Centre Hospitalier de Bastia, 20600, Bastia, Corsica, France.
Aix-Marseille Université, Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France.
Intensive Care Med. 2023 Apr;49(4):387-400. doi: 10.1007/s00134-023-07025-8. Epub 2023 Mar 27.
The prevalence of burnout in intensive care unit (ICU) professionals is difficult to establish due to the variety of survey instruments used, the heterogeneity of the targeted population, the design of the studies, and the differences among countries regarding ICU organization.
We performed a systematic review and meta-analysis examining the prevalence of high-level burnout in physicians and nurses working in adult ICUs, including only studies that use the Maslach Burnout Inventory (MBI) as a tool to evaluate burnout and involving at least 3 different ICUs.
Twenty-five studies with a combined population of 20,723 healthcare workers from adult ICUs satisfied the inclusion criteria. Combining 18 studies including 8187 ICU physicians, 3660 of them reported a high level of burnout (prevalence 0.41, range 0.15-0.71, 95% CI [0.33; 0.5], I 97.6%, 95% CI [96.9%; 98.1%]). The heterogeneity can be at least in part explained by the definition of burnout used and the response rate as confirmed by the multivariable metaregression done. In contrast, there was no significant difference regarding other factors such as the study period (before or during the coronavirus disease 2019 (COVID-19) pandemic), the income of the countries, or the Healthcare Access and Quality (HAQ) index. Combining 20 studies including 12,536 ICU nurses, 6232 of nurses were reporting burnout (prevalence 0.44, range 0.14-0.74, [95% CI 0.34; 0.55], I 98.6% 95% CI [98.4%; 98.9%]). The prevalence of high-level burnout in ICU nurses for studies performed during the COVID-19 pandemic was higher than that reported for studies performed before the COVID-19 pandemic (0.61 [95% CI, 0.46; 0.75] and 0.37 [95% CI, 0.26; 0.49] respectively, p = 0.003). As for physicians, the heterogeneity is at least in part explained by the definition used for burnout using the MBI but not by the number of participants. When compared, the prevalence of high-level burnout was not different between ICU physicians and ICU nurses. However, the proportion of ICU nurses with a high level of emotional exhaustion was higher than for ICU physicians (0.42 [95% CI, 0.37; 0.48] and 0.28 [0.2; 0.39], respectively, p = 0.022).
According to this meta-analysis, the prevalence of high-level burnout is higher than 40% in all ICU professionals. However, there is a great heterogeneity in the results. To evaluate and to compare preventive and therapeutic strategies, there is the need to use a consensual definition of burnout when using the MBI instrument.
由于使用的调查工具种类繁多、目标人群异质性、研究设计以及各国 ICU 组织方面的差异，重症监护病房（ICU）专业人员的 burnout 患病率难以确定。
我们进行了一项系统评价和荟萃分析，研究了在成人 ICU 工作的医生和护士中高水平 burnout 的患病率，仅纳入使用 Maslach Burnout Inventory（MBI）作为评估 burnout 的工具且至少涉及 3 个不同 ICU 的研究。
符合纳入标准的 25 项研究共有来自成人 ICU 的 20723 名医护人员。将 18 项研究合并，其中 8187 名 ICU 医生中有 3660 名报告高水平 burnout（患病率 0.41，范围 0.15-0.71，95%CI[0.33；0.5]，I²97.6%，95%CI[96.9%；98.1%]）。多变量荟萃回归证实，使用的 burnout 定义和应答率至少可以部分解释这种异质性。相比之下，其他因素（如研究期间（新冠肺炎疫情前或期间）、国家收入或医疗保健获取和质量（HAQ）指数）并无显著差异。将 20 项纳入 12536 名 ICU 护士的研究合并，其中 6232 名护士报告 burnout（患病率 0.44，范围 0.14-0.74，[95%CI 0.34；0.55]，I²98.6%，95%CI[98.4%；98.9%]）。在新冠肺炎疫情期间进行的研究中 ICU 护士高水平 burnout 的患病率高于在新冠肺炎疫情前进行的研究（分别为 0.61[95%CI，0.46；0.75]和 0.37[95%CI，0.26；0.49]，p=0.003）。与医生一样，使用 MBI 对 burnout 进行定义至少部分解释了这种异质性，但不能解释参与者数量的异质性。与医生相比，ICU 护士高水平 burnout 的患病率无差异。然而，ICU 护士中情感衰竭程度较高的比例高于 ICU 医生（分别为 0.42[95%CI，0.37；0.48]和 0.28[0.2；0.39]，p=0.022）。
根据这项荟萃分析，所有 ICU 专业人员高水平 burnout 的患病率均高于 40%。然而，结果存在很大的异质性。为了评估和比较预防和治疗策略，在使用 MBI 工具时，需要使用 burnout 的共识定义。
