Chest
Volume 159, Issue 2, February 2021, Pages 619-633
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Critical Care: Original Research
The Coronavirus Disease 2019 Pandemic’s Effect on Critical Care Resources and Health-Care Providers: A Global Survey

https://doi.org/10.1016/j.chest.2020.09.070Get rights and content

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.

Key Words

burnout
COVID-19
critical care
emotional distress
mechanical ventilation
resource use
survey

Abbreviations

APP
advanced practice provider
ARR
absolute risk reduction
COVID-19
coronavirus disease 2019
HCP
health-care provider
LMIC
low- and middle-income countries
MV
mechanical ventilation
PAPR
powered air-purifying respirator
PPE
personal protective equipment
RT
respiratory therapist

Cited by (0)

FUNDING/SUPPORT: The authors received no direct funding for this work. M. S. received support from National Institute of Mental Health [Grant K01MH115789]. C. S. H. reports current funding by the Federal Joint Committee Innovation Fund [Grant FKZ 01VSF17010]. C. J. C. is supported by National Institute of Neurological Disorders and Stroke [Grant NS099421].

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