• Sarah Wahlster, Monisha Sharma, Ariane K Lewis, Pratik V Patel, Christiane S Hartog, Gemi Jannotta, Patricia Blissitt, Erin K Kross, Nicholas J Kassebaum, David M Greer, CurtisJ RandallJRDivision of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, WA; Cambia Palliative Care Center of Excellence, University of Washington, WA; Cambia Health Foundation., and Claire J Creutzfeldt.
• Department of Neurology, Harborview Medical Center, University of Washington, WA; Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, WA; Department of Neurological Surgery, Harborview Medical Center, University of Washington, WA. Electronic address: wahlster@uw.edu.
• Chest. 2021 Feb 1; 159 (2): 619633619-633.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has severely affected ICUs and critical care health-care providers (HCPs) worldwide.Research QuestionHow do regional differences and perceived lack of ICU resources affect critical care resource use and the well-being of HCPs?Study Design And MethodsBetween 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.ResultsWe 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).InterpretationOur 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.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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