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
Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved..
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.
| Errataetall: | |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:161 |
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| Enthalten in: |
Chest - 161(2022), 6 vom: 07. Juni, Seite 1526-1542 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lobo, Suzana M [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 13.06.2022 Date Revised 14.02.2024 published: Print-Electronic CommentIn: Chest. 2022 Jul;162(1):30-32. - PMID 35809933 Citation Status MEDLINE |
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| doi: |
10.1016/j.chest.2022.01.057 |
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NLM336827873 |
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| 100 | 1 | |a Lobo, Suzana M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Perceptions of Critical Care Shortages, Resource Use, and Provider Well-being During the COVID-19 Pandemic |b A Survey of 1,985 Health Care Providers in Brazil |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Completed 13.06.2022 | ||
| 500 | |a Date Revised 14.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Chest. 2022 Jul;162(1):30-32. - PMID 35809933 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Brazil has been disproportionately affected by COVID-19, placing a high burden on ICUs | ||
| 520 | |a 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? | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
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| 650 | 4 | |a burnout | |
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| 650 | 4 | |a end-of-life care | |
| 650 | 4 | |a health care disparities | |
| 650 | 4 | |a resource utilization | |
| 650 | 4 | |a surge | |
| 700 | 1 | |a Creutzfeldt, Claire J |e verfasserin |4 aut | |
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| 700 | 1 | |a Çoruh, Başak |e verfasserin |4 aut | |
| 700 | 1 | |a Patel, Pratik V |e verfasserin |4 aut | |
| 700 | 1 | |a Jannotta, Gemi E |e verfasserin |4 aut | |
| 700 | 1 | |a Lewis, Ariane |e verfasserin |4 aut | |
| 700 | 1 | |a Greer, David M |e verfasserin |4 aut | |
| 700 | 1 | |a Curtis, J Randall |e verfasserin |4 aut | |
| 700 | 1 | |a Sharma, Monisha |e verfasserin |4 aut | |
| 700 | 1 | |a Wahlster, Sarah |e verfasserin |4 aut | |
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