ABSTRACT
Background: Post-traumatic stress symptoms (PTSSs) have been described in healthcare workers after disease outbreaks. Anaesthetists are at high risk of exposure to COVID-19 due to the nature of the airway procedures they perform. Anaesthetists are also at increased risk of mental health disorders, substance abuse and suicidality. When PTSSs are sufficiently high in number and severity, they become the key elements of the diagnostic criteria for post-traumatic stress disorder (PTSD). This study sought to explore the prevalence and predisposing factors of PTSSs in anaesthetists during the COVID-19 outbreak in South Africa. Methods: Members of the South African Society of Anaesthesiologists (SASA) completed an electronic survey including sociodemographic information and information regarding COVID-19 exposure. The PTSD Checklist for DSM-5 (PCL-5) was used to measure PTSSs. The resultant score indicated symptom severity, with a score of 33 or higher indicating a provisional diagnosis of PTSD. Results: A total of 483 participants completed the survey (23.8% response rate). Three hundred and ninety-one respondents were included in the study, of which 17.6% received a provisional PTSD diagnosis. Younger anaesthetists with less experience, females, single participants and those without children exhibited a greater prevalence of PTSD. Anaesthetists with pre-existing mental health conditions (p = 0.009) and those who reported loneliness (p = <0.001) and poor social support (p = 0.018) were more likely to receive a provisional PTSD diagnosis. Personal protective equipment (PPE) shortages were also associated with the development of PTSD (p = 0.009). Conclusion: The prevalence of PTSSs is unacceptably high amongst South African anaesthesia providers, especially those with pre-existing mental health conditions and poor social support. Findings from this study indicate the importance of supporting susceptible healthcare workers through interventions aimed at positive mental health promotion and PTSD prevention.
ABSTRACT
Background: Post-traumatic stress symptoms (PTSS) have been described in healthcare workers after disease outbreaks. Anaesthetists are at high risk of exposure to COVID-19 due to the nature of the airway procedures they perform. Anaesthetists are also at increased risk of mental health disorders, substance abuse and suicide. When the occurrence of PTSS is great in both number and severity, these become the key elements of the diagnostic criteria for post-traumatic stress disorder (PTSD). This study explores the prevalence and predisposing factors of PTSS in anaesthetists during the second wave of COVID-19 in South Africa. Methods: Members of the South African Society of Anaesthesiologists (SASA) completed an electronic questionnaire regarding their sociodemographic information as well as COVID-19 exposure. The PTSD checklist for DSM-5 (PCL-5) was used to measure PTSS. The resulting score gave an indication of symptom severity, with a score of 33 or higher indicating a provisional diagnosis of PTSD. Results: A total of 483 participants completed the questionnaire (23.8% response rate). Of these, 391 participants were included in the study and 69 participants (17.6%) received a provisional PTSD diagnosis. Participants who are younger and have less experience, who are female, who are single or who do not have children exhibited a greater prevalence of PTSD. Also, those participants who had pre-existing mental health conditions (p = 0.009), and those who reported loneliness (p < 0.001) and poor social support (p = 0.018) were more likely to receive a provisional PTSD diagnosis. Personal protective equipment (PPE) shortages were also associated with the development of PTSD (p = 0.009). Conclusion: The prevalence of PTSS is unacceptably high among South African anaesthetists, especially those with pre-existing mental health conditions and poor social support. This calls for support of vulnerable healthcare workers during disease pandemics. © 2022 The Author(s).
ABSTRACT
BACKGROUND: Patients with severe COVID-19 may require endotracheal intubation. Unique adjustments to endotracheal intubation and extubation practices are necessary to decrease the risk of SARS-CoV-2 transmission to healthcare workers (HCWs) while avoiding complications of airway management. OBJECTIVES: To investigate the practice of endotracheal intubation and extubation, resources available and complications encountered by clinicians performing endotracheal intubation and extubation of COVID-19 and suspected COVID-19 patients in South Africa (SA). METHOD: A cross-sectional observational study was conducted during the initial surge of COVID-19 cases in SA. Data were collected by means of a self-administered questionnaire completed by clinicians in the private and public healthcare sectors after performing an endotracheal intubation and/or extubation of a patient with confirmed or suspected COVID-19. RESULTS: Data from 135 endotracheal intubations and 45 extubations were collected. Anaesthetists accounted for 87.0% (n=120) of the study participants, specialist clinicians in their respective fields for 59.4% (n=82), and public HCWs for 71.0% (n=98). Cases from Gauteng Province made up 76.8% (n=106) of the database. Haemoglobin desaturation was the most frequent complication encountered during endotracheal intubation (40.0%;n=54). Endotracheal intubations performed at private healthcare institutions were associated with a significantly lower complication rate of 17.5% (n=7) compared with 52.6% (n=50) in the public healthcare sector (p<0.001). Endotracheal intubations performed in theatre had the lowest complication rate of 10.4% (n=5;p<0.001). Propofol was used in 90 endotracheal intubations (66.7%), and its use was associated with fewer complications relative to other induction agents. Minimising the number of intubation attempts (p=0.009) and the use of checklists (p=0.013) significantly reduced the frequency of complications encountered during endotracheal intubation. Intravenous induction technique, neuromuscular blocking agent used, intubating device used and time at which intubation was performed did not affect the incidence of complications. The majority of endotracheal extubations were uncomplicated (88.9%). CONCLUSIONS: The study provides valuable insight into the resources used by clinicians and complications encountered when endotracheal intubations and/or extubations were performed. Data from this study may be used to guide future clinical practice and research, especially in resource-limited settings.
ABSTRACT
Background. Patients with severe COVID-19 may require endotracheal intubation. Unique adjustments to endotracheal intubation and extubation practices are necessary to decrease the risk of SARS-CoV-2 transmission to healthcare workers (HCWs) while avoiding complications of airway management. Objectives. To investigate the practice of endotracheal intubation and extubation, resources available and complications encountered by clinicians performing endotracheal intubation and extubation of COVID-19 and suspected COVID-19 patients in South Africa (SA). Method. A cross-sectional observational study was conducted during the initial surge of COVID-19 cases in SA. Data were collected by means of a self-administered questionnaire completed by clinicians in the private and public healthcare sectors after performing an endotracheal intubation and/or extubation of a patient with confirmed or suspected COVID-19. Results. Data from 135 endotracheal intubations and 45 extubations were collected. Anaesthetists accounted for 87.0% (n=120) of the study participants, specialist clinicians in their respective fields for 59.4% (n=82), and public HCWs for 71.0% (n=98). Cases from Gauteng Province made up 76.8% (n=106) of the database. Haemoglobin desaturation was the most frequent complication encountered during endotracheal intubation (40.0%;n=54). Endotracheal intubations performed at private healthcare institutions were associated with a significantly lower complication rate of 17.5% (n=7) compared with 52.6% (n=50) in the public healthcare sector (p<0.001). Endotracheal intubations performed in theatre had the lowest complication rate of 10.4% (n=5;p<0.001). Propofol was used in 90 endotracheal intubations (66.7%), and its use was associated with fewer complications relative to other induction agents. Minimising the number of intubation attempts (p=0.009) and the use of checklists (p=0.013) significantly reduced the frequency of complications encountered during endotracheal intubation. Intravenous induction technique, neuromuscular blocking agent used, intubating device used and time at which intubation was performed did not affect the incidence of complications. The majority of endotracheal extubations were uncomplicated (88.9%). Conclusions. The study provides valuable insight into the resources used by clinicians and complications encountered when endotracheal intubations and/or extubations were performed. Data from this study may be used to guide future clinical practice and research, especially in resource-limited settings.