Search Results (46)

Lung vibration is a chest physiotherapy technique used to facilitate sputum mobilization and improve airway clearance; however, its effectiveness may vary due to therapist-dependent factors. This study developed a lung vibration device and evaluated its effectiveness in patients with sputum retention. Twenty-five patients, aged ≥18 years with sputum retention, including those with bronchiectasis, pneumonia, and COPD-related conditions, participated in a randomized crossover trial and received two single interventions in random order: a conventional intervention (manual percussion, manual vibration, and suction) and an experimental intervention (manual vibration replaced by the device). Sputum volume and quality, rating of perceived dyspnea (RPD), peripheral oxygen saturation (SpO₂), cardiovascular dynamics, respiratory rate, and body temperature were assessed before and immediately after each intervention. Sputum volume was significantly higher following the experimental intervention compared with the conventional intervention (p = 0.010). No significant between-intervention differences were observed in sputum quality, RPD, SpO₂, cardiovascular parameters, respiratory rate, or body temperature (all p > 0.05). No potential adverse effects were reported. These findings suggest that the lung vibration device enhances sputum clearance in the short term, with no immediate adverse physiological effects observed, and may serve as a practical alternative to manual vibration. Full article

Background: Probiotics have emerged as an effective therapeutic intervention in critically ill patients receiving enteral nutrition, yet their use remains inconsistent across intensive care units (ICUs). Understanding knowledge, attitudes, and practices (KAP) among healthcare professionals (HCPs) is essential for optimizing evidence-based probiotic administration in enteral nutrition, identifying perceived implementation barriers, and examining associations between KAP scores and study variables. Methods: A multicenter, cross-sectional online survey was administered to ICU physicians, nurses, clinical dietitians, pharmacists, and respiratory therapists. Participants completed a self-reported questionnaire assessing their knowledge of probiotic mechanisms, indications, and safety; attitudes toward probiotic therapy; and current practices in probiotic administration during enteral feeding. Results: A total of 935 ICU HCPs participated. Overall knowledge was insufficient, with only 33.2% achieving high knowledge scores (mean: 12.4/18 points), whereas attitudes were moderately favorable, with 35.5% demonstrating positive attitudes (mean: 23.9/30 points). A majority of respondents (58.7%) reported recommending or prescribing probiotics, most frequently clinical dietitians (84.5%). KAP varied significantly by profession, age group, and years of experience (p < 0.01). The most reported barriers were a lack of information about available probiotic products (73.2%), limited knowledge (41.2%), limited availability of clinically proven products (37.8%), and cost concerns (29.7%). Conclusions: Although ICU HCPs show interest and cautious acceptance of probiotics in enteral feeding, knowledge gaps, attitudinal variability, and practice inconsistencies persist across disciplines. These findings highlight the critical need for targeted, multidisciplinary educational interventions and the development of standardized, evidence-based institutional protocols to optimize probiotic use and improve patient outcomes. Full article

Background: Intensive care units (ICUs) are high-acuity environments that require respiratory therapists (RTs) to maintain vigilance, manage emotions, and make rapid clinical decisions. In such settings, performance stability is critical for patient safety. Although emotional intelligence (EI) and work–life balance (WLB) have been linked to professional outcomes in health care, their independent and direction-specific associations with job performance among ICU respiratory therapists remain underexamined. Methods: A national cross-sectional survey was conducted among respiratory therapists working in ICUs across Saudi Arabia (June 2025–January 2026). EI was measured using the Wong and Law Emotional Intelligence Scale. WLB was assessed using the work interference with personal life (WIPL), personal life interference with work (PLIW), and work–personal life enhancement (WPLE) scales. Job performance was evaluated using the Individual Work Performance Questionnaire. Correlation and multivariable linear regression analyses were performed to estimate independent associations. Results: A total of 392 RTs were included in the final analysis. Higher EI was independently associated with greater task performance (B = 0.21, p < 0.01) and contextual performance (B = 0.30, p < 0.001), and with lower counterproductive work behaviours (B = −0.24, p < 0.001). Among WLB dimensions, PLIW showed the strongest adverse association, predicting lower task performance (B = −0.20, p < 0.05) and higher counterproductive behaviours (B = 0.39, p < 0.001), but was not significantly associated with contextual performance in the fully adjusted model. WPLE demonstrated modest positive associations with performance, whereas WIPL was not significant in adjusted models. Conclusions: Job performance among ICU respiratory therapists is shaped by both emotional regulatory capacity and cross-domain strain. Personal life interference with work emerged as the most influential adverse predictor, whereas EI was associated with constructive performance patterns. Findings should be interpreted in light of the cross-sectional design and self-reported data. Sustaining performance in high-acuity settings requires attention to emotional competencies and structural sources of role conflict alongside clinical expertise. These findings inform workforce strategies to support performance and sustainability in critical care settings. Full article

Background: Although burnout among respiratory therapists (RTs) is well documented, qualitative insights into their lived experiences in Saudi Arabia remain limited. This study explored RTs’ experiences of burnout, systemic and organisational drivers of professional strain, and strategies for resilience and retention within Saudi hospitals. Methods: A qualitative descriptive design was employed. Purposive sampling was used to recruit 11 RTs from diverse regions across Saudi Arabia. Semi-structured interviews were conducted in Arabic between September and November 2025, audio-recorded, and transcribed verbatim. Data management and analysis followed a hybrid approach using NVivo 12 software alongside manual coding to support deep immersion in the data. Analysis was guided by Braun and Clarke’s reflexive thematic analysis. Methodological rigour was enhanced through reflexive memoing, peer debriefing, and adherence to a 15-point trustworthiness checklist. Results: Analysis generated one overarching theme, “Caught Between Care and Collapse: The Human Cost of Institutional Burnout,” alongside three interrelated themes. Participants described (1) “Living within a system that drains the self,” highlighting sustained physical and emotional exhaustion driven by understaffing and extended shifts; (2) “Losing meaning and recognition,” illustrating how organisational neglect eroded professional passion and replaced it with obligation and frustration; and (3) “Coping strategies and informal support,” reflecting quiet resilience through self-regulation, peer solidarity, and humane leadership. Many participants framed their endurance as an act of moral defiance rather than passive resignation. Conclusions: These findings suggest that RT burnout reflects not individual failure but a structural outcome of sustained strain and deficits in reciprocity. Burnout emerges as an institutional crisis in which therapists remain deeply committed to patient care while being pushed toward professional collapse by systemic neglect. Culturally informed, system-level interventions are urgently needed to preserve this essential workforce. Full article

Background: Evidence-based practice (EBP) has become a foundational component of modern healthcare globally. In Saudi Arabia, the understanding and application of EBP by respiratory therapists (RTs) remains underexplored. This study aimed to assess RTs’ behaviors, attitudes, awareness, knowledge, and barriers related to EBP. Methods: A previously validated online questionnaire was distributed to RTs across Saudi Arabia between February and July 2025. The survey collected sociodemographic data and included 14 items assessing behaviors, attitudes, awareness, knowledge, prior formal EBP training, and perceived barriers to EBP implementation. Results: A total of 301 RTs participated, with 290 completing the survey. Most participants (75.2%) held a bachelor’s degree. Overall, respondents demonstrated positive attitudes toward EBP, with more than 60% agreeing that understanding research methods is essential to respiratory therapy practice. The most frequently used resources for clinical decision-making were personal experience (67.3%), expert opinion (65.5%), and national or international guidelines (65.5%). Awareness of core EBP concepts was moderate; approximately 30% of participants reported a good understanding of terms such as “systematic review,” “quality of evidence,” and “risk of bias.” Several barriers to EBP implementation were identified, most commonly limited access to resources (25.2%), insufficient research knowledge and skills (23.8%), and lack of interest (21.0%). Conclusions: RTs in Saudi Arabia generally support EBP principles and use evidence-based resources in clinical decision-making. However, gaps in training, access to resources, and research competency limit full EBP implementation. Targeted strategies, including integrating mandatory EBP education, expanding professional development, and enhancing access to research resources, are recommended. Full article

Background/Objectives: Studies have demonstrated significant morbidity and mortality associated with airway management, especially when provided outside of the operative setting. The goal of this study was to compare baseline measurements of airway management procedures between anesthesia providers (CRNAs and anesthesiologists) and respiratory therapists using high-fidelity manikins. Methods: This prospective study assessed anesthesia providers and respiratory therapists performing direct laryngoscopy (DL), video laryngoscopy (VL), and LMA placement. The same Laerdal SimMan high-fidelity manikin (Laerdal, Stavanger, Norway) was used in all assessments, with the detection of end-tidal “carbon dioxide” serving as evidence of success for each procedure. Each procedure was performed twice, once under “Healthy Patient” SimMan settings, and once under the “Limited Cervical Range of Motion (ROM)” (DL), “Pharyngeal Obstruction” (VL), and “Full Tongue Edema” (LMA) settings, respectively, to simulate a moderately difficult airway. The order in which the techniques were performed was randomized for each participant. Completion time and number of attempts were recorded for each procedure and compared between the groups. Results: Sixty-two providers (30 anesthesia providers and 32 respiratory therapists) were enrolled. There were no significant differences in average time to completion for any procedure, except respiratory therapists took longer than anesthesia providers in VL with simulated pharyngeal obstruction (p = 0.0004). There were no differences in number of attempts needed for successful completion. Conclusions: This study demonstrates that while completion times for DL and LMA placement were similar amongst provider groups, average time to completion of VL for respiratory therapists was longer under difficult simulated settings. These results reflect potential areas of improvement for other provider groups that may have airway privileges at their respective institutions. Full article

Pectus excavatum (PE) is the most common deformity of the chest wall seen in children and adolescents. Besides its visible depression of the chest, this condition often causes functional impairments affecting the cardiovascular and respiratory systems, as well as postural issues. Additionally, the aesthetic aspect of the deformity can greatly impact the psychosocial well-being of those affected. This study aims to evaluate the effect of a tailored physiotherapy program on children and adolescents with PE, focusing on musculoskeletal, cardiopulmonary, postural, and balance measures. A total of 35 participants diagnosed with PE will be assessed using four complementary methods: myotonometry with MyotonPRO for the trapezius muscle involving all three fascicles and the pectoralis major muscle on both sides, cardiopulmonary exercise testing on a treadmill (including cardiopulmonary function), postural assessment with GaitOn, and static balance-stabilometry with PoData 2.0. These assessments will be performed before and three months after completing an individualized physiotherapy program, which participants will perform daily after proper instruction from a physical therapist. After three months, the initial and final results will be compared to determine how physical therapy influences treatment outcomes in patients with PE. Full article

Registered Respiratory Therapists (RRTs) have unique skills in managing chronic obstructive pulmonary disease (COPD) in primary care settings. With an 82% increase in COPD diagnoses between 2000 and 2010 in Canada, the fact that over 10% of Canadians aged 35 and older are living with COPD, and primary care reform in Ontario and Manitoba, we would expect an increasing number of RRTs working in this setting. However, this is not happening. Through the concept of job satisfaction, we want to investigate the barriers of integrating this allied healthcare professional into primary care settings. Using a pragmatic approach, we examined RRT job satisfaction in primary care via semi-structured interviews of 19 RRTs in Manitoba and Ontario in 2018 and 2019. A combined inductive and deductive (Mottaz framework) analysis approach allowed us to cross reference work context with job satisfaction. The context in which primary care is operationalized impacts RRT job satisfaction. In Ontario, retention of RRTs in primary care was the main issue due to lower salaries and benefits. In Manitoba, recruitment of RRTs in primary care was the main issue due to lack of human resources and funding. Efforts should be made to address gaps in job satisfaction of RRTs in primary care. To improve retention in Ontario, RRTs should be compensated similarly to their counterparts in acute care. In Manitoba, there should be increased positions for RRTs in primary care. Developing strategies for enhancing job satisfaction will ensure the delivery of high-quality, patient-centered care. This study provides both theoretical and practical contributions to primary care workforce research. Theoretically, our findings demonstrate how contextual factors moderate job satisfaction, showing that the primary care context produces various work situations and heavily impacts work satisfaction. Practically, our results offer specific guidance for healthcare policymakers and administrators, including standardizing compensation across care settings, converting part-time positions to full-time roles, and developing targeted educational initiatives to improve workforce recruitment and retention in underserved areas. Full article

Background: Vascular endothelial function is closely related to brain health, especially in individuals with cardiovascular risk factors. In a randomized, crossover clinical trial (NCT04121741), we have previously shown that 30 min of singing improves microvascular endothelial function in older adults with coronary artery disease. Here, we report on secondary and exploratory analyses, including (1) changes in cortisol and cytokine levels and their impact on vascular endothelial function, and (2) the impact of personal music experience on vascular function. Methods: Participants had three study visits separated by 2–7 days, according to a randomized, researcher-blinded, crossover, controlled design: (1) a 30-min period of live singing with an in-person music therapist, (2) a 30-min period of singing along to an instructional video and (3) a 30-min rest (control). Primary outcomes included macrovascular endothelial function assessed by brachial artery flow-mediated dilation (BA FMD%) and microvascular function assessed by peripheral arterial tonometry [Framingham reactive hyperemia index (fRHI) and reactive hyperemia index (RHI)]. Exploratory outcomes included (log) changes in salivary cortisol and cytokine (IL-6, TNF-α, IL-1β, IL-8) levels. Participants were asked to complete the Brief Music Experience Questionnaire (BMEQ), a 53-item validated self-report questionnaire designed to measure an individual’s overall experience with music. The BMEQ assesses how people perceive, react to, and engage with music in various aspects of their lives. Results: Sixty-five subjects (mean age 67.7 ± 6.6 years, 40% female) completed the study. Compared to those subjects completing the BMEQ (n = 31), there were no significant differences in age, sex, race, or presence of diabetes mellitus, hypertension, high cholesterol, heart failure, chronic kidney disease, or chronic respiratory disease in subjects who did not complete the BMEQ (n = 34). Total BMEQ score did not impact changes in BA FMD% (−3.49 ± 2.00, p = 0.086), changes in fRHI (0.58 ± 0.93, p = 0.535), or changes in RHI (0.73 ± 0.65, p = 0.262). When we decompose the sum of squares based on intervention, sex, race, and age, the BMEQ score does not predict changes in vascular function measures. In cross-over analyses, there were no acute changes in salivary cortisol or cytokine levels with 30 min of singing compared to control. Changes in IL-8 were directly related to changes in microvascular endothelial function (0.470 ± 0.184, p = 0.012 for RHI and 0.780 ± 0.248, p = 0.002 for fRHI). Changes in TNF-α were inversely related to changes in fRHI (−0.547 ± 0.263, p = 0.040). Changes in cortisol concentrations were not related to measures of vascular function. Conclusions: The beneficial changes in microvascular endothelial function are not modified by personal music experience in older subjects with known coronary artery disease. There were no changes in salivary cortisol or cytokine levels after 30 min of singing compared to control. Full article

Background/Objectives: Infants admitted to neonatal intensive care units (NICUs) face challenges in achieving successful oral feedings. During oral feedings, these infants commonly present with suck–swallow–breathe incoordination, with approximately 30% developing dysphagia, leading to feeding aversion, prolonged hospitalization, and increased parental stress. Cold liquid feeding has demonstrated benefits in improving feeding safety in adults with dysphagia; however, its application in neonates is relatively limited. This study aimed to examine global neonatal feeding practices, with a specific emphasis on cold milk feeding as an intervention for dysphagia. Methods: A cross-sectional global electronic survey was distributed via professional society listservs and closed online professional group forums targeting neonatal providers and feeding therapists from June 2023 to June 2024. The survey assessed institutional feeding protocols, oral feeding practices, and the use of cold milk for infants with dysphagia. Responses were analyzed descriptively. Results: A total of 210 complete responses were received from level IV (51%), level III (42%), and level II (5%) NICUs. While 30% of the respondents were aware of cold milk feeding as a dysphagia intervention, only 15% of the total respondents reported using it in practice. Among the 32 institutions implementing cold milk practices, only one had an established protocol. Additionally, 72% reported having a feeding protocol in place, often incorporating cue-based tools. Most respondents (87.5%) did not allow oral feeding during nasal continuous positive airway pressure (nCPAP), whereas 78% permitted it during high-flow nasal cannula (HFNC) support. Conclusions: Although the awareness of cold milk feeding in neonates is increasing, its implementation remains limited and lacks standardization. Significant variability exists in oral feeding practices, particularly regarding feeding during respiratory support. This underscores the need for further research and evidence-based guidelines to ensure safe and consistent care for preterm infants. Full article

Objective: To assess the experience and educational needs of hospital staff who care for pediatric patients with tracheostomies. Study Design: Staff were surveyed and participated in semi-structured, facilitated focus groups regarding their experiences caring for children with tracheostomies and their educational needs. Survey data were analyzed using descriptive statistics and Kruskal–Wallis nonparametric tests. Focus groups were transcribed verbatim and coded for thematic analysis. Results: Pediatric advanced practice providers, nurses, physicians, and respiratory therapists (152/353, 43%) completed the survey. Within the last year, 76% of staff had worked with a tracheostomy-dependent child. However, up to 59% of staff had not performed at least one tracheostomy skill (e.g., tracheostomy site assessment, tube change, etc.). Staff reported the least confidence in changing tracheostomy tubes and using home ventilators and rated these skills as most important for additional education. Forty-three staff members participated in 1 of 10 focus groups. Three themes were identified: building staff competencies in tracheostomy care, promoting the caregiver development of tracheostomy skills, and building caregiver preparedness for home life. Staff emphasized the need for participating in emergency simulations and developing their skills to better prepare caregivers for home life. They indicated a need to streamline the discharge process, gain knowledge of community resources, and develop a standardized team to provide discharge teaching. Conclusions: Hospital staff responsible for providing care to tracheostomy-dependent pediatric patients had limited opportunities to learn and maintain their skills. Survey and focus group findings can guide development of continuing education to optimize the care of tracheostomy-dependent children. Full article

Background: Chronic obstructive pulmonary disease (COPD) is a significant burden in Saudi Arabia. Improving the attitudes, awareness, and knowledge of healthcare providers toward advance directives and/or advanced care planning (ACP) can increase the use of advance directives. This study aims to investigate healthcare providers’ knowledge, attitudes, and practices concerning advance directives for COPD patients in Riyadh, Saudi Arabia. Methods: This cross-sectional study was employed to assess the knowledge, attitudes, and practices of healthcare providers towards ACP for COPD patients in Riyadh between June and December 2024. The questionnaire was adapted from previous research. Multiple logistic regression was performed to assess the factors associated with good knowledge and positive attitude. Results: A total of 268 participants were included in the analysis. The total mean of knowledge score was 6.96 ± 2.22 out of 12. A total of 161 participants (60.1%) had a poor knowledge score, and 107 participants (39.9%) had a good knowledge score. The total mean of attitude score was 16.23 ± 23.21 out of 26. A total of 148 participants (55.2%) had a poor attitude score and 120 participants (44.8%) had positive attitude. Participants with over 15 years of experience exhibited significantly higher odds of good knowledge (OR = 6.76, 95% CI = 1.03−44.21, p = 0.04). Participants who lived in the Western region had significantly lower odds of good knowledge (OR = 0.32, 95% CI = 0.14–0.71, p = 0.005). Nurses and respiratory therapists had significantly lower odds of having positive attitude (OR = 0.19, 95% CI = 0.09−0.42, p = 0.0001 and OR = 0.34, 95% CI = 0.16–0.75, p = 0.007, respectively). Participants who lived in the Western region had significantly lower odds of having positive attitude (OR = 0.42, 95% CI = 0.19–0.95, p = 0.005). Conclusions: Healthcare providers in Saudi Arabia demonstrated a moderate level of knowledge of ACP for COPD patients. This was accompanied by a moderately positive attitude towards this practice. Future studies should examine effective educational and professional interventions to enhance ACP practices. Full article

Background/Objectives: Aerosolized medications are common practice for mechanically ventilated pediatric patients. Infants often receive nebulized medications via hand ventilation using an anesthesia bag, but evidence on optimal aerosol delivery with this method is limited. For this study, various configurations of the Mapleson breathing circuit were tested to optimize albuterol delivery to a simulated pediatric model. Methods: Using a simulated pediatric lung model (ASL 5000) with the semi-open Mapleson anesthesia circuit, 2.5 mg/3 mL of albuterol sulfate solution was nebulized to a viral/bacterial filter (Respiguard 202). Four models were compared with varying fresh gas flows (FGFs), small-volume nebulizer (SVN) placements, and adjusting dead space. Five Registered Respiratory Therapists (RRTs) bagged the aerosol into a collection filter following defined ventilation parameters. Each model was tested in random order to avoid fatigue bias. Albuterol concentrations eluted from in-line filters were measured by spectrophotometry (absorbance at 276 nm). Results: No inter-user variability was observed among the RRTs. Significant differences in albuterol recovered were noted between models (One Way ANOVA, Tukey’s post hoc, n = 5). Model 4, with the nebulizer closest to the collecting filter, recovered 21.77 ± 1.89% of albuterol. The standard clinical model was the least effective, with only 0.10 ± 0.17% albuterol recovery. Conclusions: Modifying the anesthesia breathing circuit significantly improved aerosol drug delivery efficiency. Our findings suggest that current clinical practices for nebulized drug delivery are inefficient and can be markedly improved with simple adjustments in nebulizer positioning and gas flow within the circuit. Full article

Background and Objectives: Despite the significant impacts of cognitive impairment on patients with chronic obstructive pulmonary disease (COPD), there is limited information available on healthcare workers’ (HCWs) perceptions, current practice, and barriers to managing COPD patients with cognitive impairment. Materials and Methods: A cross-sectional questionnaire was distributed to HCWs in Saudi Arabia between April and December 2023. The collected responses were analysed using descriptive statistics and logistic regression models. Results: A total of 890 participants, including nursing, physical, and respiratory therapists, completed the online questionnaire. Over two-thirds of the study participants indicated not having sufficient knowledge or adequate training in managing cognitive impairment in patients with COPD. The majority of HCWs perceive cognitive impairment to underdiagnose COPD (83%), underestimate COPD severity (81%), exacerbate COPD symptoms (80%), and interfere with self-management (81%) and pulmonary rehabilitation (81%). However, less than 45% (n = 394) reported having the potential to recognise signs of cognitive impairment during patient encounters. Logistic regression analysis revealed that male healthcare practitioners were more likely to recognise cognitive impairment than females (OR: 1.48; 95% CI: 1.13 to 1.95; p < 0.001). Physical and respiratory therapists were more likely to identify cognitive impairment compared to nurses. Additionally, having more years of experience (≥10 years, OR: 1.63; 95% CI: 1.02 to 2.61; p = 0.001) and adequate knowledge of cognitive impairment (OR: 6.23; 95% CI: 4.18 to 9.29; p = 0.001) were strongly associated with better recognition. Confidence in managing cognitively impaired COPD patients was low, attributed to poor training (64%), inadequate knowledge (64%), and the absence of standardised procedures (58%). Conclusions: HCWs agreed upon the negative impacts associated with cognitive impairment in patients with COPD. However, the potential of recognising signs of cognitive impairment and confidently dealing with the existence of cognitive impairment in COPD is not optimal, owing to poor training and limited knowledge. A focus should be given to managing comorbidities alongside COPD. Full article

Background and Aims: Telerehabilitation is essential for the recovery of post-COVID-19 patients, improving exercise tolerance, dyspnea, functional capacity, and daily activity performance. This study aimed to describe telerehabilitation protocols specifically designed for individuals with post-COVID-19 sequelae. Materials and Methods: A systematic review was conducted with registration number CRD42023423678, based on searches developed in the following databases: ScienceDirect, Scopus, Dimensions.ai and PubMed, using keywords such as “telerehabilitation” and “COVID-19”. The final search date was July 2024. The selection of studies involved an initial calibration process, followed by independent filtering by the researchers. The selection criteria were applied prior to critical appraisal, data extraction, and the risk of bias assessment. Results: After reviewing 405 full-text papers, 14 articles were included that focused on telerehabilitation interventions for post-COVID-19 patients. These interventions were designed for remote delivery and included exercise protocols, vital sign monitoring, and virtual supervision by physical therapists. The studies reported improvements in physical function, muscle performance, lung capacity, and psychological outcomes. Significant gains were observed in strength, mobility, and functional capacity, as well as reductions in dyspnea, fatigue, and improvements in quality of life, particularly in social domains. Intervention protocols included aerobic, strength, and respiratory exercises, monitored using tools such as heart rate monitors and smartphones. Conclusions: Telerehabilitation positively impacts lung volumes, pulmonary capacities, dyspnea reduction, functionality, muscle performance, and independence in post-COVID-19 patients. Full article