The Coronavirus Disease 2019 Pandemic's Effect on Critical Care Resources and Health-Care Providers: A Global Survey

Abstract

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.

Keywords: COVID-19; burnout; critical care; emotional distress; mechanical ventilation; resource use; survey.

Figure 1

World maps displaying number of survey respondents per country (A), percentage of health-care providers (HCPs) reporting an insufficient number of intensivists by country (B), percentage of HCPs reporting an insufficient number of ICU nurses by country (C), percentage of HCPs reporting an insufficient number of ICU beds by country (D), and percentage of HCPs reporting limited availability of ventilators by country (E).

Figure 2

ICU resource use and availability of personal protective equipment (A), oxygenation strategies (B), and medical tests and procedures (C) in patients with coronavirus disease 2019. Not all percentages across all rows total 100% because of rounding. CAPR = controlled air-purifying respirator; HFNC = high-flow nasal cannula; NIPPV = noninvasive positive pressure ventilation; PAPR = powered air-purifying respirator.

Figure 2

ICU resource use and availability of personal protective equipment (A), oxygenation strategies (B), and medical tests and procedures (C) in patients with coronavirus disease 2019. Not all percentages across all rows total 100% because of rounding. CAPR = controlled air-purifying respirator; HFNC = high-flow nasal cannula; NIPPV = noninvasive positive pressure ventilation; PAPR = powered air-purifying respirator.