Intensive Care Department, Hospital de Base, São José do Rio Preto, São Paulo, Brazil; Associação de Medicina Intensiva Brasileira, Florianópolis, Santa Catarina, Brazil.
Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA; Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA.
Chest. 2022 Jun;161(6):1526-1542. doi: 10.1016/j.chest.2022.01.057. Epub 2022 Feb 10.
Brazil has been disproportionately affected by COVID-19, placing a high burden on ICUs.
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?
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.
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.
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.
巴西受到 COVID-19 的严重影响，给 ICU 带来了沉重负担。
在巴西 COVID-19 疫情高峰期，医护人员（HCP）对 ICU 资源可用性的看法是否与临终决策和职业倦怠有关？
我们在 2020 年 6 月和 2021 年 3 月 COVID-19 疫情高峰期期间，通过电子方式向多学科 ICU HCP 进行了两次为期两周的调查。我们跨地理区域进行了分析，并进行了多变量回归，以探讨与以下因素相关的报告：（1）家属在维持 COVID-19 患者生命支持治疗方面的决策中投入较少；（2）情绪困扰和职业倦怠。
我们纳入了 1985 名受访者（57%为医生，14%为护士，12%为呼吸治疗师，16%为其他 HCP）。与第一波相比，第二波报告的短缺情况更多（所有比较均 P<0.05），包括 ICU 医生（66%比 42%）、ICU 护士（53%比 36%）、ICU 床位（68%比 22%）和 COVID-19 患者的呼吸机（80%比 70%）短缺；北部地区的短缺情况最为严重。四分之一的 HCP 报告称，在维持 COVID-19 患者生命支持治疗的决策中，家属的投入较少，这与 ICU 医生（调整后的相对风险 [aRR]，1.37；95%CI，1.05-1.80）和 ICU 床位（aRR，1.71；95%CI，1.16-2.62）短缺以及 N95 口罩（aRR，1.43；95%CI，1.10-1.85）、无创正压通气（aRR，1.56；95%CI，1.18-2.07）和氧气浓缩器（aRR，1.50；95%CI，1.13-2.00）短缺有关，在第一波和第二波。第二波的倦怠感更高（60%比 71%；P<0.001），与在两次高峰期都目睹同事在医院感染 COVID-19（aRR，1.55[95%CI，1.25-1.93]和 1.31[95%CI，1.11-1.55]）以及对财务的担忧（aRR，1.28；95%CI，1.02-1.61）和 ICU 护士短缺（aRR，1.25；95%CI，1.02-1.53）有关。
在 COVID-19 大流行期间，巴西的 ICU HCP 经历了严重的资源短缺、地区间医疗保健差距、与资源短缺相关的临终关怀变化以及高比例的倦怠。
