Background The COVID-19 pandemic has severely impacted Intensive Care Units (ICUs) and Critical Care Healthcare Providers (HCPs) worldwide. Research Question How do regional differences and perceived lack of ICU resources affect critical care resource utilization and the well-being of HCPs? Study Design and Methods Between April 23 rd -May 7 th 2020, we electronically administered a 41-question survey to interdisciplinary HCPs caring for critically ill COVID-19 patients. The survey was distributed via critical care societies, research networks, personal contacts, and social media portals. Responses were tabulated by World Bank region. We performed multivariate log-binomial regression to assess factors associated with three main outcomes: 1) Limiting mechanical ventilation (MV), 2) changes in cardiopulmonary resuscitation (CPR) practices, and 3) emotional distress or burnout. Results We included 2700 respondents from 77 countries, including physicians (41%), nurses (40%), respiratory therapists (10%) and advanced practice providers (8%). The reported lack of ICU nurses was higher than that of intensivists (32% vs 15%). Limiting MV for COVID-19 patients was reported by 16% of respondents, was lowest in North America (10%), and was associated with reduced ventilator availability (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 female gender (aRR: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) and powered air-purifying respirators (PAPRs) (aRR:1.30 95% CI:1.09-1.55), as well as experiencing poor communication from supervisors (aRR:1.30, 95% CI:1.16-1.46). Interpretation Our findings demonstrate variability in ICU resource availability and utilization 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.

Background Assessing the impact of COVID-19 on intensive care unit (ICU) providers’ perceptions of resource availability and evaluating factors associated with emotional distress/burnout can inform interventions to promote provider well-being. Methods Between April 23-May 7, 2020, we electronically administered a survey to physicians, nurses, respiratory therapist (RTs) and advanced practice providers (APPs) caring for COVID-19 patients in the US. We conducted multivariate regression to assess associations between concerns, reported lack of resources and three outcomes: emotional distress/burnout (primary outcome), and two secondary outcomes: 1) fear that hospital is unable to keep providers safe, and 2) concern about transmitting COVID-19 to family/community. Results We included 1,651 respondents from all 50 states; 47% nurses, 25% physicians, 17% RTs, 11% APPS. Shortages of intensivists and ICU nurses were reported by 12% and 28% of providers, respectively. The largest supply restrictions reported were for powered air purifying respirators (PAPRs); (56% reporting restricted availability). Provider concerns included worries about transmitting COVID-19 to family/community (66%), emotional distress/burnout (58%), and insufficient personal protective equipment (PPE) (40%). After adjustment, emotional distress/burnout was significantly associated with insufficient PPE access (aRR: 1.43, 95% CI: 1.32 - 1.55), stigma from community (aRR: 1.32, 95% CI: 1.24 - 1.41), and poor communication with supervisors (aRR:1.13, 95% CI: 1.06 - 1.21). Insufficient PPE access was the strongest predictor of feeling that the hospital is unable to keep providers safe and worries about transmitting infection to families/communities. Conclusion Addressing insufficient PPE access, poor communication from supervisors, and community stigma may improve provider mental well-being during the COVID-19 pandemic.

Background Brazil has been disproportionately affected by COVID-19, placing a high burden on intensive care units (ICUs). Research Question Are perceptions of ICU resource availability associated with end-of-life decisions and burnout among healthcare providers (HCP) during COVID-19 surges in Brazil? Methods We electronically administered a survey to multidisciplinary ICU HCPs during two 2-week periods (June 2020, March 2021) coinciding with COVID-19 surges. We examined responses across geographical regions, and performed multivariate regressions to explore factors associated with report 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. Results We included 1,985 respondents (57% physicians, 14% nurses, 12% respiratory therapists, 16% other HCPs). More respondents reported shortages during the second surge compared to the first (P<0.05 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) 1.37,95CI: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), non-invasive 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<0.001), associated with witnessing colleagues at one's hospital contract COVID-19 during both surges (aRR 1.55,95%CI:1.25-1.93;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. Conclusions During the COVID-19 pandemic, ICU HCPs in Brazil experienced substantial resource shortages, healthcare disparities between regions, changes in end-of-life care associated with resource shortages, and high proportions of burnout.