Cargando…
The Coronavirus Disease 2019 Pandemic’s Effect on Critical Care Resources and Health-Care Providers: A Global Survey
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 DES...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American College of Chest Physicians. Published by Elsevier Inc.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484703/ https://www.ncbi.nlm.nih.gov/pubmed/32926870 http://dx.doi.org/10.1016/j.chest.2020.09.070 |
_version_ | 1783581026589605888 |
---|---|
author | Wahlster, Sarah Sharma, Monisha Lewis, Ariane K. Patel, Pratik V. Hartog, Christiane S. Jannotta, Gemi Blissitt, Patricia Kross, Erin K. Kassebaum, Nicholas J. Greer, David M. Curtis, J. Randall Creutzfeldt, Claire J. |
author_facet | Wahlster, Sarah Sharma, Monisha Lewis, Ariane K. Patel, Pratik V. Hartog, Christiane S. Jannotta, Gemi Blissitt, Patricia Kross, Erin K. Kassebaum, Nicholas J. Greer, David M. Curtis, J. Randall Creutzfeldt, Claire J. |
author_sort | Wahlster, Sarah |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7484703 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | American College of Chest Physicians. Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-74847032020-09-11 The Coronavirus Disease 2019 Pandemic’s Effect on Critical Care Resources and Health-Care Providers: A Global Survey Wahlster, Sarah Sharma, Monisha Lewis, Ariane K. Patel, Pratik V. Hartog, Christiane S. Jannotta, Gemi Blissitt, Patricia Kross, Erin K. Kassebaum, Nicholas J. Greer, David M. Curtis, J. Randall Creutzfeldt, Claire J. Chest Critical Care: Original Research 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. American College of Chest Physicians. Published by Elsevier Inc. 2021-02 2020-09-11 /pmc/articles/PMC7484703/ /pubmed/32926870 http://dx.doi.org/10.1016/j.chest.2020.09.070 Text en © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Critical Care: Original Research Wahlster, Sarah Sharma, Monisha Lewis, Ariane K. Patel, Pratik V. Hartog, Christiane S. Jannotta, Gemi Blissitt, Patricia Kross, Erin K. Kassebaum, Nicholas J. Greer, David M. Curtis, J. Randall Creutzfeldt, Claire J. The Coronavirus Disease 2019 Pandemic’s Effect on Critical Care Resources and Health-Care Providers: A Global Survey |
title | The Coronavirus Disease 2019 Pandemic’s Effect on Critical Care Resources and Health-Care Providers: A Global Survey |
title_full | The Coronavirus Disease 2019 Pandemic’s Effect on Critical Care Resources and Health-Care Providers: A Global Survey |
title_fullStr | The Coronavirus Disease 2019 Pandemic’s Effect on Critical Care Resources and Health-Care Providers: A Global Survey |
title_full_unstemmed | The Coronavirus Disease 2019 Pandemic’s Effect on Critical Care Resources and Health-Care Providers: A Global Survey |
title_short | The Coronavirus Disease 2019 Pandemic’s Effect on Critical Care Resources and Health-Care Providers: A Global Survey |
title_sort | coronavirus disease 2019 pandemic’s effect on critical care resources and health-care providers: a global survey |
topic | Critical Care: Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484703/ https://www.ncbi.nlm.nih.gov/pubmed/32926870 http://dx.doi.org/10.1016/j.chest.2020.09.070 |
work_keys_str_mv | AT wahlstersarah thecoronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT sharmamonisha thecoronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT lewisarianek thecoronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT patelpratikv thecoronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT hartogchristianes thecoronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT jannottagemi thecoronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT blissittpatricia thecoronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT krosserink thecoronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT kassebaumnicholasj thecoronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT greerdavidm thecoronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT curtisjrandall thecoronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT creutzfeldtclairej thecoronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT wahlstersarah coronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT sharmamonisha coronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT lewisarianek coronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT patelpratikv coronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT hartogchristianes coronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT jannottagemi coronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT blissittpatricia coronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT krosserink coronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT kassebaumnicholasj coronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT greerdavidm coronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT curtisjrandall coronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey AT creutzfeldtclairej coronavirusdisease2019pandemicseffectoncriticalcareresourcesandhealthcareprovidersaglobalsurvey |