Clinical Practice and Barriers of Ventilatory Support Management in COVID-19 Patients in Saudi Arabia: A Survey of Respiratory Therapists

Jaber S Alqahtani; Yousef S Aldabayan; Mohammed D AlAhmari; Saad M AlRabeeah; Abdulelah M Aldhahir; Saeed M Alghamdi; Tope Oyelade; Malik Althobiani; Ahmed M Alrajeh

doi:10.4103/sjmms.sjmms_58_21

Clinical Practice and Barriers of Ventilatory Support Management in COVID-19 Patients in Saudi Arabia: A Survey of Respiratory Therapists

Saudi J Med Med Sci. 2021 Sep-Dec;9(3):223-229. doi: 10.4103/sjmms.sjmms_58_21. Epub 2021 Aug 21.

Authors

Jaber S Alqahtani^{1

2}, Yousef S Aldabayan³, Mohammed D AlAhmari², Saad M AlRabeeah², Abdulelah M Aldhahir⁴, Saeed M Alghamdi⁵, Tope Oyelade⁶, Malik Althobiani⁷, Ahmed M Alrajeh³

Affiliations

¹ Respiratory Medicine, University College London, London, UK.
² Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia.
³ Respiratory Care Department, King Faisal University, Al-Ahsa, Saudi Arabia.
⁴ Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia.
⁵ Department of Respiratory Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia.
⁶ Division of Medicine, University College London, London, UK.
⁷ Department of Respiratory Therapy, King Abdulaziz University, Jeddah, Saudi Arabia.

Abstract

Objective: This study was conducted to determine the clinical practice and barriers of ventilatory support management in COVID-19 patients in Saudi Arabia among respiratory therapists.

Methods: A validated questionnaire comprising three parts was distributed to all critical care respiratory therapists registered with the Saudi Society for Respiratory Care through the official social networks.

Results: A total of 74 respiratory therapists completed the survey. The mean (±standard deviation) of intensive care unit beds was 67 ± 79. Clinical presentation (54%) and arterial blood gas (38%) were the two main diagnostic tools used to initiate ventilatory support. While protocols for the initiation of invasive mechanical ventilation (IMV; 81%) were widely available, participants had limited availability of protocols for the use of non-invasive ventilation (NIV; 34%) and high-flow nasal cannula (HFNC; 34%). In mild cases of COVID-19, most respondents used HFNC (57%), while IMV was mostly used in moderate (43%) and severe (93%) cases. Regular ventilator check was mostly done every 4 h (57%). BiPAP (47.3%) and full-face masks (45.9%) were the most used mode and interface, respectively, while pressure-regulated volume control (55.4%) and pressure control (27%) were the most used mechanical ventilation modes for COVID-19 patients. In terms of use of proning, 62% used it on IMV, while 26% reported using awake proning. Staff shortage (51.4%), personal protective equipment (PPE) shortage (51.4%), increased workload (45.9%), inadequate training (43.2%) and lack of available protocols and policies (37.8%) were the main barriers.

Conclusion: Ventilatory support management of COVID-19 in Saudi Arabia was inconsistent with the global practice, lacked uniformity, and there was limited use of standard protocols/treatment guidelines. Shortage of staff and PPE, increased workload and insufficient training were the most prevalent barriers.

Keywords: COVID-19; Saudi Arabia; intensive care units; mechanical ventilation; noninvasive ventilation; respiratory.