.
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Thomas S. Butler, MS

Data Analyst
Division of Critical Care Medicine, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx Center for Critical Care Outcomes and Resuscitation Research

Disclosure information not submitted.
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Arup Gope, MS

Data Analyst
Division of Critical Care Medicine, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx Center for Critical Care Outcomes and Resuscitation Research

Disclosure information not submitted.
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Amira Mohamed, MD

Associate Professor of Medicine and Program Director, Critical Care Medicine Fellowship Program
Division of Critical Care Medicine, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx Center for Critical Care Outcomes and Resuscitation Research

Disclosure information not submitted.

Introduction: Spontaneous awakening trials (SATs) reduce ICU length of stay and improve mortality. Prior studies linked non-white race and non-English language preference to increased use of restraints and sedation. We hypothesized that Black patient race and non-English language preference were associated with lower adherence to daily SAT.

Methods: A retrospective observational study was conducted, including adult ICU patients (≥18 years) on invasive mechanical ventilation at three urban hospitals who were admitted between 01/30/2016 and 01/03/2024. Patients ventilated for < 48 hours or with a prior tracheostomy were excluded. Only the first 14 days of the index respiratory failure event were analyzed. The primary outcome was SAT adherence, defined per day as whether a patient underwent SAT when they were eligible to undergo SAT. A patient was considered SAT eligible if they were receiving a continuous sedative infusion, did not require FiO2 ≥ 0.80, PEEP ≥ 10, paralytics, or high-dose vasopressors, had a pH > 7.2, a RASS < 3, and, if measured, an ICP between 0 and 22. SAT was defined to have occurred when sedatives were completely discontinued. SAT adherence was compared between patients who preferred English vs non-English and Black vs non-Black patients. The level of analysis was ventilator days. Multivariable mixed-effects logistic regression was used to control for patient-level confounders as fixed effects and patient as a random effect. Separate models tested each exposure independently.

Results: The study included 6292 patients, encompassing 33,436 SAT eligible days, and 20% of patients preferred a non-English language and 36% were Black. Baseline characteristics were similar across groups. SAT was performed on 35% of all eligible days. SAT adherence was similar among English vs non-English speakers (OR 1.03, 95% CI 0.95-1.12) and was similar among patients who were non-Black vs Black (OR 1.00, 95% CI 0.92-1.07). Female gender, SICU admission, lower APACHE, and lower BMI associated with higher SAT adherence. SAT adherence increased from 2016 to 2024, except in 2020 during COVID.

Conclusions: In this study, there was no association between language or race and SAT adherence. This differs from prior studies and may be due to the highly diverse patient population at our center.