ABSTRACT
Pregnant women are at high risk of coronavirus disease 2019 (COVID-19) complications, including acute respiratory distress syndrome (ARDS) and the need for mechanical ventilation. There is no literature on the optimal strategy for the management of difficult-to-wean pregnant and early postpartum patients. We report two cases of pregnant women with COVID-19 pneumonia and ARDS, who required mechanical ventilation and high doses of analgesia, and sedation with neuromuscular blocking agents to facilitate ventilation and oxygenation. Both patients had a tracheostomy procedure to facilitate weaning from mechanical ventilation and sedation. Shortly after tracheostomy, sedation and analgesia, along with ventilatory support were weaned off. Both patients were discharged home. These cases propose early tracheostomy as a strategy to facilitate weaning from mechanical ventilation and sedation in pregnant and early postpartum patients.
ABSTRACT
OBJECTIVES: This study aimed at investigating the effects of an extracorporeal membrane oxygenation (ECMO) service on Burnout syndrome (BOS) development in the intensive care unit (ICU). DESIGN: The authors conducted a cross-sectional descriptive study. SETTINGS: Eight ICUs within 5 tertiary hospitals in 1 country. PARTICIPANTS: Intensive care practitioners (nurses, physicians, and respiratory therapists). INTERVENTION: Using an online questionnaire, the Maslach Burnout Inventory Human Services Survey for Medical Personnel. In addition, demographic variables, workload, salary satisfaction, and caring for COVID-19 patients were assessed. Participants were divided based on working in an ICU with ECMO (ECMO-ICU) and without (non-ECMO-ICU) ECMO service, and burnout status (burnout and no burnout). MEASUREMENTS AND MAIN RESULTS: The response rate for completing the questionnaire was 36.4% (445/1,222). Male patients represented 53.7% of the participants. The overall prevalence of burnout was 64.5%. The overall burnout prevalence did not differ between ECMO- and non-ECMO-ICU groups (64.5% and 63.7, respectively). However, personal accomplishment (PA) score was significantly lower among ECMO-ICU personnel compared with those in a non-ECMO-ICU (42.7% v 52.6, p = 0.043). Significant predictors of burnout included profession (nurse or physician), acquiring COVID-19 infection, knowing other practitioners who were infected with COVID-19, salary dissatisfaction, and extremes of workload. CONCLUSION: Burnout was equally prevalent among participants from ECMO- and non-ECMO-ICU, but PA was lower among participants in the ICU with an ECMO service. The reported high prevalence of burnout, and its predictors, requires special attention to try to reduce its occurrence.