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Original Article
A nationwide survey on health resources and clinical practices during the early COVID-19 pandemic in Brazil
Rev Bras Ter Intensiva. 2022;34(1):107-115
Abstract
Original ArticleA nationwide survey on health resources and clinical practices during the early COVID-19 pandemic in Brazil
Rev Bras Ter Intensiva. 2022;34(1):107-115
DOI 10.5935/0103-507X.20220005-en
Views1ABSTRACT
Objective:
To evaluate clinical practices and hospital resource organization during the early COVID-19 pandemic in Brazil.
Methods:
This was a multicenter, cross-sectional survey. An electronic questionnaire was provided to emergency department and intensive care unit physicians attending COVID-19 patients. The survey comprised four domains: characteristics of the participants, clinical practices, COVID-19 treatment protocols and hospital resource organization.
Results:
Between May and June 2020, 284 participants [median (interquartile ranges) age 39 (33 – 47) years, 56.3% men] responded to the survey; 33% were intensivists, and 9% were emergency medicine specialists. Half of the respondents worked in public hospitals. Noninvasive ventilation (89% versus 73%; p = 0.001) and highflow nasal cannula (49% versus 32%; p = 0.005) were reported to be more commonly available in private hospitals than in public hospitals. Mechanical ventilation was more commonly used in public hospitals than private hospitals (70% versus 50%; p = 0,024). In the Emergency Departments, positive endexpiratory pressure was most commonly adjusted according to SpO2, while in the intensive care units, positive end-expiratory pressure was adjusted according to the best lung compliance. In the Emergency Departments, 25% of the respondents did not know how to set positive end-expiratory pressure. Compared to private hospitals, public hospitals had a lower availability of protocols for personal protection equipment during tracheal intubation (82% versus 94%; p = 0.005), managing mechanical ventilation [64% versus 75%; p = 0.006] and weaning patients from mechanical ventilation [34% versus 54%; p = 0.002]. Finally, patients spent less time in the emergency department before being transferred to the intensive care unit in private hospitals than in public hospitals [2 (1 – 3) versus 5 (2 – 24) hours; p < 0.001].
Conclusion:
This survey revealed significant heterogeneity in the organization of hospital resources, clinical practices and treatments among physicians during the early COVID-19 pandemic in Brazil.
Keywords:BrazilCoronavirus infectionsCOVID-19Emergency servicehospitalHospital administrationIntensive care unitsPandemicsPhysiciansPractice patternsSurveys and questionnairesSee more
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness Extracorporeal membrane oxygenation Infant, newborn Intensive care Intensive care units Intensive care units, pediatric mechanical ventilation Mortality Physical therapy modalities Prognosis Respiration, artificial Respiratory insufficiency risk factors SARS-CoV-2 Sepsis