A Smart HRV-Guided Respiratory Biofeedback System for Combined Respiratory and Psychological Recovery During COVID-19 Oxygen Weaning

The COVID-19 pandemic has placed substantial pressure on intensive care units (ICUs), particularly in managing patients who require oxygen therapy and must be safely weaned from it. This study evaluated an HRV-guided respiratory biofeedback program as a non-pharmacological method to reduce respiratory discomfort and psychological distress during oxygen weaning in COVID-19 patients. A non-randomized quasi-experimental study was conducted with 80 ICU patients at Albehera Hospital, Beheira, Egypt. Patients were allocated to either a biofeedback group ([Formula: see text]) or a control group ([Formula: see text]). Both groups received standard oxygen-weaning care and routine nursing support, but only the biofeedback group received structured sessions combining diaphragmatic breathing with heart rate variability based respiratory training. The Respiratory Distress Observation Scale (RDOS) and the Depression Anxiety Stress Scale (DASS-21) were administered before and after the intervention. After adjusting for baseline scores, the biofeedback group demonstrated a markedly larger reduction in RDOS scores (from 14.48 to 4.23; [Formula: see text]) and significant improvements in DASS-21 depression, anxiety, and stress subscales ([Formula: see text]), whereas the control group showed only minimal changes. These findings suggest that HRV-guided respiratory biofeedback may enhance both respiratory comfort and psychological well-being during oxygen weaning in COVID-19 patients and could serve as a valuable adjunct to standard ICU care. Further randomized controlled trials are warranted to confirm these results and guide clinical implementation.