The Coronavirus Disease 2019 Pandemic's Effect on Critical Care Resources and Health-Care Providers A Global Survey
The Coronavirus Disease 2019 Pandemic's Effect on Critical Care Resources and Health-Care Providers A Global Survey
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DOI：
10.1016/j.chest.2020.09.070
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发表时间：
2021-02-04
期刊：
影响因子：
9.6
通讯作者：
Creutzfeldt, Claire J.
中科院分区：
文献类型：
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作者：
Wahlster, Sarah;Sharma, Monisha;Creutzfeldt, Claire J.
背景技术背景：2019冠状病毒病（COVID-19）大流行严重影响了全球ICU和重症监护医疗服务提供者（HCP）。研究问题：地区差异和ICU资源的缺乏如何影响重症监护资源的使用和HCP的健康？研究设计和方法：在2020年4月23日至5月7日期间，我们以电子方式向照顾COVID-19重症患者的跨学科HCP进行了一项41个问题的调查。该调查通过重症监护协会、研究网络、个人联系人和社交媒体门户网站分发。答复按世界银行区域分列。我们进行了多变量对数二项回归，以评估与三个主要结局相关的因素：限制性机械通气（MV），CPR实践的变化，情绪困扰和burners.Results：我们包括来自77个国家的2,700名受访者，包括医生（41%），护士（40%），呼吸治疗师（11%）和高级实践提供者（8%）。ICU护士的缺乏率高于重症监护医师（32% vs 15%）。16%的受访者报告了COVID-19患者的限制MV，在北美最低（10%），并与呼吸机可用性降低相关（绝对风险降低[ARR]，2.10; 95% CI，1.61-2.74）。总体而言，66%的受访者报告了CPR实践的变化。各地区的情绪困扰或倦怠程度都很高（52%，北美最高），并与女性有关（机械通气，1.16; 95%CI，1.01-1.33），护士（ARR，1.31; 95% CI，1.13-1.53），报告ICU护士短缺（ARR，1.18; 95% CI，1.05-1.33），报告电动空气净化器短缺（ARR，1.30; 95%CI，1.09-1.55），并经历了与主管沟通不畅（ARR，1.30; 95%CI，1.16-1.46）。解释：我们的研究结果表明，ICU资源的可用性和使用在世界范围内的变化。提供者倦怠的高患病率及其与所报告的资源不足和主管沟通不畅的相关性表明，需要有针对性的干预措施来支持第一线的HCP。
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: BetweenApril 23 andMay 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.