The association between resource availability and knowledge, attitudes, and practice about protective ventilation among ICU directors – A nationwide cross-sectional survey

OBJECTIVES: To assess the association between geographic region and availability of ICU resources in Brazil, as well as the relationship between resource availability and KAP for protective ventilation. METHODS: We conducted a cross-sectional study of ICU directors using a validated online survey that included 29 items about ICU characteristics and the availability of 38 resources, and 27 KAP items. We used a Likert scale to score KAP items and calculated a KAP score as the sum of the points, standardized on a scale of 0-100. We used multiple linear regression to assess associations between geographic regions, resources, and KAP. RESULTS: We included 255 ICUs, 12% of the country's ICUs, in a geographically representative distribution of all regions in Brazil. The median of resources available was 34 (interquartile range [IQR] 33-36) out of 38, with statistically significant inequalities among regions, p < 0.001 and 178 (70%) of participants reported an increase in resources available after the COVID-19 pandemic. The median KAP score was 83 (IQR 77-90) and there was a significant association between a greater number of resources and higher KAP (p = 0.031). CONCLUSION: In this study including a representative sample of ICUs in Brazil, we identified regional inequalities in the availability of ICU resources. KAP scores regarding protective ventilation were generally high but varied across regions. Although greater resource availability was associated with higher KAP scores, the magnitude of this association was modest, suggesting that factors beyond resource availability may also contribute to differences in knowledge, attitudes, and practices related to protective ventilation.