COVID-19 infection and maternal morbidity in critical care units in Scotland: a national cohort study.

BACKGROUND: Previous research has shown that, in comparison with non-pregnant women of reproductive age, pregnant women with COVID-19 are more likely to be admitted to critical care, receive invasive ventilation, and die. At present there are limited data in relation to outcomes and healthcare utilisation following hospital discharge of pregnant and recently pregnant women admitted to critical care. METHODS: A national cohort study of pregnant and recently pregnant women who were admitted to critical care in Scotland with confirmed or suspected COVID-19. We examined hospital outcomes as well as hospital re-admission rates. RESULTS: Between March 2020 and March 2022, 75 pregnant or recently pregnant women with laboratory-confirmed COVID-19 were admitted to 24 Intensive Care Units across Scotland. Almost two thirds (n=49, 65%) were from the most deprived socio-economic areas. Complete 90-day acute hospital re-admission data were available for 74 (99%) patients. Nine (12%) women required an emergency non-obstetric hospital re-admission within 90 days. Less than 5% of the cohort had received any form of vaccination. CONCLUSIONS: This national cohort study has demonstrated that pregnant or recently pregnant women admitted to critical care with COVID-19 were more likely to reside in areas of socio-economic deprivation, and fewer than 5% of the cohort had received any form of vaccination. More targeted public health campaigning across the socio-economic gradient is urgently required.

Post-Icu Clinics May Reduce Icu Staff Burnout: Critical & Acute Illness Recovery Organization Report

INTRODUCTION: Clinician burnout is far-reaching and impact individuals, healthcare systems, and patient care, and has been declared an area of major priority by leading critical care societies. The unprecedented demands of the COVID-19 pandemic have exacerbated mental health issues, including anxiety and post-traumatic stress disorder for intensive care unit (ICU) staff who were already at increased risk, leading to subsequent increased burnout. Therefore, we explored the secondary role that post-ICU clinics may play in reducing the symptoms of ICU staff burnout. METHOD(S): We performed a qualitative secondary analysis of semi-structured interviews with multidisciplinary post-ICU clinician members of the Critical and Acute Illness Recovery Organization (CAIRO) between February and March 2021. The original study examined how clinicians perceived the COVID-19 pandemic changed post-ICU care delivery. Data were analyzed post-hoc through a constant comparative method. RESULT(S): Twenty-nine multidisciplinary clinicians from 15 international sites (Canada, the United States, the United Kingdom) participated in the study. The sample was largely female (72.4%) working in academic clinical settings (69.0%). Median length of time in clinician role was 16 years (IQR 7, 21), and median length of time working with a post-ICU program was 3 years (IQR 1, 4). We identified two overlapping mechanisms by which participants perceived reduced symptoms of ICU staff burnout: 1) staff exposure to and expression of humanizing behaviors and 2) visualizing and communicating treatment successes. Practical examples included sharing videos, photographs, and written stories of survivors with the ICU team;directly staffing post-ICU clinics;and in-person contact between ICU staff and survivors and families after ICU discharge. CONCLUSION(S): Multidisciplinary clinicians in post- ICU clinics commonly perceived that a bidirectional compassionate relationship and authentic interaction and communication with ICU survivors reduced the symptoms of burnout. Interprofessional teams in the ICU and healthcare administration should consider how programs that facilitate interaction with critical illness survivors may reduce the symptoms of burnout in ICU staff.