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The Coronavirus Disease 2019 Pandemic's Effect on Critical Care Resources and Health-Care Providers: A Global Survey.
Wahlster, Sarah; Sharma, Monisha; Lewis, Ariane K; Patel, Pratik V; Hartog, Christiane S; Jannotta, Gemi; Blissitt, Patricia; Kross, Erin K; Kassebaum, Nicholas J; Greer, David M; Curtis, J Randall; Creutzfeldt, Claire J.
  • Wahlster S; Department of Neurology, Harborview Medical Center, University of Washington, WA; Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, WA; Department of Neurological Surgery, Harborview Medical Center, University of Washington, WA. Electronic address:
  • Sharma M; Department of Global Health, University of Washington, WA.
  • Lewis AK; Departments of Neurology and Neurosurgery, New York University, NY.
  • Patel PV; Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, WA.
  • Hartog CS; Klinik für Anaesthesie und operative Intensivmedizin, Charité Universitaetsmedizin Berlin, Berlin; Klinik Bavaria Kreischa, Germany.
  • Jannotta G; Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, WA.
  • Blissitt P; Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, WA.
  • Kross EK; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, WA; Cambia Palliative Care Center of Excellence, University of Washington, WA.
  • Kassebaum NJ; Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, WA; Department of Global Health, University of Washington, WA.
  • Greer DM; Department of Neurology, Boston University, Boston, MA.
  • Curtis JR; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, WA; Cambia Palliative Care Center of Excellence, University of Washington, WA; Cambia Health Foundation.
  • Creutzfeldt CJ; Department of Neurology, Harborview Medical Center, University of Washington, WA; Cambia Palliative Care Center of Excellence, University of Washington, WA; Cambia Health Foundation.
Chest ; 159(2): 619-633, 2021 02.
Article in English | MEDLINE | ID: covidwho-1049757
ABSTRACT

BACKGROUND:

The coronavirus disease 2019 (COVID-19) pandemic has severely affected ICUs and critical care health-care providers (HCPs) worldwide. RESEARCH QUESTION How do regional differences and perceived lack of ICU resources affect critical care resource use and the well-being of HCPs? STUDY DESIGN AND

METHODS:

Between April 23 and May 7, 2020, we electronically administered a 41-question survey to interdisciplinary HCPs caring for patients critically ill with COVID-19. The survey was distributed via critical care societies, research networks, personal contacts, and social media portals. Responses were tabulated according to World Bank region. We performed multivariate log-binomial regression to assess factors associated with three main

outcomes:

limiting mechanical ventilation (MV), changes in CPR practices, and emotional distress and burnout.

RESULTS:

We included 2,700 respondents from 77 countries, including physicians (41%), nurses (40%), respiratory therapists (11%), and advanced practice providers (8%). The reported lack of ICU nurses was higher than that of intensivists (32% vs 15%). Limiting MV for patients with COVID-19 was reported by 16% of respondents, was lowest in North America (10%), and was associated with reduced ventilator availability (absolute risk reduction [ARR], 2.10; 95% CI, 1.61-2.74). Overall, 66% of respondents reported changes in CPR practices. Emotional distress or burnout was high across regions (52%, highest in North America) and associated with being female (mechanical ventilation, 1.16; 95% CI, 1.01-1.33), being a nurse (ARR, 1.31; 95% CI, 1.13-1.53), reporting a shortage of ICU nurses (ARR, 1.18; 95% CI, 1.05-1.33), reporting a shortage of powered air-purifying respirators (ARR, 1.30; 95% CI, 1.09-1.55), and experiencing poor communication from supervisors (ARR, 1.30; 95% CI, 1.16-1.46).

INTERPRETATION:

Our findings demonstrate variability in ICU resource availability and use worldwide. The high prevalence of provider burnout and its association with reported insufficient resources and poor communication from supervisors suggest a need for targeted interventions to support HCPs on the front lines.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Health Personnel / Critical Care / Personal Protective Equipment / COVID-19 / Health Workforce / Health Resources Type of study: Experimental Studies / Observational study / Prognostic study / Qualitative research / Randomized controlled trials Limits: Female / Humans / Male Language: English Journal: Chest Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Health Personnel / Critical Care / Personal Protective Equipment / COVID-19 / Health Workforce / Health Resources Type of study: Experimental Studies / Observational study / Prognostic study / Qualitative research / Randomized controlled trials Limits: Female / Humans / Male Language: English Journal: Chest Year: 2021 Document Type: Article