Work

The Association Between Language and Race and the Conduct of Spontaneous Awakening Trials Among Mechanically Ventilated Patients

Year: 2026

Type: article

Abstract: Background Spontaneous awakening trials (SATs) reduce ICU length of stay and improve mortality. Prior studies linked non-English language preference and Black race to increased use of restraints and sedation. Research Question Are non-English language preference and Black patient race associated with lower adherence to daily SATs? Study Design and Methods This was a retrospective observational study of adult patients admitted to ICUs within the same health care system between January 30, 2016, and January 3, 2024. The outcome of interest was SAT adherence, defined per day as whether a patient underwent an SAT when they were clinically eligible. The odds of a patient undergoing an SAT when they were eligible to do so were compared between patients who preferred a non-English language and those who preferred English and between Black patients and patients of other races. The analysis was carried out at the level of intubation day. Mixed-effect multivariable logistic regression was used to account for potential confounders. This was a hypothesis-generating analysis without correction for multiple testing. Results The study included 8,881 patients, encompassing 48,431 SAT-eligible days. A total of 1,706 patients (19%) preferred a non-English language, and 3,379 patients (38%) were Black. An SAT was performed on 11,748 (24%) of all eligible days. No significant difference in SAT adherence was found comparing non-English speakers vs English speakers (25% vs 24%; adjusted OR, 0.99; 95% CI, 0.89-1.10) or between Black and non-Black patients (23% vs 25%; OR, 0.93; 95% CI, 0.85-1.02). In a subgroup analysis, we observed a lower SAT adherence among Black vs White patients (OR, 0.89; 95% CI, 0.80-0.99). Interpretation Our results show that SAT adherence was similar among patients who preferred a non-English language and those who preferred English. SAT adherence was observed to be lower among Black patients compared with White patients, but not when Black patients were compared with all other races.

Source: CHEST Critical Care

DOI: 10.1016/j.chstcc.2026.100292