• Suzana M Lobo, Claire J Creutzfeldt, Israel S Maia, James A Town, Edilberto Amorim, Erin K Kross, Başak Çoruh, Pratik V Patel, Gemi E Jannotta, Ariane Lewis, David M Greer, CurtisJ RandallJRDepartment of Intensive Care Medicine, Hospital Nereu Ramos, Florianópolis, Santa Catarina, Brazil; Department of Neurology, University of California, San Francisco, San Francisco, CA., Monisha Sharma, and Sarah Wahlster.
• Intensive Care Department, Hospital de Base, São José do Rio Preto, São Paulo, Brazil; Associação de Medicina Intensiva Brasileira, Florianópolis, Santa Catarina, Brazil.
• Chest. 2022 Jun 1; 161 (6): 152615421526-1542.

BackgroundBrazil has been disproportionately affected by COVID-19, placing a high burden on ICUs.Research QuestionAre perceptions of ICU resource availability associated with end-of-life decisions and burnout among health care providers (HCPs) during COVID-19 surges in Brazil?Study Design And MethodsWe 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.ResultsWe 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.InterpretationDuring 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.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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