Evaluation of knowledge and attitudes among intensive care physicians during the COVID-19 pandemic: a cross-sectional survey

ABSTRACT BACKGROUND: The novel coronavirus (COVID-19) emerged in Wuhan, China, in December 2019. OBJECTIVES: To evaluate the knowledge of intensive care physicians in Turkey about COVID-19 and their attitudes towards the strategies and application methods to be used for COVID-19 cases that need to be followed up in an intensive care unit, and to raise awareness about this issue. DESIGN AND SETTING: The population for this descriptive study comprised clinicians working in a variety of healthcare organizations in Turkey who provide monitoring and treatment within the intensive care process for COVID-19 patients. METHODS: Data were collected online using a survey form on the SurveyMonkey website between April 20 and April 25, 2020. RESULTS: The mean age of the 248 intensive care clinicians participating in the study was 37.2 ± 13.7 years and 49.19% were female. High rates of classical laryngoscope use were observed, especially among clinicians employed in state hospitals. Among all the participants, 54.8% stated that they were undecided about corticosteroid treatment for patients who had been intubated due to COVID-19. CONCLUSIONS: Many medications and methods are used for COVID-19 treatment. All national science committees are attempting to create standard treatment protocols. For intensive care treatment of COVID-19 patients, many factors require management, and clinicians’ experience is guiding future processes. We believe that this study will create awareness about this topic and contribute to the creation of standard treatment algorithms and the provision of better and safer healthcare services for this patient group.


METHODS
The population in this descriptive study comprised clinicians working in a variety of healthcare organizations in Turkey who provide monitoring and treatment within the intensive care process for COVID-19 patients. Permission for the study was granted by the clinical research ethics committee of Çanakkale Onsekiz Mart University (date: April 14, 2020; approval no. 2020/116). The sample size for the study was calculated using Minitab 16.0 (Minitab LLC, PA, United States). With a 95% confidence interval, 5% type 1 error and 90% power, and based on data from similar studies in terms of the parameters investigated, the power analysis determined that at least 244 people should be contacted. Data were collected online using a survey form on the SurveyMonkey website (SurveyMonkey, San Mateo, CA, United States) between April 20, 2020, and April 25,

Members of the Turkish Anesthesiology and Reanimation
Association were asked to participate in the study, via the Twitter, LinkedIn and WhatsApp social media platforms and through e-mail. Those who agreed to participate completed the abovementioned survey. The researchers prepared survey questions that were in line with recommendations within the COVID-19 guidelines that were published by the General Directorate of Public Health of the Turkish Ministry of Health and the World Health Organization (WHO). [5][6][7] The survey contained 21 items: these questions related to sociodemographic characteristics, workplace features and treatment processes within intensive care that would be used in the event of a diagnosis of COVID-19.

RESULTS
The mean age of the 248 intensive care clinicians who participated in the study was 37.2 ± 13.7 years, and 49.19% were female.
Regarding the length of time for which the participants had worked in the field of anesthesia, 32.7% had worked for 1-5 years, while 24.3% had worked for 6-10 years. Evaluation of the participants' titles showed that 56.4% were specialist doctors, while 26.6% were residents. Among the doctors who participated, 41.1% were working in universities, 30.6% in state hospitals and 16.1% in education-research hospitals. Some sociodemographic characteristics and professional information about the participants are shown in Table 1.
Among the clinicians working in intensive care, 50.8% stated they had received education about the COVID-19 disease from their organization. While 48.8% worked in university or education-research hospitals involved in education, 41.1% worked in state hospitals and 10.1% worked in private hospitals. Among all the participants, 87.1% worked in pandemic hospitals, and 84.6% of the clinicians considered that they had come into contact with COVID-19-positive patients.
The proportion who thought that their workload had increased since the pandemic began was 59.6%. Among all the clinicians included in this study, 50.8% stated that COVID-19-positive patients were admitted to intensive care from the emergency service, while 44.3% stated that COVID-19-positive patients were admitted from the wards where they were being monitored.
In this study, it appeared that 45.1% of the intensive care physicians were using a videolaryngoscope, 13.7% were using an aerosol box and 41.1% were using classical laryngoscope for the intubation procedures. The proportion of intensive care clinicians stating that extubation procedures were completed at the patient's bedside was 62.1%, while 22.5% said that extubation was done in isolated areas within intensive care and 15.3% said that extubation was done after transfer to another intensive care area. The treatment approaches and relevant opinions of the clinicians participating in the study, relating to patients who developed acute respiratory distress syndrome(ARDS) during COVID-19 treatment are shown in Table 2.
When asked about the time at which favipiravir treatment   Table 3.

DISCUSSION
In this study, the clinicians participating in intensive care moni-

CONCLUSION
The COVID-19 pandemic has spread rapidly around the world.
Concerns about a second wave have been expressed worldwide.