Saudi Cultural Missions Theses & Dissertations
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Item Restricted The Perception of Skills for Maximizing Patient Comfort During Non-Invasive Ventilation Among Respiratory Therapists at KFSH&RC(Georgia State University, 2023-11-17) Albaqawi, Ahmed; Gardenhire, DouglasBackground: Noninvasive ventilation (NIV) is a modality that supports patient breathing through different types of face interfaces, such as a full-face mask and nasal mask. Noninvasive Ventilation modalities have proven to improve morbidity and mortality rates for patients suffering from respiratory failure in the hospital setting and Outpatient. It also helped prevent escalating the treatment to more advanced methods such as invasive ventilation. However, several elements are required for optimizing the therapy, including Health care providers' training in operating the different brands of NIV, equipment availability, cost, and appropriate adjustment to the settings according to patient response. Purpose: This study aims to assess the level of perception of maximizing patient comfort during non-invasive ventilation devices among respiratory therapists at KFSH&RC by utilizing specific features of NIV. For instance, ramp, Flex, humidification, and auto-adjusting pressure. In addition, how RTs perceive mask selection and other contributing factors that contribute to maximizing patients' comfort. Methods: The study used an online, cross-sectional survey with 20 questions were sent to Respiratory therapists at KFSH&RC. In this survey, data collected from targeted population regarding their perceptions of skills for maximizing patient comfort during non-invasive ventilation will be analyzed using the Statistical Package for the Social Sciences (SPSS). Result: The findings indicated that respiratory therapists at KFSH&RC generally hold a positive view about utilizing various aspects of NIV, such as auto-adjusting pressure, noise reduction, humidification, and specific NIV settings, to maximize patient comfort. They also recognized the importance of effective communication, patient encouragement, and addressing patient comfort before and after initiating NIV therapy. The study found that demographic factors like gender, country of graduation, years of experience, and age did not significantly impact the therapists' attitudes, except for therapists working in respiratory care community services (RCCS), who placed greater emphasis on maximizing patient comfort during NIV (P=.019). Conclusion: This research conducted at King Faisal Specialist Hospital & Research Centre (KFSH&RC) concluded that respiratory therapists demonstrated positive perception about utilizing different elements of NIV to maximize patient comfort during therapy. Majority of therapists believed that features such as auto-adjusting pressure, noise reduction, humidification, and the utilization of certain NIV settings such as the FLEX and RAMP have significance for enhancing patient comfort.39 0Item Restricted Using Continuous Positive Airway Pressure with Hypoxemic Acute Respiratory Failure: A Systematic Review and Meta-Analysis of Randomised Controlled Trials(Saudi Digital Library, 2023-11-25) Alenazi, Bushra; Parekh, Dhruv; Grudzinska, FrancesBackground: Hypoxemic acute respiratory failure (hARF) is a common cause of emergency room and intensive care unit (ICU) admissions. Although the use of continuous positive airway pressure (CPAP) in this group of patients generally has steadily increased, the evidence supporting its use remains sparse. This systematic review and meta-analysis aims to summarise the findings of randomized controlled trials (RCTs) that have evaluated the need for intubation, and in-hospital mortality rate in patients with hARF treated specifically with CPAP compared to any other interventions. Method: CENTRAL, Embase, PubMed, CINAHL and Medline databases were searched. Studies including adults aged ≥ 18 years with hARF and RCTs that compared CPAP to any comparator/control were included. The studies were narratively and statistically analysed, and the outcomes assessed are intubation and in-hospital mortality rate. The risk of bias was assessed using the Cochrane risk of bias checklist for randomized control trials. Studies were reviewed in accordance with PRISMA guidelines. Results: Among 3488 studies identified. Six studies were eligible for inclusion involving 2,966 participants included in the meta-analyses and were descriptively synthesised. Results from the meta-analysis suggest reductions in intubation rate with CPAP compared to standard oxygen therapy (SOT) and high-flow nasal cannula (HFNC) (RR= 0.81, CI= 0.70 to 0.95, P-value=0.007). When doing subgroup analysis, CPAP suggests a reduction in the intubation rate with non-COVID-19 compared to COVID-19 studies. (P-value= 0.0010, 0.10, respectively). This study also suggests that helmet CPAP decreases the intubation rate in comparison to face mask CPAP (P-value <0.00001, 0.08, respectively). On the other hand, the study found that there was no significant difference in the in-hospital mortality rate between CPAP and other comparators (SOT and HFNC), (RR= 0.86, CI= 0.71 to 1.05) and a P-value of 0.13. This lack of significance was observed also in subgroup analysis in COVID-19 and non-COVID-19 studies. However, when looking at CPAP interventions using different interfaces, the risk ratio for face mask studies was not statically significant (RR=0.92, P-value=0.43), but the use of helmet CPAP was found to have a significant effect (risk ratio=0.23, P-value=0.0009). Conclusion: This systematic review highlights the available evidence to support the use of CPAP with hARF patients. Findings suggest that CPAP may reduce the need for intubation, especially in non-COVID-19 patients. However, CPAP has not been shown to have an effect on the in-hospital mortality rate. Using CPAP therapy with a helmet has shown to be a promising approach to lowering intubation and in-hospital mortality rates among this group of patients (hARF). Further studies are needed for a higher certainty of evidence. Other: This systematic review is registered with PROSPERO, CRD420234520233 0Item Restricted Determinants of In-Hospital Mortality of Patients Receiving Ward-Based Non-invasive Ventilation for Acute Hypercapnic Respiratory Failure(Saudi Digital Library, 2023-08-25) Alqahtani, Ahmed S.; Mukherjee, RahulIntroduction: Door-to-mask time is a quality metric for Non-Invasive Ventilation (NIV) treatment that is applicable across the United Kingdom. This study examined the efficacy of this metric in predicting in-hospital mortality, alongside other variables including maximum IPAP, age, and degree of acidosis after rigorous infection control measures were introduced during COVID-19 pandemic that led to substantial delays in the provision of NIV treatment. Methods: All acute NIV applications for hypercapnic respiratory failure (AHRF) pre- and post-pandemic were included in this study (April – December 2019 and April – December 2021). Mann-Whitney U test and Chi-squared test were used for continuous and categorical variables, respectively. ANOVA test was used for the analysis of variance of mean door-to-mask time and mean maximum IPAP, and logistic regression was used to predict in-hospital death adjusted odds ratios across both cohorts combined. Results: From 2019 to 2021 total patients receiving NIV decreased by 26.2% (83 vs 45). There was not a significant difference in patients age across cohorts (p=0.93). Indications for NIV treatment was not significantly different, the majority received NIV treatment for COPD 87 (66.9%) vs 63 (65.6%) in 2019 and 2021, respectively. Door-to-mask time was significantly increased, 5.45 to 10.85 hours (p<0.001). However, in-hospital deaths were not significantly different, 27 (20.8%) vs 28 (29.2%) (p=0.15). Age and degree of acidosis affected significantly in-hospital mortality, odds ratio (95% CI), 1.037 (1.01, 1.07) (p=0.02) and 0.009 (0.00, 0.70) (p=0.03), respectively. However, door to mask time did not significantly affect odds ratio of in-hospital mortality, 1.004 (1.00, 1.01), (p=0.07). Prolonged door-to-mask time and lower maximum IPAP were associated with higher in-hospital mortality, (p=0.045) and (p=0.048), respectively. Conclusion: Within this cohort, age and degree of acidosis were independent predictors of in-hospital mortality. However, door-to-mask time was not a strong predictor of in-hospital mortality, despite the association observed between prolonged door-to-mask times and higher mortality rates. Hence further research on door-to-mask time is necessary to explore its association with increased in-hospital mortality.15 0