Mental Health and Emotional Disorders During the COVID-19 Pandemics: Prevalence and Extent in PICU Staff.

OBJECTIVES: To assess the prevalence of burnout, anxiety and depression symptoms, and posttraumatic stress disorder (PTSD) in PICU workers in Brazil during the first peak of the COVID-19 pandemic. To compare the results of subgroups stratified by age, gender, professional category, health system, and previous mental health disorders. DESIGN: Multicenter, cross-sectional study using an electronic survey. SETTING: Twenty-nine public and private Brazilian PICUs. SUBJECTS: Multidisciplinary PICU workers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Self-reported questionnaires were used to measure burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), and PTSD (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5]) in 1,084 respondents. Subjects were mainly young (37.1 ± 8.4 yr old) and females (85%), with a median workload of 50 hours per week. The prevalence of anxiety and depression was 33% and 19%, respectively, whereas PTSD was 13%. The overall median burnout scores were high in the emotional exhaustion and personal accomplishment dimensions (16 [interquartile range (IQR), 8-24] and 40 [IQR, 33-44], respectively) whereas low in the depersonalization one (2 [IQR, 0-5]), suggesting a profile of overextended professionals, with a burnout prevalence of 24%. Professionals reporting prior mental health disorders had higher prevalence of burnout (30% vs 22%; p = 0.02), anxiety (51% vs 29%; p < 0.001), and depression symptoms (32.5% vs 15%; p < 0.001), with superior PCL-5 scores for PTSD ( p < 0.001). Public hospital workers presented more burnout (29% vs 18.6%, p < 0.001) and more PTSD levels (14.8% vs 10%, p = 0.03). Younger professionals were also more burned out ( p < 0.05 in all three dimensions). CONCLUSIONS: The prevalence of mental health disorders in Brazilian PICU workers during the first 2020 peak of COVID-19 was as high as those described in adult ICU workers. Some subgroups, particularly those reporting previous mental disorders and younger professionals, should receive special attention to prevent future crises.

Perfil das internações por causas respiratórias em duas unidades de terapia intensiva pediátricas em Salvador, Bahia / Profile of hospitalizations for respiratory causes in two pediatric intensive care units in Salvador, Bahia / Perfil de hospitalizaciones por causas respiratórias en dos unidades de cuidados intensivos pediátricos en Salvador, Bahía

As doenças respiratórias são associadas a grande morbidade e mortalidade na faixa etária pediátrica e, assim, responsáveis por hospitalizações em Unidades de Terapia Intensiva Pediátricas (UTIPs). O objetivo deste estudo foi descrever as principais causas de admissão por doenças respiratórias e a evolução desses pacientes em duas UTIPs. Tratou-se de estudo descritivo e retrospectivo. Foram coletados dados de todos os pacientes admitidos por doença do trato respiratório, durante o ano de 2011, em duas UTIPs terciárias, da cidade de Salvador, Bahia. Nesse período, foram admitidos 625 pacientes, dos quais 355 (56,8%) tinham doença do trato respiratório. Destes, a maioria foi do sexo masculino (55,2%) e houve predominância de lactentes (55,8%). O tempo de permanência em UTIP esteve entre um e sete dias (75,8%). Pneumonia foi a principal causa de admissão (37,7%), seguida de bronquiolite (18,9%) e asma (12,4%). O uso de ventilação não invasiva foi verificado em 178 pacientes (50,1%) e 86 pacientes (24,2%) necessitaram de ventilação invasiva. Houve 23 óbitos (6,47%). Concluiu- -se que as doenças respiratórias constituem ainda causas importantes de morbimortalidade na infância.

Respiratory diseases are associated to high morbidity and mortality in pediatric patients and so are responsible for hospitalizations in Pediatric Intensive Care Units (PICUs). The objective of this study was to describe the main causes of admission due to respiratory diseases and the evolution of these patients in two PICUs. This was a descriptive and a retrospective study. Data were collected from all patients admitted for respiratory tract disease in two tertiary PICUs, in Salvador-Bahia, during the year 2011. During this period, 625 patients were admitted, of whom 355 (56,8%) had respiratory tract disease. The majority of them was male (55,2%) predominantly infants (55,8%). The length of stay in PICUs range was between one to seven days (75,8%). Pneumonia was the leading cause of admission (37,7%), followed by bronchiolitis (18,9%) and asthma (12,4%). The use of noninvasive ventilation was found in 178 patients (50,1%) and 86 patients (24,2%) required invasive ventilation. In conclusion, respiratory diseases are current important causes of morbidity and mortality in childhood.

Enfermedades respiratorias se asocian con una alta morbilidad y mortalidad en pacientes pediátricos y por lo tanto responsable de las hospitalizaciones en unidades de cuidados intensivos pediátricos (UCIP). El objetivo de este estudio fue describir las principales causas de internamiento por enfermedades respiratorias y la evolución de estos pacientes en dos UCIP. Se trató de un estudio descriptivo y retrospectivo. Se recogieron datos de todos los pacientes internados por enfermedades respiratorias durante el año 2011, en dos UCIP terciarias de Salvador-Bahía. Durante este período, 625 pacientes internados, de los cuales, 355 (56,8%) tenían enfermedad del tracto respiratorio. De ellos, la mayoría fue del sexo masculino (55,2%) y hubo un predominio de lactantes (55,8%). El tiempo de permanencia en la UCIP varió de un a siete días (75,8%). La neumonía es la principal causa de internamiento (37,7%), seguida por bronquiolitis (18,9%) y el asma (12,4%). Se observó el uso de la ventilación no invasiva en 178 pacientes (50,1%) y 86 pacientes (24,2%) requirieron ventilación invasiva. Hubo 23 muertes (6,47%). Las enfermedades respiratorias son causas importantes de morbilidad y mortalidad en la infancia.

Validation of sedation scores in mechanically ventilated children admitted to a tertiary pediatric intensive care unit. / Validação de escalas de sedação em crianças submetidas à ventilação mecânica internadas em uma unidade de terapia intensiva pediátrica terciária.

OBJECTIVES: Sedation scores are important tools for use in pediatric intensive care units. The Comfort-Behavior scale is a valid method for the assessment of children although it is considered an extensive scale. The motor activity assessment scale is validated for an adult population. We considered it simpler then the one above and suitable for application in children. None of these scores had been translated into Portuguese. Our objective was to apply both scales in Portuguese to a pediatric population under mechanical ventilation. Secondary objectives were to evaluate the sedation level of children on mechanical ventilation in tertiary pediatric intensive care units and to compare the Comfort- Behavior and motor activity assessment scales in this population. METHODS: After translating the scales into Portuguese, both were simultaneously applied to 26 patients by 2 pediatricians. Each scale was applied 116 times in total. RESULTS: The intraclass correlation coefficient was 0.90 (0.85 - 0.93 CI 95%) for the Comfort-Behavior and 0.94 (0.92 - 0.96 CI 95%) for the motor activity assessment scale. When applying the Comfort-Behavior scale, the Crombach's alpha was 0.81 for observer A and 0.92 for observer B. The Spearman coefficient was 0.86 for observer A and 0.91 for observer B. These patients were found to be deeply sedated, showing low values in both scales. CONCLUSIONS: The scales were successfully translated into Portuguese and both were adequate to assess pain and sedation in the pediatric population under mechanical ventilation. Sedation level was high in this sample of applications.

Validação de escalas de sedação em crianças submetidas à ventilação mecânica internadas em uma unidade de terapia intensiva pediátrica terciária / Validation of sedation scores in mechanically ventilated children admitted to a tertiary pediatric intensive care unit

OBJETIVOS: O uso de escalas de sedação é fundamental em unidades de terapia intensiva pediátrica. A escala Comfort-Behavior é validada para avaliação de crianças, contudo, é um instrumento extenso. A escala de avaliação da atividade motora está validada para adultos, é mais simples do que a anterior e possível de ser usada em crianças. Nenhuma dessas escalas está validada na língua portuguesa. O objetivo primário deste estudo foi validar as duas escalas traduzidas para o português em crianças submetidas à ventilação mecânica. Os objetivos secundários foram avaliar o nível de sedação dos pacientes em ventilação mecânica de unidades de terapia intensiva pediátrica terciária e comparar o desempenho das duas escalas nesta população. MÉTODOS: Após a tradução para o português, as escalas foram aplicadas em 26 pacientes por dois médicos, simultaneamente. Obteve-se um total de 116 observações por escala. RESULTADOS: O coeficiente de correlação intraclasse foi 0,90 (IC95 por cento 0,85 - 0,93) para a escala Comfort-Behavior e 0,94 (IC 95 por cento 0,92 - 0,96) para a avaliação da atividade motora. O alfa de Crombach para o observador A ao aplicar a escala Comfort-Behvior foi 0,81 e para o observador B, 0,92. O coeficiente de Spearman para o observador A foi 0,86 e para o observador B, 0,91. As aplicações das escalas revelaram pacientes bastante sedados, atingindo pontuações baixas em ambas. CONCLUSÕES: A validação das escalas Comfort-Behavior e avaliação da atividade motora para o português foi realizada com sucesso. Ambas foram adequadas para emprego em crianças em ventilação mecânica. Nas aplicações avaliadas, o nível de sedação observado na unidade estudada foi alto.

OBJECTIVES: Sedation scores are important tools for use in pediatric intensive care units. The Comfort-Behavior scale is a valid method for the assessment of children although it is considered an extensive scale. The motor activity assessment scale is validated for an adult population. We considered it simpler then the one above and suitable for application in children. None of these scores had been translated into Portuguese. Our objective was to apply both scales in Portuguese to a pediatric population under mechanical ventilation. Secondary objectives were to evaluate the sedation level of children on mechanical ventilation in tertiary pediatric intensive care units and to compare the Comfort- Behavior and motor activity assessment scales in this population. METHODS: After translating the scales into Portuguese, both were simultaneously applied to 26 patients by 2 pediatricians. Each scale was applied 116 times in total. RESULTS: The intraclass correlation coefficient was 0.90 (0.85 - 0.93 CI 95 percent) for the Comfort-Behavior and 0.94 (0.92 - 0.96 CI 95 percent) for the motor activity assessment scale. When applying the Comfort-Behavior scale, the Crombach's alpha was 0.81 for observer A and 0.92 for observer B. The Spearman coefficient was 0.86 for observer A and 0.91 for observer B. These patients were found to be deeply sedated, showing low values in both scales. CONCLUSIONS: The scales were successfully translated into Portuguese and both were adequate to assess pain and sedation in the pediatric population under mechanical ventilation. Sedation level was high in this sample of applications.