Perceptions of Critical Care Shortages, Resource Use, and Provider Well-being During the COVID-19 Pandemic: A Survey of 1,985 Health Care Providers in Brazil.
Perceptions of Critical Care Shortages, Resource Use, and Provider Well-being During the COVID-19 Pandemic: A Survey of 1,985 Health Care Providers in Brazil.
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DOI：
10.1016/j.chest.2022.01.057
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发表时间：
2022-06
期刊：
影响因子：
9.6
通讯作者：
Wahlster S
中科院分区：
文献类型：
--
作者：
Lobo SM;Creutzfeldt CJ;Maia IS;Town JA;Amorim E;Kross EK;Çoruh B;Patel PV;Jannotta GE;Lewis A;Greer DM;Curtis JR;Sharma M;Wahlster S
巴西受到COVID-19的影响不成比例，给ICU带来了沉重的负担。在巴西COVID-19激增期间，ICU资源可用性的看法是否与医疗保健提供者（HCP）的临终决策和倦怠相关？我们在两个为期两周的期间（2020年6月和2021年3月）对多学科ICU HCP进行了电子调查，恰逢COVID-19激增。我们检查了不同地理区域的反应，并进行了多变量回归，以探索与以下报告相关的因素：（1）在决定对COVID-19患者维持生命治疗方面，家庭被允许的参与较少，以及（2）情绪困扰和倦怠。我们纳入了1，985名受访者（57%为医生，14%为护士，12%为呼吸治疗师，16%为其他HCP）。与第一次相比，更多的受访者报告了第二次激增期间的短缺（所有比较P < .05），包括重症监护医生（66%对42%），ICU护士（53%对36%），ICU床位（68%对22%）和COVID-19患者的呼吸机（80%对70%）的可用性降低;北部短缺最严重。四分之一的HCP报告说，在决定对COVID-19患者进行维持生命治疗时，家庭的参与较少，这与缺乏重症监护医生有关（调整的相对危险度[aRR]，1.37; 95% CI，1.05-1.80）和ICU床位（aRR，1.71; 95% CI，1.16-2.62）在第一次激增和缺乏N95口罩期间（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）在第二次浪涌。在第二次增兵期间，（60%对71%; P < .001），与在两次激增期间目睹自己医院的同事感染COVID-19有关（aRR分别为1.55 [95%CI，1.25-1.93]和1.31 [95%CI，1.11-1.55]），以及对财务状况的担忧（aRR，1.28; 95% CI，1.02-1.61）和ICU护士缺乏（aRR，1.25; 95% CI，1.02-1.53）。在2019冠状病毒病大流行期间，巴西的ICU医护人员经历了严重的资源短缺、地区之间的医疗保健差异、与资源短缺相关的临终关怀变化以及高比例的倦怠。
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.
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DOI：
10.1186/cc9390
发表时间：
2010
期刊：
Critical care (London, England)
影响因子：
--
作者：
Fumis RR;Deheinzelin D
通讯作者：
Deheinzelin D
影响因子：
56.3
作者：
Machado, Flavia R.;Cavalcanti, Alexandre Biasi;Pontes Azevedo, Luciano Cesar
通讯作者：
Pontes Azevedo, Luciano Cesar
DOI：
10.1016/s0140-6736(18)31221-2
发表时间：
2018-09-01
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2016 Brazil Collaborators
通讯作者：
GBD 2016 Brazil Collaborators
影响因子：
--
作者：
Kaplan, Lewis J;Kleinpell, Ruth;Ferraro, David M
通讯作者：
Ferraro, David M
影响因子：
15.1
作者：
Azevedo, Luciano C. P.;Park, Marcelo;Soares, Marcio
通讯作者：
Soares, Marcio