Hassan Aljohani

Background: The long-term health-related quality of life (HRQoL) of intensive care unit (ICU) survivors is a key concern. This study investigates HRQoL among ICU survivors in Saudi Arabia, highlighting its importance for advancing healthcare and improving outcomes. Methods: A cross-sectional study was conducted among ICU survivors and a control healthy group. Participants were aged ≥ 18 years, with ICU survivors discharged for at least six months excluding individuals with severe cognitive impairments or mental illness. The SF-36 questionnaire assessed HRQoL across eight domains, with data collected from a tertiary hospital in Riyadh. Statistical analysis included the Mann–Whitney U-test, the Fisher exact, and multiple linear regression. Results: Data from 151 ICU survivors and 181 controls were analyzed. Chronic diseases were more common among ICU survivors (51.7% vs 23.8%, p=0.00). Independent of chronic diseases, ICU survivors had significantly lower scores in HRQoL. Prolonged ICU stays were associated with worse quality outcomes. Additionally, being discharged for ≥ seven months improved general health (p=0.05). ICU survivors displayed notably lower scores in physical functioning (65 [IQR 55] vs 80 [IQR 45], p=0.00), limitations due to physical health (25 [IQR 100] vs 100 [IQR 75], p=0.00), limitations due to emotional problems (33.33 [IQR 100] vs 66.67 [IQR 100], p=0.00), less social functioning (62.5 [IQR 50] vs 75 [IQR 38], p=7.00), more pain 67.5 [IQR 45] vs 80 [IQR 33] (p=0.00), and general health (55 [IQR 25] vs 65 [IQR 23], p=0.00). Conclusion: ICU survivors experience significant HRQoL impairments exacerbated by prolonged ICU stays, highlighting the need for early and comprehensive rehabilitation services. The low utilization of these rehabilitation services suggests a need to provide access and quality for tailored early rehabilitation services to improve ICU survivors’ long-term HRQoL.

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality, morbidity, and high healthcare costs. While previous studies have addressed the burden of COPD at the national level, there is a lack of current data examining the prevalence of COPD with comorbidities as a predictor for hospital length of stay (LOS). This study aimed to investigate the average LOS and its predictors among patients with COPD admitted to a tertiary healthcare center. A cross-sectional study was conducted in a tertiary care healthcare center in Saudi Arabia between 2017 and 2022. Adult patients with a primary COPD diagnosis admitted at least once to the medical department during the study period were identified. Data on the demographics and co-existing comorbidities were extracted from the electronic medical records of each patient. The main outcome was the LOS among admitted patients. Linear regression analysis was conducted to examine COPD predictors among the demographic and clinical variables. This study involved 629 patients diagnosed with COPD, primarily females, with a mean age of 74 years. The median length of hospital stay was 5 days, and hypertension was the most common comorbidity among the participants (78.8%). The hospital LOS of male patients was expected to be 1.30 days longer than that of female patients (95% confidence interval, 0.15–2.77), and the hospital LOS of patients with cancer was expected to be 3 days longer than that of patients without cancer (B coefficient, 2.73; 95% confidence interval, 0.78–5.37). Male sex and cancer were strong predictors of prolonged hospitalization among patients with COPD. These findings highlight the need for healthcare providers to observe the presence of these comorbidities when managing COPD in patients to reduce their hospital stay.

Background: Artificial intelligence is experiencing rapid growth, with continual innovation and advancements in the health care field. Objective: This study aims to evaluate the application of artificial intelligence technologies across various domains of respiratory care. Methods: We conducted a narrative review to examine the latest advancements in the use of artificial intelligence in the field of respiratory care. The search was independently conducted by respiratory care experts, each focusing on their respective scope of practice and area of interest. Results: This review illuminates the diverse applications of artificial intelligence, highlighting its use in areas associated with respiratory care. Artificial intelligence is harnessed across various areas in this field, including pulmonary diagnostics, respiratory care research, critical care or mechanical ventilation, pulmonary rehabilitation, telehealth, public health or health promotion, sleep clinics, home care, smoking or vaping behavior, and neonates and pediatrics. With its multifaceted utility, artificial intelligence can enhance the field of respiratory care, potentially leading to superior health outcomes for individuals under this extensive umbrella. Conclusions: As artificial intelligence advances, elevating academic standards in the respiratory care profession becomes imperative, allowing practitioners to contribute to research and understand artificial intelligence’s impact on respiratory care. The permanent integration of artificial intelligence into respiratory care creates the need for respiratory therapists to positively influence its progression. By participating in artificial intelligence development, respiratory therapists can augment their clinical capabilities, knowledge, and patient outcomes.

Background: Assessing the neuromechanical coupling of inspiratory muscles during mechanical ventilation (MV) could reveal the physiological mechanism of MV failure. This study examined the respiratory neuromechanical characteristics between MV liberation success and failure. Methods: This is an observational prospective study that included patients during their ventilator liberation process. Assessment of surface electromyography (sEMG) of inspiratory muscles, including the diaphragm and extra-diaphragmatic (scalene, sternocleidomastoid, and parasternal) muscles, was performed 15 minutes after the initiation of spontaneous breathing trials. Neuromechanical efficiency of the diaphragm (NMEDia) and extra-diaphragmatic muscles (NMEExtra) were compared in patients who were successfully liberated from MV with those who failed MV liberation within 72 hours after extubation. Results: A total of 45 patients were enrolled and 28 were female (67%). The sample median age was 63 (IQR 47, 69) years old. One-third of patients failed MV liberation within 72 hours of their spontaneous breathing trials (SBTs). NMEDia was significantly lower in patients who failed MV liberation with a root mean square of (M 0.27), (IQR 0.21, 0.37) compared with (M 0.371), (IQR 0.3, 0.631) for the success group (p=0.0222). The area under the curve for NMEDia was lower in the failure group (M 0.270), (IQR 0.160, 0.370) and (M 0.485), (IQR 0.280, 0.683) for the success group (p=0.024). However, NMEExtra was not statistically different between the two groups. Conclusion: Reduced NMEDia is a predictor of MV liberation failure. NMEExtra was not a major contributor to MV liberation outcomes. Further studies should assess the performance of inspiratory muscles NME indices to predict MV liberation outcomes.

Background: There is overwhelming evidence of improved patient outcomes as a result of early mobilization in the intensive care unit (ICU). However, several barriers of ICU mobility remain understated with reference to clinical roles. The purpose of this study is to investigate the perceived barriers of early mobility of critically ill patients among ICU healthcare providers.Methods: In this cross‐sectional study, the Mobilization Attitudes and Beliefs Survey (PMABS‐ICU) was administered to ICU healthcare providers using an online survey. The study investigated barriers related to knowledge, attitudes, and behaviors regarding ICU mobility practices. These barriers were compared among different ICU clinical roles.Results: The survey yielded a total number of 214 healthcare providers with 41% female and 59% male. Respiratory therapists reported the highest perceived barriers to ICU mobility (M 39, IQR 36, 43) % compared to physical therapists (who reported the lowest barriers), occupational therapists, nurses, and physicians (p ≤ 0.05). ICU healthcare providers’ behavior towards ICU mobility such as perceived benefits and safety is ranked as the primary barrier (M 49, IQR 42, 52) %. Professional experience did not significantly vary among all groups.Conclusion: Our findings highlight that ICU healthcare providers’ perceptions, including both potential benefits and safety concerns regarding mobility, are significant barriers to implement mobility practices. ICU mobility barriers should be tackled by providing education and training. A focused effort to include RTs and nurses could advance interdisciplinary ICU mobility practice and reduce associated barriers.

There is a paucity of research on knowledge, practice, counseling confidence, and intention to use ask, advice, and refer (AAR) model of smoking cessation among respiratory therapists (RTs). Thus, we aimed to analyze the characteristics and factors that may influence them. We collected data using online questionnaires from convenience sample of active licensed RTs in Saudi Arabia. We included 206 participants. A descriptive analysis of the demographic information and characteristics of smoking cessation counseling practices and confidence were conducted. Multiple linear regression was used to test whether demographic variables and AAR model components significantly predicted the RTs’ calculated cumulative score of tobacco counseling confidence skills. Our results showed a deficiency in tobacco knowledge among RTs. Most RTs did not have certifications or attend lectures or seminars related to tobacco treatment. RTs were unfamiliar with the smoking cessation program contact information and mobile smoking cessation clinics but reported a high tobacco counseling confidence score. Clinical experience (P = .008), familiarity with smoking cessation program contact information (P = .02), inquiry regarding smoking status (P < .001), and advice regarding smoking status (P = .03) significantly predicted tobacco counseling confidence levels in RTs. RT experience, knowledge, and awareness of smoking cessation programs could enhance the confidence level among them in implementing AAR model.

Introduction: There is a paucity of studies on e-cigarette use among adults with chronic lung disease. In the present study, we aimed to assess whether psychosocial or cognitive factors elucidate the relationship between chronic lung disease (CLD) and susceptibility to e-cigarette use and...

Evidence from the literature suggests an association between the microbiome and asthma development. Here, we aimed to identify the current evidence for the association between asthma and the upper airway, lower airway and/or the gut microbiome. An electronic systemic search of PubMed, EBSCO, Science Direct and Web of Science was conducted until February 2022 to identify the eligible studies. The Newcastle–Ottawa Scale and the Systematic Review Centre for Laboratory Animal Experimentation risk of the bias tools were used to assess quality of included studies. Twenty-five studies met the inclusion criteria. Proteobacteria and Firmicutes were identified as being significantly higher in the asthmatic children compared with the healthy controls. The high relative abundance of Veillonella, Prevotella and Haemophilus in the microbiome of the upper airway in early infancy was associated with a higher risk of asthma development later in life. The gut microbiome analyses indicated that a high relative abundance of Clostridium in early childhood might be associated with asthma development later in life. The findings reported here serve as potential microbiome signatures associated with the increased risk of asthma development. There is a need for large longitudinal studies to further identify high-risk infants, which will help in design strategies and prevention mechanisms to avoid asthma early in life.

Quality of life (QoL) is essential for maintaining a healthy, balanced lifestyle, especially among individuals with chronic diseases. Saudi Arabia (SA) launched a health sector transformation program as part of the nationwide Vision 2030 initiative to ensure the sustainable development of efficient healthcare services, aiming to improve health by increasing well-being and QoL. More investigation into the current status of health rehabilitation services provided to individuals with chronic diseases and future needs to optimize services and improve QoL is needed. This was narratively discussed by experts from different health rehabilitation services in SA. Comprehensive health rehabilitation services including orthopedic, occupational, cardiac, pulmonary, critical care, perioperative, hearing and speech, substance use disorders, and vocational rehabilitation services were addressed. Health rehabilitation services in SA, as in other countries, are suboptimal for individuals in health rehabilitation programs. To optimize the QoL of individuals with chronic diseases, health rehabilitation services should be tailored based on the unique requirements of each service and its serving patients. The shared need to improve health rehabilitation services includes the adoption of home-based and telehealth services, the integration of multi-governmental sectors, the empowerment and allocation of health rehabilitation specialists, public awareness campaigns, policy legislation and guideline development, and the implementation of a long-term follow-up system. This review is one of the first to address the intersection of health rehabilitation services and QoL in SA; urgent and holistic actions are paramount to address the pressing need to optimize SA’s health rehabilitation services. The experts’ recommendations in this study may be applicable to other countries’ health systems, as health rehabilitation services are not well optimized globally.

Introduction: Recently, Saudi Arabia has extensively reformed its tobacco control policies and extended its smoking cessation services. A public outrage on social media among smokers was witnessed, especially after the implementation of plain cigarette packaging, which might have discredited...