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Perceptions of Critical Care Shortages, Resource Use, and Provider Well-being During the COVID-19 Pandemic: A Survey of 1,985 Health Care Providers in Brazil.
Lobo, Suzana M; Creutzfeldt, Claire J; Maia, Israel S; Town, James A; Amorim, Edilberto; Kross, Erin K; Çoruh, Basak; Patel, Pratik V; Jannotta, Gemi E; Lewis, Ariane; Greer, David M; Curtis, J Randall; Sharma, Monisha; Wahlster, Sarah.
  • Lobo SM; Intensive Care Department, Hospital de Base, São José do Rio Preto, São Paulo, Brazil; Associação de Medicina Intensiva Brasileira, Florianópolis, Santa Catarina, Brazil.
  • Creutzfeldt CJ; Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA; Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA.
  • Maia IS; Department of Intensive Care Medicine, Hospital Nereu Ramos, Florianópolis, Santa Catarina, Brazil.
  • Town JA; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA.
  • Amorim E; Department of Neurology, University of California, San Francisco, San Francisco, CA.
  • Kross EK; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA.
  • Çoruh B; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA.
  • Patel PV; Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
  • Jannotta GE; Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
  • Lewis A; Departments of Neurology and Neurosurgery, New York University, New York, NY.
  • Greer DM; Department of Neurology, Boston University, Boston, MA.
  • Curtis JR; Department of Intensive Care Medicine, Hospital Nereu Ramos, Florianópolis, Santa Catarina, Brazil; Department of Neurology, University of California, San Francisco, San Francisco, CA.
  • Sharma M; Department of Global Health, University of Washington, Seattle, WA.
  • Wahlster S; Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA; Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA; Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattl
Chest ; 161(6): 1526-1542, 2022 06.
Article in English | MEDLINE | ID: covidwho-1704181
ABSTRACT

BACKGROUND:

Brazil has been disproportionately affected by COVID-19, placing a high burden on ICUs. RESEARCH QUESTION Are perceptions of ICU resource availability associated with end-of-life decisions and burnout among health care providers (HCPs) during COVID-19 surges in Brazil? STUDY DESIGN AND

METHODS:

We electronically administered a survey to multidisciplinary ICU HCPs during two 2-week periods (in June 2020 and March 2021) coinciding with COVID-19 surges. We examined responses across geographical regions and performed multivariate regressions to explore factors associated with reports of (1) families being allowed less input in decisions about maintaining life-sustaining treatments for patients with COVID-19 and (2) emotional distress and burnout.

RESULTS:

We included 1,985 respondents (57% physicians, 14% nurses, 12% respiratory therapists, 16% other HCPs). More respondents reported shortages during the second surge compared with the first (P < .05 for all comparisons), including lower availability of intensivists (66% vs 42%), ICU nurses (53% vs 36%), ICU beds (68% vs 22%), and ventilators for patients with COVID-19 (80% vs 70%); shortages were highest in the North. One-quarter of HCPs reported that families were allowed less input in decisions about maintaining life-sustaining treatments for patients with COVID-19, which was associated with lack of intensivists (adjusted relative risk [aRR], 1.37; 95% CI, 1.05-1.80) and ICU beds (aRR, 1.71; 95% CI, 1.16-2.62) during the first surge and lack of N95 masks (aRR, 1.43; 95% CI, 1.10-1.85), noninvasive positive pressure ventilation (aRR, 1.56; 95% CI, 1.18-2.07), and oxygen concentrators (aRR, 1.50; 95% CI, 1.13-2.00) during the second surge. Burnout was higher during the second surge (60% vs 71%; P < .001), associated with witnessing colleagues at one's hospital contract COVID-19 during both surges (aRR, 1.55 [95% CI, 1.25-1.93] and 1.31 [95% CI, 1.11-1.55], respectively), as well as worries about finances (aRR, 1.28; 95% CI, 1.02-1.61) and lack of ICU nurses (aRR, 1.25; 95% CI, 1.02-1.53) during the first surge.

INTERPRETATION:

During the COVID-19 pandemic, ICU HCPs in Brazil experienced substantial resource shortages, health care disparities between regions, changes in end-of-life care associated with resource shortages, and high proportions of burnout.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Burnout, Professional / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Humans Country/Region as subject: South America / Brazil Language: English Journal: Chest Year: 2022 Document Type: Article Affiliation country: J.chest.2022.01.057

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Burnout, Professional / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Humans Country/Region as subject: South America / Brazil Language: English Journal: Chest Year: 2022 Document Type: Article Affiliation country: J.chest.2022.01.057