Brazil has been disproportionately affected by COVID-19, placing a high burden on intensive care units (ICUs).
Are perceptions of ICU resource availability associated with end-of-life decisions and burnout among healthcare providers (HCP) during COVID-19 surges in Brazil?
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.
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.
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.

Copyright © 2022. Published by Elsevier Inc.