A Qualitative Interview Study of Respiratory Therapists' Perceptions and Attitudes Toward APRV in Western Saudi Arabia

Abstract

Background: Airway Pressure Release Ventilation (APRV) is an advanced mechanical ventilation mode with demonstrated benefits for acute respiratory distress syndrome (ARDS), including improved oxygenation and alveolar recruitment. Despite decades of global evidence, its adoption in Western Saudi Arabia remains limited. Respiratory therapists (RTs) face challenges in its clinical application, including insufficient training, physician hesitancy, and lack of standardized protocols. Understanding RTs’ perceptions is essential to improving APRV integration and enhancing critical care practices in non-Western healthcare settings. Purpose: This study aimed to explore RTs’ perceptions and attitudes toward APRV in Western Saudi Arabia, with a focus on identifying perceived benefits and disadvantages, implementation barriers, and the influence of clinical experience and training on APRV utilization. Methods: A qualitative design using semi-structured, in-depth interviews was employed. Eight RTs from various hospitals in Western Saudi Arabia participated in virtual interviews guided by 14 open-ended questions covering demographic background, APRV perceptions, and implementation experiences. Face validity of the interview guide was established by three respiratory therapy faculty members from Georgia State University. Data were analyzed thematically using NVivo 14, following Braun and Clarke’s six-phase framework. Results: All eight RTs completed the interviews. Thematic analysis yielded 14 focused codes, which were organized into 7 sub-superordinate themes and 4 overarching superordinate themes: (1) Perceptions of APRV, (2) Barriers to Use, (3) Impact of Training and Experience, and (4) Proposed Solutions. While RTs acknowledged APRV’s benefits for oxygenation and lung protection, its use was frequently described as a last-resort strategy. Barriers included physician control over ventilator modes, lack of protocols, limited exposure, and fear of misapplication. RTs reported that confidence in using APRV improved with hands-on experience, mentorship, and simulation training. Conclusion: APRV remains underutilized in Western Saudi Arabia due to a complex interplay of institutional, educational, and experiential factors. Findings highlight the need for standardized protocols, simulation-based training, and national efforts to promote APRV literacy among both RTs and physicians. Addressing these barriers could enhance the safe and confident use of APRV in critical care.