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Kuribara T, Unoki T, Yamakita S, Hashimoto N, Yoshino Y, Sakuramoto H, Aikawa G, Okamoto S. Nation-wide survey of oral care practice in Japanese intensive care units: A descriptive study. PLoS One 2024; 19:e0301258. [PMID: 38551939 PMCID: PMC10980190 DOI: 10.1371/journal.pone.0301258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/13/2024] [Indexed: 04/01/2024] Open
Abstract
Oral care for critically ill patients helps provide comfort and prevent ventilator-associated pneumonia. However, a standardized protocol for oral care in intensive care units is currently unavailable. Thus, this study aimed to determine the overall oral care practices, including those for intubated patients, in Japanese intensive care units. We also discuss the differences in oral care methods between Japanese ICUs and ICUs in other countries. This study included all Japanese intensive care units meeting the authorities' standard set criteria, with a minimum of 0.5 nurses per patient at all times and admission of adult patients requiring mechanical ventilation. An online survey was used to collect data. Survey responses were obtained from one representative nurse per intensive care unit. Frequency analysis was performed, and the percentage of each response was calculated. A total of 609 hospitals and 717 intensive care units nationwide participated; among these, responses were collected from 247 intensive care units (34.4%). Of these, 215 (87.0%) and 32 (13.0%) reported standardized and non-standardized oral care, respectively. Subsequently, the data from 215 intensive care units that provided standardized oral care were analyzed in detail. The most common frequency of practicing oral care was three times a day (68.8%). Moreover, many intensive care units provided care at unequal intervals (79.5%), mainly in the morning, daytime, and evening. Regarding oral care methods, 96 (44.7%) respondents used only a toothbrush, while 116 (54.0%) used both a toothbrush and a non-brushing method. The findings of our study reveal current oral care practices in ICUs in Japan. In particular, most ICUs provide oral care three times a day at unequal intervals, and almost all use toothbrushes as a common tool for oral care. The results suggest that some oral care practices in Japanese ICUs differ from those in ICUs in other countries.
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Affiliation(s)
- Tomoki Kuribara
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
| | - Sachika Yamakita
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Master Program, Sapporo, Hokkaido, Japan
| | - Naoya Hashimoto
- Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Yasuyo Yoshino
- Faculty of Nursing Department of Nursing Adult Nursing, Komazawa Women’s University, Inagi-shi, Tokyo, Japan
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan
| | - Gen Aikawa
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Omika, Hitachi, Ibaraki, Japan
| | - Saiko Okamoto
- Department of Nursing, Hitachi General Hospital, Jonancho, Hitachi, Ibaraki, Japan
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Kitayama M, Unoki T, Liu K, Nakamura K. Enteral nutrition practice in the prone position in patients with coronavirus disease 2019: An international one-day point prevalence analysis. Clin Nutr ESPEN 2024; 59:257-263. [PMID: 38220384 DOI: 10.1016/j.clnesp.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS Enteral nutrition (EN) in the prone position for severe respiratory failure is considered possible with care. However, the extent to which it is feasible, especially its association with the length of intensive care unit (ICU) stay, is unclear. Therefore, we investigated the relationship between the duration of prone position therapy and adequacy of EN delivery and explored factors associated with this relationship in an observational study of critically ill patients with coronavirus disease 2019 (COVID-19) who were actively treated in the prone position. METHODS This study was a secondary analysis of a worldwide one-day prevalence study in the COVID-19 era. We investigated the care and nutritional therapy provided to critically ill patients with COVID-19 admitted to ICU, along with ICU-related information. We targeted patients who received only tube feeding and analyzed the relationship between the duration of prone position, length of ICU stays, and nutrition delivery via EN. In addition, a multivariate analysis was performed to examine factors affecting the achievement of EN delivery of 20 kcal/kg/day or more in patients who were placed in the prone position for at least 6 h. RESULTS A total of 399 patients who received only EN, excluding parenteral nutrition and oral intake, were included, of whom 58 % received EN energy delivery of ≥20 kcal/kg/day; this rate increased with the length of ICU stay, regardless of the duration of prone position. In a multivariate analysis of 121 patients who were in the prone position for at least 6 h, the presence of dedicated dietitians in the ICU (OR = 6.91, 95 % CI = 1.98 to 24.1, p < 0.01) was associated with a higher energy delivery. Conversely, the use of muscle relaxants (OR = 0.32, 95 % CI = 0.11 to 0.98, p = 0.04) and presence of nutrition protocols (OR = 0.24, 95 % CI = 0.07 to 0.77, p = 0.02) was associated with a lower energy delivery. CONCLUSIONS Patients with COVID-19 received adequate nutrition by EN even during prone position. Target EN delivery would be achieved with the introduction of prone position.
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Affiliation(s)
- Mio Kitayama
- Nursing Department Heart Center, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan.
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Institute for Molecular Bioscience, The University of Queensland, Australia; Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan.
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, Yokohama, Kanagawa, Japan.
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Takahashi T, Oyama Y, Sakuramoto H, Tamoto M, Sato T, Nanjo Y, Hosoi S, Unoki T. Nurses' Attitudes, Practices, and Barriers to Assessing Symptoms of Discomfort in Mechanically Ventilated Patients: A Cross-Sectional Study. SAGE Open Nurs 2024; 10:23779608241245209. [PMID: 38596509 PMCID: PMC11003335 DOI: 10.1177/23779608241245209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 02/17/2024] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Critically ill patients experience various stressful symptoms of discomfort, including dyspnea, pain, and sleep disruption. Notably, ventilated patients have difficulty self-reporting discomfort symptoms. Nurses need to assess discomfort symptoms to alleviate them, but limited research exists on discomfort symptom assessment and management in critically ill patients. Objective To identify the practices, attitudes, and barriers among nurses related to the assessment of discomfort symptoms in mechanically ventilated patients. Methods Using a cross-sectional, descriptive study design, a web-based survey was conducted between May and June 2022 with critical care nurses sampled through Japanese academic societies and social networking services. The survey contained questions relative to the above-stated objective. Descriptive statistical analysis was performed without sample size calculation because of the descriptive and exploratory nature of this study. Results There were 267 respondents to the questionnaire. The discomfort symptoms that nurses perceived as important to assess were pain (median 100 [interquartile range, IQR 90-100]), insomnia (99 [80-100]), and dyspnea (96.5 [75-100]). Most participants (89.8%) routinely assessed pain in mechanically ventilated patients using a scale; however, other discomfort symptoms were assessed by less than 40% (dyspnea [28.4%], fatigue [8.1%], thirst [13.1%], insomnia [37.3%], and anxiety [13.6%]). Two major barriers to assessing discomfort symptoms were lack of assessment culture within the intensive care unit and lack of knowledge of the relevant evaluation scales. Conclusions Nurses were aware of the importance of using scales to assess the discomfort symptoms experienced by mechanically ventilated patients. However, except for pain, most nurses did not routinely use scales to assess discomfort symptoms. Barriers to routine discomfort symptom assessment included the lack of an assessment culture and the lack of knowledge of the assessment scales. Clinicians should be educated regarding the existence of validated rating scales and develop additional rating scales utilizable for minor discomforts in mechanically ventilated patients.
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Affiliation(s)
- Tomohiko Takahashi
- Intensive Care Unit, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Yusuke Oyama
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan
| | - Mitsuhiro Tamoto
- Department of Nursing, Kyoto University Hospital, Kyoto, Kyoto, Japan
| | - Tomoo Sato
- Acute Care Nursing Division, Kobe City College of Nursing, Kobe, Hyogo, Japan
| | - Yuko Nanjo
- Department of Fundamental Nursing, Faculty of Nursing, Ishikawa Prefectural Nursing University, Kahoku, Ishikawa, Japan
| | - Sayaka Hosoi
- Department of Coronary Care Unit, Hitachi General Hospital, Ibaraki, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
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Aikawa G, Imanaka R, Sakuramoto H, Hatozaki C, Unoki T, Okamoto S. Assessment of Dyspnea in Critically Ill Patients: A Comparative Analysis of Evaluation Scales. Cureus 2024; 16:e52751. [PMID: 38389589 PMCID: PMC10881446 DOI: 10.7759/cureus.52751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Purpose This study aimed to evaluate the Respiratory Distress Observation Scale (RDOS), Intensive Care RDOS (IC-RDOS), and Mechanical Ventilation RDOS (MV-RDOS) as potential markers of dyspnea in ICU patients by describing their relationship with the Dyspnea Visual Analog Scale (D-VAS). Materials and methods A researcher and a trained nurse independently assessed ICU patients simultaneously. One researcher assessed the RDOS (IC/MV-RDOS) and the depth of sedation. An objective evaluation using the observational D-VAS was simultaneously performed by a trained nurse. Results The correlation coefficients for each scale were 0.338 for the D-VAS and RDOS, 0.239 for the IC-RDOS, and 0.237 for the MV-RDOS, indicating a low correlation. The prediction of self-reported dyspnea showed that each scale's area under the curve (AUC) as a predictor of D-VAS ≥4 was 0.79 (95% Confidence Interval [CI] 0.71-0.87) for RDOS, 0.77 (95% CI 0.68-0.84) for IC-RDOS, and 0.73 (95% CI 0.64-0.81) for MV-RDOS. Conclusions The objective rating scales RDOS, IC-RDOS, and MV-RDOS can predict subjective dyspnea to a certain extent; however, they have limitations in accurately discriminating dyspnea intensity.
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Affiliation(s)
- Gen Aikawa
- College of Nursing, Ibaraki Christian University, Hitachi, JPN
| | - Ryota Imanaka
- Department of Nursing, Kyorin University Hospital, Mitaka, JPN
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, JPN
| | - Chie Hatozaki
- Department of Nursing, University of Tsukuba Hospital, Tsukuba, JPN
| | - Takeshi Unoki
- School of Nursing, Sapporo City University, Sapporo, JPN
| | - Saiko Okamoto
- Department of Nursing, Hitachi General Hospital, Hitachi, JPN
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Inoue S, Nakanishi N, Amaya F, Fujinami Y, Hatakeyama J, Hifumi T, Iida Y, Kawakami D, Kawai Y, Kondo Y, Liu K, Nakamura K, Nishida T, Sumita H, Taito S, Takaki S, Tsuboi N, Unoki T, Yoshino Y, Nishida O. Post-intensive care syndrome: Recent advances and future directions. Acute Med Surg 2024; 11:e929. [PMID: 38385144 PMCID: PMC10879727 DOI: 10.1002/ams2.929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 12/23/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
Post-intensive care syndrome comprises physical, cognitive, and mental impairments in patients treated in an intensive care unit (ICU). It occurs either during the ICU stay or following ICU discharge and is related to the patients' long-term prognosis. The same concept also applies to pediatric patients, and it can greatly affect the mental status of family members. In the 10 years since post-intensive care syndrome was first proposed, research has greatly expanded. Here, we summarize the recent evidence on post-intensive care syndrome regarding its pathophysiology, epidemiology, assessment, risk factors, prevention, and treatments. We highlight new topics, future directions, and strategies to overcome post-intensive care syndrome among people treated in an ICU. Clinical and basic research are still needed to elucidate the mechanistic insights and to discover therapeutic targets and new interventions for post-intensive care syndrome.
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Affiliation(s)
- Shigeaki Inoue
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
| | - Nobuto Nakanishi
- Division of Disaster and Emergency Medicine, Department of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Fumimasa Amaya
- Department of Pain Management and Palliative Care MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Yoshihisa Fujinami
- Department of Emergency MedicineKakogawa Central City HospitalKakogawaJapan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care MedicineOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Toru Hifumi
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalTokyoJapan
| | - Yuki Iida
- Faculty of Physical Therapy, School of Health SciencesToyohashi Sozo UniversityToyohashiJapan
| | - Daisuke Kawakami
- Department of Intensive Care MedicineAso Iizuka HospitalFukuokaJapan
| | - Yusuke Kawai
- Department of NursingFujita Health University HospitalToyoakeJapan
| | - Yutaka Kondo
- Department of Emergency and Critical Care MedicineJuntendo University Urayasu HospitalUrayasuJapan
| | - Keibun Liu
- Critical Care Research GroupThe Prince Charles HospitalChermsideQueenslandAustralia
- Faculty of MedicineThe University of Queensland, Mayne Medical SchoolHerstonQueenslandAustralia
- Non‐Profit Organization ICU Collaboration Network (ICON)TokyoJapan
| | - Kensuke Nakamura
- Department of Critical Care MedicineYokohama City University School of MedicineYokohamaJapan
| | - Takeshi Nishida
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakaJapan
| | | | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Practice and SupportHiroshima University HospitalHiroshimaJapan
| | - Shunsuke Takaki
- Department of Critical Care MedicineYokohama City University School of MedicineYokohamaJapan
| | - Norihiko Tsuboi
- Division of Critical Care Medicine, Department of Critical Care and AnesthesiaNational Center for Child Health and DevelopmentSetagayaJapan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of NursingSapporo City UniversitySapporoJapan
- Teine Keijinkai HospitalSapporoJapan
| | - Yasuyo Yoshino
- Department of Nursing, Faculty of NursingKomazawa Women's UniversityTokyoJapan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care MedicineFujita Health University School of MedicineToyoakeJapan
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6
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Unoki T, Hayashida K, Kawai Y, Taito S, Ando M, Iida Y, Kasai F, Kawasaki T, Kozu R, Kondo Y, Saitoh M, Sakuramoto H, Sasaki N, Saura R, Nakamura K, Ouchi A, Okamoto S, Okamura M, Kuribara T, Kuriyama A, Matsuishi Y, Yamamoto N, Yoshihiro S, Yasaka T, Abe R, Iitsuka T, Inoue H, Uchiyama Y, Endo S, Okura K, Ota K, Otsuka T, Okada D, Obata K, Katayama Y, Kaneda N, Kitayama M, Kina S, Kusaba R, Kuwabara M, Sasanuma N, Takahashi M, Takayama C, Tashiro N, Tatsuno J, Tamura T, Tamoto M, Tsuchiya A, Tsutsumi Y, Nagato T, Narita C, Nawa T, Nonoyama T, Hanada M, Hirakawa K, Makino A, Masaki H, Matsuki R, Matsushima S, Matsuda W, Miyagishima S, Moromizato M, Yanagi N, Yamauchi K, Yamashita Y, Yamamoto N, Liu K, Wakabayashi Y, Watanabe S, Yonekura H, Nakanishi N, Takahashi T, Nishida O. Japanese Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients 2023 (J-ReCIP 2023). J Intensive Care 2023; 11:47. [PMID: 37932849 PMCID: PMC10629099 DOI: 10.1186/s40560-023-00697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023] Open
Abstract
Providing standardized, high-quality rehabilitation for critically ill patients is a crucial issue. In 2017, the Japanese Society of Intensive Care Medicine (JSICM) promulgated the "Evidence-Based Expert Consensus for Early Rehabilitation in the Intensive Care Unit" to advocate for the early initiation of rehabilitations in Japanese intensive care settings. Building upon this seminal work, JSICM has recently conducted a rigorous systematic review utilizing the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. This endeavor resulted in the formulation of Clinical Practice Guidelines (CPGs), designed to elucidate best practices in early ICU rehabilitation. The primary objective of this guideline is to augment clinical understanding and thereby facilitate evidence-based decision-making, ultimately contributing to the enhancement of patient outcomes in critical care settings. No previous CPGs in the world has focused specifically on rehabilitation of critically ill patients, using the GRADE approach. Multidisciplinary collaboration is extremely important in rehabilitation. Thus, the CPGs were developed by 73 members of a Guideline Development Group consisting of a working group, a systematic review group, and an academic guideline promotion group, with the Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitation in Intensive Care of the JSICM at its core. Many members contributed to the development of the guideline, including physicians and healthcare professionals with multiple and diverse specialties, as well as a person who had been patients in ICU. Based on discussions among the group members, eight important clinical areas of focus for this CPG were identified. Fourteen important clinical questions (CQs) were then developed for each area. The public was invited to comment twice, and the answers to the CQs were presented in the form of 10 GRADE recommendations and commentary on the four background questions. In addition, information for each CQ has been created as a visual clinical flow to ensure that the positioning of each CQ can be easily understood. We hope that the CPGs will be a useful tool in the rehabilitation of critically ill patients for multiple professions.
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Affiliation(s)
- Takeshi Unoki
- Department Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan.
| | - Kei Hayashida
- Department of Emergency Medicine, South Shore University Hospital, Northwell Health, Bay Shore, NY, USA
| | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, Toyoake, Japan
| | - Shunsuke Taito
- Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Morihide Ando
- Department of Pulmonary Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yuki Iida
- Faculty of Physical Therapy, School of Health Sciences, Toyohashi Sozo University, Toyohashi, Japan
| | - Fumihito Kasai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Kawasaki
- Department of Pediatric Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Japan
| | - Nobuyuki Sasaki
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ryuichi Saura
- Department of Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical and Pharmaceutical University School of Medicine, Takatsuki, Japan
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Saiko Okamoto
- Department of Nursing, Hitachi General Hospital, Hitachi, Japan
| | - Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tomoki Kuribara
- Department Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Akira Kuriyama
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yujiro Matsuishi
- School of Nursing, St. Luke's International University, Tokyo, Japan
| | - Norimasa Yamamoto
- Department of Nursing, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Shodai Yoshihiro
- Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, Japan
| | - Taisuke Yasaka
- Global Nursing Research Center, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Ryo Abe
- Department of Rehabilitation, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takahito Iitsuka
- Department of Rehabilitation, Amagasaki Daimotsu Rehabilitation Hospital, Amagasaki, Japan
| | - Hiroyasu Inoue
- Department of Rehabilitation, Showa University School of Nursing and Rehabilitation Sciences, Yokohama, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Satoshi Endo
- Rehabilitation Center, Amayama Hospital, Matsuyama, Japan
| | - Kazuki Okura
- Division of Rehabilitation, Akita University Hospital, Akita, Japan
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahisa Otsuka
- Department of Rehabilitation Medicine, Okayama University Hospital, Okayama, Japan
| | - Daisuke Okada
- Department of Rehabilitation, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kengo Obata
- Department of Rehabilitation, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Yukiko Katayama
- Department of Nursing, Sakakibara Heart Institute, Fuchu, Japan
| | - Naoki Kaneda
- Rehabilitation Division, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Mio Kitayama
- Nursing Department, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Shunsuke Kina
- Department of Rehabilitation, Nakagami Hospital, Okinawa, Japan
| | - Ryuichi Kusaba
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | | | - Naoki Sasanuma
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Japan
| | | | | | - Naonori Tashiro
- Rehabilitation Center, Showa University Hospital, Tokyo, Japan
| | - Junko Tatsuno
- Department of Nursing, Kokura Memorial Hospital, Kitakyusyu, Japan
| | - Takahiko Tamura
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Nankoku, Japan
| | - Mitsuhiro Tamoto
- Department of Nursing, Kyoto University Hospital, Kyoto, Kyoto, Japan
| | - Asuka Tsuchiya
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Yusuke Tsutsumi
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center, Mito, Japan
| | - Tadashi Nagato
- Department of Respiratory Medicine and Infectious Diseases, JCHO Tokyo Yamate Medical Center, Tokyo, Japan
| | - Chihiro Narita
- Department of Emergency Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomohiro Nawa
- Department of Pediatric Cardiology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Tadayoshi Nonoyama
- Department of Rehabilitation, University of Fukui Hospital, Fukui, Japan
| | - Masatoshi Hanada
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Kotaro Hirakawa
- Department of Rehabilitation, Sakakibara Heart Institute, Fuchu, Japan
| | - Akiko Makino
- School of Nursing, St. Luke's International University, Tokyo, Japan
| | - Hirotaka Masaki
- Department of Nursing, Nagoya University Hospital, Nagoya, Japan
| | - Ryosuke Matsuki
- Department of Rehabilitation, Kansai Electric Power Hospital, Osaka, Japan
| | | | - Wataru Matsuda
- Department of Emergency Medicine & Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku, Japan
| | - Saori Miyagishima
- Division of Rehabilitation, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Masaru Moromizato
- Department of Nursing, Chubu Tokushukai Hospital, Kitanakagusuku, Japan
| | - Naoya Yanagi
- Department of Rehabilitation, Kitasato University Medical Center, Kitamoto, Japan
| | - Kota Yamauchi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Yuhei Yamashita
- Division of Rehabilitation Medicine, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Natsuhiro Yamamoto
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
| | - Yuki Wakabayashi
- Department of Nursing, Kobe City Center General Hospital, Kobe, Japan
| | - Shinichi Watanabe
- Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, Gifu, Japan
| | - Hiroshi Yonekura
- Department of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Nobuto Nakanishi
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Fujita Health University, Toyoake, Japan
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7
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Nakanishi N, Liu K, Kawauchi A, Okamura M, Tanaka K, Katayama S, Mitani Y, Ota K, Taito S, Fudeyasu K, Masuka Y, Yoshihiro S, Utsumi S, Nishikimi M, Masuda M, Iida Y, Kawai Y, Hatakeyama J, Hifumi T, Unoki T, Kawakami D, Obata K, Katsukawa H, Sumita H, Morisawa T, Takahashi M, Tsuboi N, Kozu R, Takaki S, Haruna J, Fujinami Y, Nosaka N, Miyamoto K, Nakamura K, Kondo Y, Inoue S, Nishida O. Instruments to assess post-intensive care syndrome assessment: a scoping review and modified Delphi method study. Crit Care 2023; 27:430. [PMID: 37936249 PMCID: PMC10629074 DOI: 10.1186/s13054-023-04681-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The assessment of post-intensive care syndrome (PICS) is challenging due to the numerous types of instruments. We herein attempted to identify and propose recommendations for instruments to assess PICS in intensive care unit (ICU) survivors. METHODS We conducted a scoping review to identify PICS follow-up studies at and after hospital discharge between 2014 and 2022. Assessment instruments used more than two times were included in the modified Delphi consensus process. A modified Delphi meeting was conducted three times by the PICS committee of the Japanese Society of Intensive Care Medicine, and each score was rated as not important (score: 1-3), important, but not critical (4-6), and critical (7-9). We included instruments with ≥ 70% of respondents rating critical and ≤ 15% of respondents rating not important. RESULTS In total, 6972 records were identified in this scoping review, and 754 studies were included in the analysis. After data extraction, 107 PICS assessment instruments were identified. The modified Delphi meeting reached 20 PICS assessment instrument recommendations: (1) in the physical domain: the 6-min walk test, MRC score, and grip strength, (2) in cognition: MoCA, MMSE, and SMQ, (3) in mental health: HADS, IES-R, and PHQ-9, (4) in the activities of daily living: the Barthel Index, IADL, and FIM, (5) in quality of life: SF-36, SF-12, EQ-5D-5L, 3L, and VAS (6), in sleep and pain: PSQI and Brief Pain Inventory, respectively, and (7) in the PICS-family domain: SF-36, HADS, and IES-R. CONCLUSION Based on a scoping review and the modified Delphi method, 20 PICS assessment instruments are recommended to assess physical, cognitive, mental health, activities of daily living, quality of life, sleep, and pain in ICU survivors and their families.
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Affiliation(s)
- Nobuto Nakanishi
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki, Chuo-ward, Kobe, 650-0017, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4067, Australia
- Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, 113-0033, Japan
| | - Akira Kawauchi
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, 389-1, Asakura-Machi, Maebashi-shi, Gunma, 371-0811, Japan
| | - Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kohei Tanaka
- Department of Rehabilitation Medicine, Osaka Police Hospital, 10-31 Kitayama, Tennouji, Osaka, 543-0035, Japan
| | - Sho Katayama
- Department of Rehabilitation Medicine, Okayama University Hospital, 2-5-1 Shikata, Kitaku, Okayama, 700-8558, Japan
| | - Yuki Mitani
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Kenichi Fudeyasu
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Yuki Masuka
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shodai Yoshihiro
- Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Shu Utsumi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mamoru Masuda
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, 389-1, Asakura-Machi, Maebashi-shi, Gunma, 371-0811, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, 20-1, Matsushita, Ushikawa, Toyohashi, 440-8511, Japan
| | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Kita 11 Nishi 13, Chuo-ku, Sapporo, 060-0011, Japan
| | - Daisuke Kawakami
- Department of Intensive Care Medicine, Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan
| | - Kengo Obata
- Department of Rehabilitation, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ward, Okayama, 700-8607, Japan
| | - Hajime Katsukawa
- Department of Scientific Research, Japanese Society for Early Mobilization, 1-2-12, Kudan-kita, Chiyoda-ku, Tokyo, 102-0073, Japan
| | - Hidenori Sumita
- Clinic Sumita, 305-12, Minamiyamashinden, Ina-cho, Toyokawa, Aichi, 441-0105, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Masahiro Takahashi
- Department of Rehabilitation, Sapporo General Hospital, Kita11-Nishi13, Chuou-ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Norihiko Tsuboi
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo, 157-8535, Japan
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Shunsuke Takaki
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Junpei Haruna
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yoshihisa Fujinami
- Department of Emergency Medicine, Kakogawa Central City Hospital, 439 Kakogawacho Honmachi, Kakogawa-city, Hyogo, 675-8611, Japan
| | - Nobuyuki Nosaka
- Department of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, 279-0021, Japan
| | - Shigeaki Inoue
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki, Chuo-ward, Kobe, 650-0017, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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8
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Unoki T, Sakuramoto H, Ouchi A, Inagaki N, Kitayama M, Kawai Y, Furumaya T, Tsukada Y. Return-to-Work Prevalence Among COVID-19 Patients After Receiving Intensive Care: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e46315. [PMID: 37916253 PMCID: PMC10617249 DOI: 10.7759/cureus.46315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/03/2023] Open
Abstract
Returning to work can be a serious issue for patients who have undergone intensive care. Previous studies have reported a relatively low return-to-work prevalence among such patients. Some patients with coronavirus disease 2019 (COVID-19) experience severe pneumonia and require intensive care, including mechanical ventilation. However, little is known about the return-to-work prevalence among such patients. Therefore, we conducted a systematic review and meta-analysis of the literature describing the return-to-work prevalence among COVID-19 patients who received intensive care. The eligibility criteria were determined based on the medical condition, context, and population framework of each study, as follows: (1) full-text observational studies, (2) context: COVID-19 patients admitted to ICU, (3) condition: return-to-work prevalence after ICU discharge, and (4) population: critically ill patients who are 18 years and older. Eligible studies included randomized controlled trials (RCTs) and observational studies. Review articles, case reports, letters to the editor, and comments without data involving return-to-work prevalence were excluded. We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE, via PubMed), the Cumulated Index to Nursing and Allied Health Literature (CINAHL, via EBSCOhost), and the International Clinical Trials Registry Platform (ICTRP) databases from their inception till July 26, 2022, and updated the search on June 14, 2023. Specifically, we collected studies reporting data on the return-to-work prevalence among COVID-19 patients after receiving intensive care. Data extraction and quality assessment were performed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Prevalence Studies. Pre-developed standard forms were used for data collection, and pooled prevalence for return-to-work was calculated. Out of the 2221 available records, 42 full texts were reviewed, 20 of which were included in the qualitative synthesis. The number of return-to-work cases reported at 0-3 months, 4-6 months, and 7-12 months were three, 11, and nine, respectively. At 0-3 months, the pooled prevalence was 0.49 (three trials; n = 73; 95% CI: 0.15-0.84; I2 = 82%). At 4-6 months, the pooled prevalence was 0.57 (11 trials; n = 900; 95% CI: 0.40-0.73; I2 = 92%). Finally, at 7-12 months, the pooled prevalence was 0.64 (nine trials; n = 281; 95% CI: 0.50-0.77; I2 = 80%). However, the overall quality of the included studies was low. Based on the results, approximately one-third of COVID-19 patients did not return to work 12 months after receiving intensive care. Given the quality and limitations of the studies, a more detailed and extensive cohort study is required; also, concerned authorities should implement adequate measures in terms of providing integrated job support for this patient population.
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Affiliation(s)
- Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, JPN
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, JPN
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, JPN
| | | | - Mio Kitayama
- Department of Nursing, Kanazawa Medical University Hospital, Uchinada, JPN
| | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, Toyoake, JPN
| | - Tomomi Furumaya
- Department of Nursing, Saitama Red Cross Hospital, Saitama, JPN
| | - Yoko Tsukada
- Department of Nursing, Tokyo Medical and Dental University Hospital, Tokyo, JPN
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9
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Yoshihiro S, Taito S, Yamauchi K, Kina S, Terayama T, Tsutsumi Y, Kataoka Y, Unoki T. Follow-up focused on psychological intervention initiated after intensive care unit in adult patients and informal caregivers: a systematic review and meta-analysis. PeerJ 2023; 11:e15260. [PMID: 37312876 PMCID: PMC10259442 DOI: 10.7717/peerj.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/28/2023] [Indexed: 06/15/2023] Open
Abstract
Psychological dysfunction is one of the considerable health-related outcomes among critically-ill patients and their informal caregivers. Follow-up of intensive care unit (ICU) survivors has been conducted in a variety of different ways, with different timing after discharge, targets of interest (physical, psychological, social) and measures used. Of diverse ICU follow-up, the effects of follow-ups which focused on psychological interventions are unknown. Our research question was whether follow-up with patients and their informal caregivers after ICU discharge improved mental health compared to usual care. We published a protocol for this systematic review and meta-analysis in https://www.protocols.io/ (https://dx.doi.org/10.17504/protocols.io.bvjwn4pe). We searched PubMed, Cochrane Library, EMBASE, CINAHL and PsycInfo from their inception to May 2022. We included randomized controlled trials for follow-ups after ICU discharge and focused on psychological intervention for critically ill adult patients and their informal caregivers. We synthesized primary outcomes, including depression, post-traumatic stress disorder (PTSD), and adverse events using the random-effects method. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate the certainty of evidence. From the 10,471 records, we identified 13 studies (n = 3, 366) focusing on patients and four (n = 538) focusing on informal caregivers. ICU follow-up for patients resulted in little to no difference in the prevalence of depression (RR 0.89, 95% CI [0.59-1.34]; low-certainty evidence) and PTSD (RR 0.84, 95% CI [0.55-1.30]; low-certainty evidence) among patients; however, it increased the prevalence of depression (RR 1.58 95% CI [1.01-2.46]; very low-certainty evidence), PTSD (RR 1.36, 95% CI [0.91-2.03]; very low-certainty evidence) among informal caregivers. The evidence for the effect of ICU follow-up on adverse events among patients was insufficient. Eligible studies for informal caregivers did not define any adverse event. The effect of follow-ups after ICU discharge that focused on psychological intervention should be uncertain.
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Affiliation(s)
- Shodai Yoshihiro
- Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, Japan
| | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Kota Yamauchi
- Division of Rehabilitation, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Shunsuke Kina
- Division of Rehabilitation, Nakagami Hospital, Okinawa, Japan
| | - Takero Terayama
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Yusuke Tsutsumi
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
- Department of Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Kataoka
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
- Section of Clinical Epidemiology Section, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
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10
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Hashimoto N, Unoki T, Nagano N, Funamizu R, Sawamoto K. Prevalence, Location, and Interference With Daily Life of Chronic Pain in Long-Term Survivors After Discharge From a Tertiary Emergency Center. Cureus 2023; 15:e35382. [PMID: 36987483 PMCID: PMC10039969 DOI: 10.7759/cureus.35382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/30/2023] Open
Abstract
Background This study aimed to investigate the prevalence, location, and characteristics of new-onset chronic pain by using a new definition in long-term survivors after discharge from a tertiary emergency center. Materials and methods We conducted a single-center ambidirectional cohort study from January to May 2022. A survey of patients was conducted by postal mail two to 2.5 years after their discharge from a tertiary emergency center. We used the Brief Pain Inventory to investigate chronic pain parameters, and the painDETECT questionnaire to investigate neuropathic pain. Patient information during hospitalization was collected retrospectively from medical records. Results The survey was sent to 78 patients, 63 (81%) of whom responded and were included in the analysis. Nine of the 63 patients (14%) had new-onset chronic pain. Of these, six (67%) had chronic pain of moderate or severe intensity which interfered with daily life. The most frequent location of chronic pain was the foot/ankle (n=4, 44%). Neuropathic pain was present in four (44%) patients with new-onset chronic pain. Conclusion New-onset chronic pain may occur for up to two to 2.5 years after discharge from a tertiary emergency center, and this may interfere with daily life. Therefore, a follow-up system for chronic pain is warranted.
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Affiliation(s)
- Naoya Hashimoto
- Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, JPN
- Acute and Critical Care Nursing, Graduate School of Nursing, Sapporo City University, Sapporo, JPN
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, JPN
| | - Nozomi Nagano
- Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, JPN
- Doctoral Program, Graduate School of Nursing, Sapporo City University, Sapporo, JPN
| | - Ryota Funamizu
- Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, JPN
| | - Keigo Sawamoto
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, JPN
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11
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Sakuramoto H, Kuribara T, Ouchi A, Haruna J, Unoki T. Clinical practice competencies for standard critical care nursing: consensus statement based on a systematic review and Delphi survey. BMJ Open 2023; 13:e068734. [PMID: 36697042 PMCID: PMC9884938 DOI: 10.1136/bmjopen-2022-068734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES A clear development process and scientifically validated clinical practice competencies in standard critical care nursing (SCCN) have not yet been developed in Japan. Thus, this study aimed to develop a consensus-based set of SCCN competencies to provide a framework for critical care nursing education, training and evaluation. DESIGN Multistep, modified Delphi study (a systematic review, focus group interviews, a three-round web-based Delphi survey and an external validation process). PARTICIPANTS A systematic review of 23 studies, focus group interviews by 12 experts, a Delphi survey by 239 critical care experts (physicians, nurses and physical therapists) and an external validation by 5 experts (physicians and nurses). RESULTS A systematic review identified 685 unique competencies. The focus group interviews resulted in the addition of 3 performance indicator items, a synthesis of 2 subdomains and 10 elements. Of the 239 participants, 218 (91.2%), 209 (98.9%) and 201 (96.2%) responded in rounds 1, 2 and 3 of the Delphi survey, respectively. After round 3, 57 items were below the consensus level and were removed in the final round. External validation process feedback was received from experts after two revisions to ensure that the final competencies were valid, applicable, useful and clear. The final set of competencies was classified into 6 domains, 26 subdomains, 99 elements and 525 performance indicators. CONCLUSIONS This study found a set of SCCN competencies after a multistep, modified Delphi study. The results of this study are robust, and the competency framework can be used in multiple areas to improve clinical practice, including the assessment, training and certification of standard critical care nurses.
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Affiliation(s)
- Hideaki Sakuramoto
- Department of Critical care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan
| | - Tomoki Kuribara
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Ibaraki, Japan
| | - Junpei Haruna
- Intensive Care Unit, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
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12
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Tabah A, Elhadi M, Ballard E, Cortegiani A, Cecconi M, Unoki T, Galarza L, Rosa RG, Barbier F, Azoulay E, Laupland KB, Kai NSY, Ostermann M, Francois G, De Waele JJ, Fiest K, Spronk P, Benbenishty J, Pellegrini M, Rose L. Variation in communication and family visiting policies in intensive care within and between countries during the Covid-19 pandemic: The COVISIT international survey. J Crit Care 2022; 71:154050. [PMID: 35525226 PMCID: PMC9067300 DOI: 10.1016/j.jcrc.2022.154050] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, intensive care units (ICU) introduced restrictions to in-person family visiting to safeguard patients, healthcare personnel, and visitors. METHODS We conducted a web-based survey (March-July 2021) investigating ICU visiting practices before the pandemic, at peak COVID-19 ICU admissions, and at the time of survey response. We sought data on visiting policies and communication modes including use of virtual visiting (videoconferencing). RESULTS We obtained 667 valid responses representing ICUs in all continents. Before the pandemic, 20% (106/525) had unrestricted visiting hours; 6% (30/525) did not allow in-person visiting. At peak, 84% (558/667) did not allow in-person visiting for patients with COVID-19; 66% for patients without COVID-19. This proportion had decreased to 55% (369/667) at time of survey reporting. A government mandate to restrict hospital visiting was reported by 53% (354/646). Most ICUs (55%, 353/615) used regular telephone updates; 50% (306/667) used telephone for formal meetings and discussions regarding prognosis or end-of-life. Virtual visiting was available in 63% (418/667) at time of survey. CONCLUSIONS Highly restrictive visiting policies were introduced at the initial pandemic peaks, were subsequently liberalized, but without returning to pre-pandemic practices. Telephone became the primary communication mode in most ICUs, supplemented with virtual visits.
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Affiliation(s)
- Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health services, Queensland, Australia,Queensland University of Technology, Brisbane, Queensland, Australia,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia,Corresponding author at: Intensive Care, Redcliffe Hospital, Anzac Av, Redcliffe, 4020, Queensland, Australia
| | | | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Maurizio Cecconi
- Anaesthesia and Intensive Care Units, Humanitas Research Hospital, Milan, Italy,Humanitas University, Milan, Italy
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Laurą Galarza
- Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain
| | - Regis Goulart Rosa
- Intensive Care Unit, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Francois Barbier
- Médecine Intensive – Réanimation Hôpital de la Source - CHR Orléans, Orléans, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Groupe FAMIREA, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Kevin B. Laupland
- Queensland University of Technology, Brisbane, Queensland, Australia,Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Marlies Ostermann
- Department of Critical Care & Nephrology, King's College London, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Guy Francois
- Division of Scientific Affairs, Research, European Society of Intensive Care Medicine, Brussels, Belgium
| | - Jan J. De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium,Division of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Kirsten Fiest
- Departments of Critical Care Medicine, Community Health Sciences, Psychiatry, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Peter Spronk
- Departments of Intensive Care Medicine, Gelre Hospitals, Albert Schweitzerlaan, Apeldoorn, the Netherlands
| | | | - Mariangela Pellegrini
- Intensive Care Unit, AnOpIVA, Akademiska sjukhuset, Uppsala, Sweden,Hedenstierna Laboratory, Department of Surgical Science, Uppsala University, Uppsala, Sweden
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK,Critical Care and Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - the COVISIT contributorsRamananMahesh1234BaileyRachel5KronbergerIrmgard E.32CerovacAnis3334SliglWendy6PeršecJasminka78Lincango-NaranjoEddy35OsmanNermin91011TanasYousef12DeanYomna13AbbasAhmed Mohamed3652ElbahnasawyMohamed Gamal14ElshennawyEslam Mohamed37ElmandouhOmar38AhmedFatima Hamed39KoulentiDespoina15TsakiridisIoannis40GurjarMohan16CindryaniMarilaeta41MahmoodpoorAta424356AldawoodyHogir Imad Rasheed44ZuccaroFrancesco17IozzoPasquale57IppolitoMariachiara5859KatayamaYukiko60KuribaraTomoki61MiyazakiSatoko62NakayamaAsami63OuchiAkira64SakuramotoHideaki65TamotoMitsuhiro66YamadaToru67SerhanHashem Abdulaziz Abu45AlsakarnehSaqr Ghaleb Ghassab46KaligozhinZhannur18VidermanDmitriy19KaroutLina47HasanMohd Shahnaz20ZakariaAndee Dzulkarnaen55Ñamendys-SilvaSilvio A.21RaiLajpat48AbelloAntonio Thaddeus R.22PovoaPedro23TomescuDana2425DrozdovEvgeniy49GallegoAlberto Orejas26Jariod-FerrerUrsula M.53Nuñez-GarçiaBernardo54MohamedAhmed Mohamed Ibrahim50GeorgeAbram Raymon Moneer51JeitzinerMarie-Madlen27SaracogluKemal Tolga28IsikArda29AslanAbdullah Tarik30TorlinskiTomasz31Intensive Care Units, Caboolture and Prince Charles Hospitals, Queensland, AustraliaSchool of Medicine, University of Queensland, AustraliaThe George Institute for Global Health, Sydney, AustraliaUniversity of New South Wales, Sydney, AustraliaIntensive Care Outreach, Caboolture Hospital, Caboolture, QLD, AustraliaCritical Care Medicine and Infectious Diseases, Adjunct Appointment, School of Public Health, University of Alberta, CanadaClinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, Zagreb, CroatiaCroatian Society of Intensive Care Medicine, CroatiaMedical Statistics, Medical Research Institute, Alexandria University, EgyptUnited Nations System Staff College Intern-UNITAR, EgyptMember of the Royal Statistical Association, EgyptAlexandria University Main Hospital, EgyptAlexandria University Main Hospital, EgyptTanta University Faculty of Medicine, Egypt2nd Critical Care Department, Attikon University Hospital, Athens, GreeceDepartment of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Rae Bareli Road, Lucknow, UP 226014, IndiaMedico Chirurgo - Anestesia e Rianimazione, Responsabile U.O.S. Coordinamento Aziendale Trapianti d'Organo E Tessuti, ItalyNational Research Center for Oncology and Transplantation, Astana, KazakhstanNazarbayev University School of Medicine, National Research Oncology Center, Department of Anesthesiology and Intensive Care, Nur-Sultan, KazakhstanUMMC, Kuala Lumpur, MalaysiaDivision of Pulmonary, Anesthesia and Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoThe Medical City Clark, Mabalacat, Pampanga, PhilippinesNOVA Medical School, New University of Lisbon, PortugalAnesthesia and Intensive Care, "Carol Davila "University of Medicine and Pharmacy, RomaniaAnesthesiology & Intensive Care Dept 3, Fundeni Clinical Institute, Sos Fundeni 258 sect 2 zip, 22328, Bucharest, ROMANIAHospital Universitario Severo Ochoa, Leganés, Madrid, SpainDepartment of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Freiburgstrasse 4, 3010 Bern, SwitzerlandDepartment of Anesthesiology and Intensive Care, Health Sciences University, Kartal Dr Lutfi Kirdar City Hospital, Istanbul, TurkeyGeneral Surgery, Division of General Surgery,School of Medicine, Istanbul Medeniyet University, Kadıkoy/Istanbul, TurkeyDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, TurkeyAnaesthetics - University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, UKMedical University Innsbruck, Department of Visceral, Transplant and Thoracic Surgery, Anichstrasse 35, A-6020 Innsbruck, AustriaGeneral Hospital Tešanj, Department for Gynecology and Obstetrics, Bosnia and HerzegovinaSchool of Medicine, Department for Anatomy, University of Tuzla, Bosnia and HerzegovinaHospital Vozandes Quito, Quito, EcuadorAssiut University, EgyptKafr Elshikh University Hospital, EgyptAlexandria University Hospital, EgyptFaculty of Medicine Alkasr Alainy, Cairo University, Cairo, EgyptThird Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceICU IRD Sanglah, IndonesiaAnesthesiology, IranResearch Deputy of Faculty of Medicine, Tabriz University of Medical Sciences, IranKhanaqin General Hospital, IraqJordan Hospitals, JordanAl-Balqa’ Applied University, JordanAmerican University of Beirut Medical Center, LebanonDow University of Health Sciences Karachi, PakistanSiberian State Medical University, Tomsk, RussiaGadarif Teaching Hospital, SudanSoba University Hospital, SudanFaculty of Medicine, Assiut University, Assiut, EgyptMiguel Servet University Hospital, Zaragoza, SpainUniversity Hospital Parc Taulí de Sabadell, SpainSchool of Medical Sciences & Hospital, Universiti Sains, MalaysiaDirector of ICU Program, IranDepartment of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, ItalyDepartment of Surgical Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, ItalyDepartment of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, ItalyNursing Department, Sakakibara Memorial Hospital, Fuchu, JapanSchool of Nursing, Sapporo City University, Sapporo, JapanNursing Department, Tokai University Hospital, Isehara, JapanNursing Department, Dokkyo Medical University Hospital, Mibu, JapanCollege of Nursing, Ibaraki Christian University, Omika, JapanSchool of Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, JapanNursing Department, University of Kyoto Hospital, Kyoto, JapanNursing Department, Toho University Omori Hospital, Tokyo, Japan
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Kumagai Y, Akiyama M, Unoki T, Shinkai Y. P07-04 Contribution of Nrf2 and cystathionine gamma-lyase to environmental electrophile-mediated toxicity in mice. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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14
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Kitayama M, Unoki T, Matsuda Y, Matsuishi Y, Kawai Y, Iida Y, Teramoto M, Tatsuno J, Hamamoto M. Development and initial validation of the Japanese healthy work environment assessment tool for critical care settings. PLoS One 2022; 17:e0268124. [PMID: 35552559 PMCID: PMC9098038 DOI: 10.1371/journal.pone.0268124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
Abstract
AIM This study aims to translate the Healthy Work Environment Assessment Tool (HWE-AT) into Japanese and evaluate its validity and reliability. DESIGN AND METHODS The authors followed the guidelines for scale translation, adaptation, and validation in cross-cultural healthcare research. After translation and back-translation, a series of pilot studies were conducted to assess comprehensibility. Subsequently, an expert panel established the content validity. Content validity was calculated using the content validity index (CVI). Finally, we verified the construct validity and calculated the test-retest reliability. RESULTS The updated HWE-AT achieved sufficient comprehensibility after conducting the two pilot tests. Content validity was calculated using the scale-level CVI/average and all the items were 1.00. The content validity indices CFI and RMSEA were 0.918 and 0.082, respectively. Intraclass correlation coefficients for all dimensions ranged from 0.618 to 0.903, indicating acceptable test-retest reliability. Our findings suggest that the Japanese version of the HWE-AT has good validity and reliability.
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Affiliation(s)
- Mio Kitayama
- Nursing Department, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Takeshi Unoki
- School of Nursing, Sapporo City University, Sapporo, Japan
| | - Yui Matsuda
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, United States of America
| | | | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, Toyoake, Japan
| | - Yasuo Iida
- Division of General Education, Natural Sciences, Mathematics, Kanazawa Medical University, Uchinada, Japan
| | - Mio Teramoto
- Teachers College, Columbia University, New York, NY, United States of America
| | - Junko Tatsuno
- Nursing Department, Kokura Memorial Hospital, Kokura, Japan
| | - Miya Hamamoto
- Nursing Department, Tosei General Hospital, Seto, Japan
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15
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Shinohara F, Unoki T, Horikawa M. Relationship between no-visitation policy and the development of delirium in patients admitted to the intensive care unit. PLoS One 2022; 17:e0265082. [PMID: 35263384 PMCID: PMC8906646 DOI: 10.1371/journal.pone.0265082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 02/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Due to the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic, many hospitals imposed a no-visitation policy for visiting patients in hospitals to prevent the transmission of SARS-CoV-2 among visitors and patients. The objective of this study was to investigate the association between the no-visitation policy and delirium in intensive care unit (ICU) patients. Methods This was a single-center, before-after comparative study. Patients were admitted to a mixed medical-surgical ICU from September 6, 2019 to October 18, 2020. Because no-visitation policy was implemented on February 26, 2020, we compared patients admitted after this date (after phase) with the patients admitted before the no-visitation policy (before phase) was implemented. The primary outcome was the incidence of delirium during the ICU stay. Cox regression was used for the primary analysis and was calculated using hazard ratios (HRs) and 95% confidence intervals (CIs). Covariates were age, sex, APACHE II, dementia, emergency surgery, benzodiazepine, and mechanical ventilation use. Results Of the total 200 patients consecutively recruited, 100 were exposed to a no-visitation policy. The number of patients who developed delirium during ICU stay during the before phase and the after phase were 59 (59%) and 64 (64%), respectively (P = 0.127). The adjusted HR of no-visitation policy for the number of days until the first development of delirium during the ICU stay was 0.895 (0.613–1.306). Conclusion The no-visitation policy was not associated with the development of delirium in ICU patients.
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Affiliation(s)
- Fumihide Shinohara
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
- Intensive Care Unit, Kin-ikyo Chuo Hospital, Sapporo, Hokkaido, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
- * E-mail:
| | - Megumi Horikawa
- Intensive Care Unit, Kin-ikyo Chuo Hospital, Sapporo, Hokkaido, Japan
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16
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Tamoto M, Imai T, Aida R, Harada Y, Wakabayashi Y, Satone G, Ichoda S, Unoki T, Shintani A. Survey of Glasgow Coma Scale and
PaO
2
/
FIO
2
ratio assessment methods for the Sequential Organ Failure Assessment score in Japanese intensive care units. Acute Med Surg 2022; 9:e785. [PMID: 36176324 PMCID: PMC9480922 DOI: 10.1002/ams2.785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
Aim Accurately calculating the Sequential Organ Failure Assessment (SOFA) score is essential for medical resource allocation and decision‐making. This study surveyed Japanese intensive care units regarding their assessment of the Glasgow Coma Scale (GCS) and PaO2/FIO2 ratio, components of the SOFA score. Methods A cross‐sectional, web‐based survey was conducted among healthcare workers. The survey consisted of questions about the intensive care units where they work and questions for respondents. It was distributed to healthcare workers by e‐mail through the Japanese Society of Intensive Care Medicine mailing list and social networking service. Results Among 414 responses, we obtained 211 valid responses and 175 survey results from unique intensive care units. When assessing GCS in patients under the influence of sedatives, 45.1% (95% confidence interval, 37.6–52.8) of intensive care units assessed GCS assuming that the sedatives had no influence. For the PaO2/FIO2 ratio in the SOFA score, calculation based on the Japanese Intensive Care Patient Database definition document and mechanical ventilator settings were the most common methods in patients with oxygen masks and on extracorporeal membrane oxygenation, respectively. Approximately 60% of respondents indicated that it was difficult to assess GCS assuming that sedatives had no influence. Conclusion In patients under the influence of sedatives, approximately half of the intensive care units assessed assumed GCS. There was variation in the methods used to assess the PaO2/FIO2 ratio. Standardized assessment methods for GCS and the PaO2/FIO2 ratio are needed to obtain valid SOFA score.
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Affiliation(s)
- Mitsuhiro Tamoto
- Department of Medical Statistics, Graduate School of Medicine Osaka City University Osaka Japan
| | - Takumi Imai
- Department of Medical Statistics, Graduate School of Medicine Osaka City University Osaka Japan
| | - Rei Aida
- Department of Medical Statistics, Graduate School of Medicine Osaka City University Osaka Japan
| | - Yusuke Harada
- Department of Nursing Osaka City University Hospital Osaka Japan
| | - Yuki Wakabayashi
- Department of Nursing Kobe City Medical Center General Hospital Kobe Japan
| | - Gaku Satone
- Department of Nursing Teine Keijinkai Hospital Hokkaido Japan
| | | | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing Sapporo City University Sapporo Hokkaido Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine Osaka City University Osaka Japan
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17
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Haruna J, Unoki T, Ishikawa K, Okamura H, Kamada Y, Hashimoto N. Influence of Mutual Support on Burnout among Intensive Care Unit Healthcare Professionals. SAGE Open Nurs 2022; 8:23779608221084977. [PMID: 35284634 PMCID: PMC8915210 DOI: 10.1177/23779608221084977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Burnout among healthcare professionals in intensive care units (ICUs) is a serious issue that leads to early retirement and medication errors. Their gender, lower years of experience, and lower education have been reported as risk factors. Simultaneously, mutual support—commonly referred to as “back-up behavior,” in which staff members support each other—is critical for team performance. However, little is known about the influence of mutual support among ICU healthcare professionals on burnout. The U.S. Agency for Healthcare Research and Quality refers to mutual support as the involvement of team members in: assisting one another, providing and receiving feedback, and exerting assertive and advocacy behaviors when patient safety is threatened. Objective This study aimed to verify the hypothesis that lower mutual support among ICU healthcare professionals is associated with increased probability of burnout. Methods A web-based survey was conducted from March 4 to 20, 2021. All ICU healthcare professionals in Japan were included. An invitation was sent via the mailing list of the Japanese Society of Intensive Care Medicine and asked to mail to local communities and social network services. We measured burnout severity using the Maslach Burnout-Human Services Survey and mutual support using the TeamSTEPPS Teamwork Perceptions Questionnaire, as well as occupational background. The cutoff value for burnout was predefined and conducted logistic regression. Results We received 335 responses, all of which were analyzed. The majority of respondents were nurses (58.5%), followed by physicians (18.5%) and clinical engineers (10.1%). The burnout group scored significantly lower on mutual support than the non-burnout group. After adjusting for covariates in a logistic regression, low mutual support was an independent factor predicting a high probability of burnout. Conclusions This study suggests that it is important to focus on mutual support among ICU healthcare professionals to reduce the frequency of burnout.
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Affiliation(s)
- Junpei Haruna
- Department of Intensive Care Medicine, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
| | - Koji Ishikawa
- Department of Nursing, Hokkaido University of Science, Sapporo, Hokkaido, Japan
| | - Hideaki Okamura
- Nursing Department, NTT Medical Center Sapporo, Sapporo, Hokkaido, Japan
| | - Yoshinobu Kamada
- Department of Nursing, Kyouaikai, Tokushukai Hospital, Hakodate, Hokkaido, Japan
| | - Naoya Hashimoto
- Department of Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
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18
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Unoki T, Kametani M, Matsuura J, Toyofuku T, Konami Y, Suzuyama H, Inoue M, Horio E, Yufu T, Kodama K, Yamamuro M, Taguchi E, Sawamura T, Nakao K, Sakamoto T. Percutaneous coronary intervention on combined VA-ECMO and IMPELLA (ECPELLA) support may reduce myocardial damage in cardiogenic shock patients with STEMI who required mechanical circulatory support. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an effective therapeutic modality for patients with cardiogenic shock (CS) including STEMI. The VA-ECMO maintains end-organ perfusion, however, it significantly increases damaged left ventricular (LV) afterload. Combined treatment of VA-ECMO and a micro-axial Impella pump, ECPELLA, simultaneously provides systemic circulatory support and LV loading reduction (LV unloading). Studies in ischemic animal models displayed that LV unloading reduced myocardial size. However, it remains unknown whether LV unloading effect by ECPELLA during percutaneous coronary intervention (PCI) can reduce myocardial damage in human STEMI patients with severe cardiogenic shock.
Purpose
This study was to assess whether PCI on ECPELLA support can reduce myocardial damage in STEMI patients with severe cardiogenic shock.
Methods
Sixteen consecutive patients with STEMI and lethal CS (SCAI stage E) were enrolled. All patients suffered from cardiac arrest. Fifteen patients (94%) underwent extracorporeal cardiopulmonary resuscitation using VA-ECMO. From October 2018 to November 2019, PCI was carried out on VA-ECMO support and the mechanical circulatory support (MCS) modality during PCI was switched to ECPELLA since December 2019. There were 8 patients who underwent PCI on ECPELLA support (ECPELLA-PCI) and 8 patients who underwent PCI on single VA-ECMO support (ECMO-PCI). All patients in ECMO-PCI group were escalated to ECPELLA after PCI. Therefore, the difference between groups was timing of LV unloading, i.e., pre-PCI or post-PCI condition. We assessed total MCS flow during PCI, and peak and time course changes in CK-MB levels from days 0 to 3.
Results
There were no significant differences in age, rate of male sex, body surface area, shockable rhythm, serum lactate levels, and door to MCS time. Patients in ECPELLA-PCI had significantly longer door to recanalization time (73min in ECPELLA vs. 49min in VA-ECMO, p<0.05), and higher total MCS flow during PCI (3.1 L/min/sqM vs. 2.0 L/min/sqM, p<0.05). Peak and the area under the curves (AUC) from day 0 to day 3 of CK-MB in ECPELLA-PCI were significantly lower than ECMO-PCI group (peak CK-MB 120 vs. 524 IU/L and CK-MB AUC 143 vs. 464 IU/L*Day, respectively, p<0.05). While all patients received red blood cell (RBC) and plasma (PL) transfusions, ECPELLA-PCI required larger amount of RBC and PL transfusions (p<0.05).
Conclusion
The ECPELLA-PCI appeared to reduce myocardial damage shown by peak and AUC of CK-MB levels. Lager amount of blood transfusion is a major drawback of this treatment modality. Further studies are necessary whether ECPELLA-PCI is an effective revascularization approach for myocardial damage reduction with favorable mid- and long-term outcome in patients with STEMI with severe cardiogenic shock.
Funding Acknowledgement
Type of funding sources: None. Total MCS FLow and Ttoal MCS flow indexPeak CK-MB and CK-MB AUC
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Affiliation(s)
- T Unoki
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - M Kametani
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - J Matsuura
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - T Toyofuku
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Y Konami
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - H Suzuyama
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - M Inoue
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - E Horio
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - T Yufu
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - K Kodama
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - M Yamamuro
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - E Taguchi
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - T Sawamura
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - K Nakao
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - T Sakamoto
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
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Nakanishi N, Liu K, Kawakami D, Kawai Y, Morisawa T, Nishida T, Sumita H, Unoki T, Hifumi T, Iida Y, Katsukawa H, Nakamura K, Ohshimo S, Hatakeyama J, Inoue S, Nishida O. Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives. J Clin Med 2021; 10:3870. [PMID: 34501316 PMCID: PMC8432235 DOI: 10.3390/jcm10173870] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022] Open
Abstract
Intensive care unit survivors experience prolonged physical impairments, cognitive impairments, and mental health problems, commonly referred to as post-intensive care syndrome (PICS). Previous studies reported the prevalence, assessment, and prevention of PICS, including the ABCDEF bundle approach. Although the management of PICS has been advanced, the outbreak of coronavirus disease 2019 (COVID-19) posed an additional challenge to PICS. The prevalence of PICS after COVID-19 extensively varied with 28-87% of cases pertaining to physical impairments, 20-57% pertaining to cognitive impairments, and 6-60% pertaining to mental health problems after 1-6 months after discharge. Each component of the ABCDEF bundle is not sufficiently provided from 16% to 52% owing to the highly transmissible nature of the virus. However, new data are emerging about analgesia, sedation, delirium care, nursing care, early mobilization, nutrition, and family support. In this review, we summarize the recent data on PICS and its new challenge in PICS after COVID-19 infection.
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Affiliation(s)
- Nobuto Nakanishi
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan;
| | - Keibun Liu
- Critical Care Research Group, Faculty of Medicine, University of Queensland and The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD 4032, Australia;
| | - Daisuke Kawakami
- Department of Intensive Care Medicine, Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka 820-8505, Japan;
| | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan;
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| | - Takeshi Nishida
- Osaka General Medical Center, Division of Trauma and Surgical Critical Care, 3-1-56, Bandai-Higashi, Sumiyoshi, Osaka 558-8558, Japan;
| | - Hidenori Sumita
- Clinic Sumita, 305-12, Minamiyamashinden, Ina-cho, Toyokawa, Aichi 441-0105, Japan;
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Kita 11 Nishi 13, Chuo-ku, Sapporo 060-0011, Japan;
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan;
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, 20-1, Matsushita, Ushikawa, Toyohashi 440-8511, Japan;
| | - Hajime Katsukawa
- Department of Scientific Research, Japanese Society for Early Mobilization, 1-2-12, Kudan-kita, Chiyoda-ku, Tokyo 102-0073, Japan;
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan;
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan;
| | - Junji Hatakeyama
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan;
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan;
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan;
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Egi M, Ogura H, Yatabe T, Atagi K, Inoue S, Iba T, Kakihana Y, Kawasaki T, Kushimoto S, Kuroda Y, Kotani J, Shime N, Taniguchi T, Tsuruta R, Doi K, Doi M, Nakada TA, Nakane M, Fujishima S, Hosokawa N, Masuda Y, Matsushima A, Matsuda N, Yamakawa K, Hara Y, Sakuraya M, Ohshimo S, Aoki Y, Inada M, Umemura Y, Kawai Y, Kondo Y, Saito H, Taito S, Takeda C, Terayama T, Tohira H, Hashimoto H, Hayashida K, Hifumi T, Hirose T, Fukuda T, Fujii T, Miura S, Yasuda H, Abe T, Andoh K, Iida Y, Ishihara T, Ide K, Ito K, Ito Y, Inata Y, Utsunomiya A, Unoki T, Endo K, Ouchi A, Ozaki M, Ono S, Katsura M, Kawaguchi A, Kawamura Y, Kudo D, Kubo K, Kurahashi K, Sakuramoto H, Shimoyama A, Suzuki T, Sekine S, Sekino M, Takahashi N, Takahashi S, Takahashi H, Tagami T, Tajima G, Tatsumi H, Tani M, Tsuchiya A, Tsutsumi Y, Naito T, Nagae M, Nagasawa I, Nakamura K, Nishimura T, Nunomiya S, Norisue Y, Hashimoto S, Hasegawa D, Hatakeyama J, Hara N, Higashibeppu N, Furushima N, Furusono H, Matsuishi Y, Matsuyama T, Minematsu Y, Miyashita R, Miyatake Y, Moriyasu M, Yamada T, Yamada H, Yamamoto R, Yoshida T, Yoshida Y, Yoshimura J, Yotsumoto R, Yonekura H, Wada T, Watanabe E, Aoki M, Asai H, Abe T, Igarashi Y, Iguchi N, Ishikawa M, Ishimaru G, Isokawa S, Itakura R, Imahase H, Imura H, Irinoda T, Uehara K, Ushio N, Umegaki T, Egawa Y, Enomoto Y, Ota K, Ohchi Y, Ohno T, Ohbe H, Oka K, Okada N, Okada Y, Okano H, Okamoto J, Okuda H, Ogura T, Onodera Y, Oyama Y, Kainuma M, Kako E, Kashiura M, Kato H, Kanaya A, Kaneko T, Kanehata K, Kano KI, Kawano H, Kikutani K, Kikuchi H, Kido T, Kimura S, Koami H, Kobashi D, Saiki I, Sakai M, Sakamoto A, Sato T, Shiga Y, Shimoto M, Shimoyama S, Shoko T, Sugawara Y, Sugita A, Suzuki S, Suzuki Y, Suhara T, Sonota K, Takauji S, Takashima K, Takahashi S, Takahashi Y, Takeshita J, Tanaka Y, Tampo A, Tsunoyama T, Tetsuhara K, Tokunaga K, Tomioka Y, Tomita K, Tominaga N, Toyosaki M, Toyoda Y, Naito H, Nagata I, Nagato T, Nakamura Y, Nakamori Y, Nahara I, Naraba H, Narita C, Nishioka N, Nishimura T, Nishiyama K, Nomura T, Haga T, Hagiwara Y, Hashimoto K, Hatachi T, Hamasaki T, Hayashi T, Hayashi M, Hayamizu A, Haraguchi G, Hirano Y, Fujii R, Fujita M, Fujimura N, Funakoshi H, Horiguchi M, Maki J, Masunaga N, Matsumura Y, Mayumi T, Minami K, Miyazaki Y, Miyamoto K, Murata T, Yanai M, Yano T, Yamada K, Yamada N, Yamamoto T, Yoshihiro S, Tanaka H, Nishida O. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020). J Intensive Care 2021; 9:53. [PMID: 34433491 PMCID: PMC8384927 DOI: 10.1186/s40560-021-00555-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 02/08/2023] Open
Abstract
The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.
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Affiliation(s)
- Moritoki Egi
- Department of Surgery Related, Division of Anesthesiology, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, Japan.
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Medical School, Yamadaoka 2-15, Suita, Osaka, Japan.
| | - Tomoaki Yatabe
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuaki Atagi
- Department of Intensive Care Unit, Nara Prefectural General Medical Center, Nara, Japan
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan
| | - Yasuyuki Kakihana
- Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tatsuya Kawasaki
- Department of Pediatric Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster, and Critical Care Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Joji Kotani
- Department of Surgery Related, Division of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takumi Taniguchi
- Department of Anesthesiology and Intensive Care Medicine, Kanazawa University, Kanazawa, Japan
| | - Ryosuke Tsuruta
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Matsuyuki Doi
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masaki Nakane
- Department of Emergency and Critical Care Medicine, Yamagata University Hospital, Yamagata, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
| | - Naoto Hosokawa
- Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Japan
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Asako Matsushima
- Department of Advancing Acute Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Naoyuki Matsuda
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical College, Osaka, Japan
| | - Yoshitaka Hara
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshitaka Aoki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mai Inada
- Member of Japanese Association for Acute Medicine, Tokyo, Japan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, Toyoake, Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Hiroki Saito
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Support and Practice, Hiroshima University Hospital, Hiroshima, Japan
| | - Chikashi Takeda
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Takero Terayama
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | | | - Hideki Hashimoto
- Department of Emergency and Critical Care Medicine/Infectious Disease, Hitachi General Hospital, Hitachi, Japan
| | - Kei Hayashida
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoya Hirose
- Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan
| | - Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tomoko Fujii
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
| | - Shinya Miura
- The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Kohkichi Andoh
- Division of Anesthesiology, Division of Intensive Care, Division of Emergency and Critical Care, Sendai City Hospital, Sendai, Japan
| | - Yuki Iida
- Department of Physical Therapy, School of Health Sciences, Toyohashi Sozo University, Toyohashi, Japan
| | - Tadashi Ishihara
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Kentaro Ide
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kenta Ito
- Department of General Pediatrics, Aichi Children's Health and Medical Center, Obu, Japan
| | - Yusuke Ito
- Department of Infectious Disease, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yu Inata
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Akemi Utsunomiya
- Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Koji Endo
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Akira Ouchi
- College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Masayuki Ozaki
- Department of Emergency and Critical Care Medicine, Komaki City Hospital, Komaki, Japan
| | - Satoshi Ono
- Gastroenterological Center, Shinkuki General Hospital, Kuki, Japan
| | | | | | - Yusuke Kawamura
- Department of Rehabilitation, Showa General Hospital, Tokyo, Japan
| | - Daisuke Kudo
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenji Kubo
- Department of Emergency Medicine and Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Kiyoyasu Kurahashi
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare School of Medicine, Narita, Japan
| | | | - Akira Shimoyama
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Takeshi Suzuki
- Department of Anesthesiology, Tokai University School of Medicine, Isehara, Japan
| | - Shusuke Sekine
- Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan
| | - Motohiro Sekino
- Division of Intensive Care, Nagasaki University Hospital, Nagasaki, Japan
| | - Nozomi Takahashi
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sei Takahashi
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Hiroshi Takahashi
- Department of Cardiology, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
| | - Goro Tajima
- Nagasaki University Hospital Acute and Critical Care Center, Nagasaki, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masanori Tani
- Division of Critical Care Medicine, Saitama Children's Medical Center, Saitama, Japan
| | - Asuka Tsuchiya
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Yusuke Tsutsumi
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Takaki Naito
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaharu Nagae
- Department of Intensive Care Medicine, Kobe University Hospital, Kobe, Japan
| | | | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Tetsuro Nishimura
- Department of Traumatology and Critical Care Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shin Nunomiya
- Department of Anesthesiology and Intensive Care Medicine, Division of Intensive Care, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yasuhiro Norisue
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Satoru Hashimoto
- Department of Anesthesiology and Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daisuke Hasegawa
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Naoki Hara
- Department of Pharmacy, Yokohama Rosai Hospital, Yokohama, Japan
| | - Naoki Higashibeppu
- Department of Anesthesiology and Nutrition Support Team, Kobe City Medical Center General Hospital, Kobe City Hospital Organization, Kobe, Japan
| | - Nana Furushima
- Department of Anesthesiology, Kobe University Hospital, Kobe, Japan
| | - Hirotaka Furusono
- Department of Rehabilitation, University of Tsukuba Hospital/Exult Co., Ltd., Tsukuba, Japan
| | - Yujiro Matsuishi
- Doctoral program in Clinical Sciences. Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Minematsu
- Department of Clinical Engineering, Osaka University Hospital, Suita, Japan
| | - Ryoichi Miyashita
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuji Miyatake
- Department of Clinical Engineering, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Megumi Moriyasu
- Division of Respiratory Care and Rapid Response System, Intensive Care Center, Kitasato University Hospital, Sagamihara, Japan
| | - Toru Yamada
- Department of Nursing, Toho University Omori Medical Center, Tokyo, Japan
| | - Hiroyuki Yamada
- Department of Primary Care and Emergency Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuhei Yoshida
- Nursing Department, Osaka General Medical Center, Osaka, Japan
| | - Jumpei Yoshimura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | | | - Hiroshi Yonekura
- Department of Clinical Anesthesiology, Mie University Hospital, Tsu, Japan
| | - Takeshi Wada
- Department of Anesthesiology and Critical Care Medicine, Division of Acute and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Eizo Watanabe
- Department of Emergency and Critical Care Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Japan
| | - Takakuni Abe
- Department of Anesthesiology and Intensive Care, Oita University Hospital, Yufu, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Naoya Iguchi
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masami Ishikawa
- Department of Anesthesiology, Emergency and Critical Care Medicine, Kure Kyosai Hospital, Kure, Japan
| | - Go Ishimaru
- Department of General Internal Medicine, Soka Municipal Hospital, Soka, Japan
| | - Shutaro Isokawa
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Ryuta Itakura
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hisashi Imahase
- Department of Biomedical Ethics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Imura
- Department of Infectious Diseases, Rakuwakai Otowa Hospital, Kyoto, Japan
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | | | - Kenji Uehara
- Department of Anesthesiology, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Noritaka Ushio
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Takeshi Umegaki
- Department of Anesthesiology, Kansai Medical University, Hirakata, Japan
| | - Yuko Egawa
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshifumi Ohchi
- Department of Anesthesiology and Intensive Care, Oita University Hospital, Yufu, Japan
| | - Takanori Ohno
- Department of Emergency and Critical Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Nobunaga Okada
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yohei Okada
- Department of Primary care and Emergency medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Okano
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Jun Okamoto
- Department of ER, Hashimoto Municipal Hospital, Hashimoto, Japan
| | - Hiroshi Okuda
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Takayuki Ogura
- Tochigi prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai, Utsunomiya Hospital, Utsunomiya, Japan
| | - Yu Onodera
- Department of Anesthesiology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yuhta Oyama
- Department of Internal Medicine, Dialysis Center, Kichijoji Asahi Hospital, Tokyo, Japan
| | - Motoshi Kainuma
- Anesthesiology, Emergency Medicine, and Intensive Care Division, Inazawa Municipal Hospital, Inazawa, Japan
| | - Eisuke Kako
- Department of Anesthesiology and Intensive Care Medicine, Nagoya-City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hiromi Kato
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Akihiro Kanaya
- Department of Anesthesiology, Sendai Medical Center, Sendai, Japan
| | - Tadashi Kaneko
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Keita Kanehata
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Ken-Ichi Kano
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Hiroyuki Kawano
- Department of Gastroenterological Surgery, Onga Hospital, Fukuoka, Japan
| | - Kazuya Kikutani
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hitoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takahiro Kido
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Sho Kimura
- Division of Critical Care Medicine, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroyuki Koami
- Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, USA
| | - Daisuke Kobashi
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Iwao Saiki
- Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan
| | - Masahito Sakai
- Department of General Medicine Shintakeo Hospital, Takeo, Japan
| | - Ayaka Sakamoto
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tetsuya Sato
- Tohoku University Hospital Emergency Center, Sendai, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Center for Advanced Joint Function and Reconstructive Spine Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Manabu Shimoto
- Department of Primary care and Emergency medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinya Shimoyama
- Department of Pediatric Cardiology and Intensive Care, Gunma Children's Medical Center, Shibukawa, Japan
| | - Tomohisa Shoko
- Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Yoh Sugawara
- Department of Anesthesiology, Yokohama City University, Yokohama, Japan
| | - Atsunori Sugita
- Department of Acute Medicine, Division of Emergency and Critical Care Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Intensive Care, Okayama University Hospital, Okayama, Japan
| | - Yuji Suzuki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Suhara
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Sonota
- Department of Intensive Care Medicine, Miyagi Children's Hospital, Sendai, Japan
| | - Shuhei Takauji
- Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Kohei Takashima
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Sho Takahashi
- Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan
| | - Yoko Takahashi
- Department of General Internal Medicine, Koga General Hospital, Koga, Japan
| | - Jun Takeshita
- Department of Anesthesiology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Yuuki Tanaka
- Fukuoka Prefectural Psychiatric Center, Dazaifu Hospital, Dazaifu, Japan
| | - Akihito Tampo
- Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Taichiro Tsunoyama
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Kenichi Tetsuhara
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kentaro Tokunaga
- Department of Intensive Care Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshihiro Tomioka
- Department of Anesthesiology and Intensive Care Unit, Todachuo General Hospital, Toda, Japan
| | - Kentaro Tomita
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Tominaga
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Mitsunobu Toyosaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukitoshi Toyoda
- Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Isao Nagata
- Intensive Care Unit, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Tadashi Nagato
- Department of Respiratory Medicine, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Yoshimi Nakamura
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Yuki Nakamori
- Department of Clinical Anesthesiology, Mie University Hospital, Tsu, Japan
| | - Isao Nahara
- Department of Anesthesiology and Critical Care Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Hiromu Naraba
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Chihiro Narita
- Department of Emergency Medicine and Intensive Care Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoya Nishimura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kei Nishiyama
- Division of Emergency and Critical Care Medicine Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Taiki Haga
- Department of Pediatric Critical Care Medicine, Osaka City General Hospital, Osaka, Japan
| | - Yoshihiro Hagiwara
- Department of Emergency and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Katsuhiko Hashimoto
- Research Associate of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Takeshi Hatachi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Toshiaki Hamasaki
- Department of Emergency Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Takuya Hayashi
- Division of Critical Care Medicine, Saitama Children's Medical Center, Saitama, Japan
| | - Minoru Hayashi
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Atsuki Hayamizu
- Department of Emergency Medicine, Saitama Saiseikai Kurihashi Hospital, Kuki, Japan
| | - Go Haraguchi
- Division of Intensive Care Unit, Sakakibara Heart Institute, Tokyo, Japan
| | - Yohei Hirano
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Ryo Fujii
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Imperial Foundation Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Motoki Fujita
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Naoyuki Fujimura
- Department of Anesthesiology, St. Mary's Hospital, Our Lady of the Snow Social Medical Corporation, Kurume, Japan
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Masahito Horiguchi
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Jun Maki
- Department of Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Naohisa Masunaga
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Matsumura
- Department of Intensive Care, Chiba Emergency Medical Center, Chiba, Japan
| | - Takuya Mayumi
- Department of Internal Medicine, Kanazawa Municipal Hospital, Kanazawa, Japan
| | - Keisuke Minami
- Ishikawa Prefectual Central Hospital Emergency and Critical Care Center, Kanazawa, Japan
| | - Yuya Miyazaki
- Department of Emergency and General Internal Medicine, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Kazuyuki Miyamoto
- Department of Emergency and Disaster Medicine, Showa University, Tokyo, Japan
| | - Teppei Murata
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Machi Yanai
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takao Yano
- Department of Critical Care and Emergency Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Kohei Yamada
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Naoki Yamada
- Department of Emergency Medicine, University of Fukui Hospital, Fukui, Japan
| | - Tomonori Yamamoto
- Department of Intensive Care Unit, Nara Prefectural General Medical Center, Nara, Japan
| | - Shodai Yoshihiro
- Pharmaceutical Department, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Hiroshi Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
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21
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Sakuramoto H, Hatozaki C, Unoki T, Aikawa G, Kobayashi S, Okamoto S, Shimomura S, Kawasaki A, Fukui M. Translation, reliability, and validity of Japanese version of the Respiratory Distress Observation Scale. PLoS One 2021; 16:e0255991. [PMID: 34379672 PMCID: PMC8357131 DOI: 10.1371/journal.pone.0255991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022] Open
Abstract
Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases and is defined as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” However, Japanese intensive care units (ICUs) do not routinely screen for dyspnea, as no validated Japanese version of the Respiratory Distress Observation Scale (RDOS) is available. Therefore, we aimed to translate the English version of this questionnaire into Japanese and assess its validity and reliability. To translate the RDOS, we conducted a prospective observational study in a 12-bed ICU of a universal hospital that included 42 healthcare professionals, 10 expert panels, and 128 ventilated patients. The English version was translated into Japanese, and several cross-sectional web-based questionnaires were administered to the healthcare professionals. After completing the translation process, a validity and reliability evaluation was performed in the ventilated patients. Inter-rater reliability was evaluated using Cohen’s weighted kappa coefficient. Criterion validity was ascertained based on the correlation between RDOS and the dyspnea visual analog scale. The area under the receiver operating characteristic curve analysis was used to evaluate the ability of the RDOS to identify patients with self-reported dyspnea. The average content validity index at the scale level was 0.95. Data from the 128 patients were collected and analyzed. Cohen’s weighted kappa coefficient and the correlation coefficient between the two scales were 0.76 and 0.443 (95% confidence intervals 0.70–0.82 and 0.23–0.62), respectively. For predicting self-reported dyspnea, the area under the receiver operating characteristic curve was 0.81 (95% confidence interval 0.67–0.97). The optimal cutoff used was 1, with a sensitivity and specificity of 0.89 and 0.61, respectively. Our findings indicated that the Japanese version of the RDOS is acceptable for face validity, understandability, criterion validity, and inter-rater reliability in lightly sedated mechanically ventilated patients, indicating its clinical utility.
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Affiliation(s)
- Hideaki Sakuramoto
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Omika, Hitachi, Ibaraki, Japan
| | - Chie Hatozaki
- Intensive Care Unit, University of Tsukuba Hospital, Amakubo, Tsukuba, Ibaraki, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
| | - Gen Aikawa
- Intensive Care Unit, University of Tsukuba Hospital, Amakubo, Tsukuba, Ibaraki, Japan
| | - Shunsuke Kobayashi
- Paediatric Intensive Care Unit, University of Tsukuba Hospital, Amakubo, Tsukuba, Ibaraki, Japan
| | - Saiko Okamoto
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Omika, Hitachi, Ibaraki, Japan
| | - Shinichi Shimomura
- Intensive Care Unit, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki, Japan
| | - Ayako Kawasaki
- Department of Nursing, Hitachi General Hospital, Jonan-cho, Hitachi, Ibaraki, Japan
| | - Miwako Fukui
- Intensive Care Unit, Tsukuba Medical Centre Hospital, Amakubo, Tsukuba, Ibaraki, Japan
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22
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Unoki T, Kawai Y, Hamamoto M, Tamoto M, Miyamoto T, Sakuramoto H, Ito Y, Moro E, Tatsuno J, Nishida O. Workforce and Task Sharing of Nurses in the Japanese Intensive Care Unit-Cross-Sectional Postal Survey. Healthcare (Basel) 2021; 9:healthcare9081017. [PMID: 34442154 PMCID: PMC8394815 DOI: 10.3390/healthcare9081017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to estimate the number of nurses who independently care for patients with severe respiratory failure receiving mechanical ventilation (MV) or veno-venous extracorporeal membrane oxygenation (VV-ECMO). Additionally, the study analyzed the actual role of nurses in the treatment of patients with MV and VV-ECMO. We performed a cross-sectional study using postal questionnaire surveys. The study included 725 Japanese intensive care units (ICUs). Data were analyzed using descriptive statistics. Among the 725 ICUs, we obtained 302 responses (41.7%) and analyzed 282 responses. The median number of nurses per bed was 3.25. The median proportion of nurses who independently cared for patients with MV was 60% (IQR: 42.3–77.3). The median proportion of nurses who independently cared for patients with VV-ECMO was 46.9 (35.7–63.3%) in the ICUs that had experience with VV-ECMO use. With regard to task-sharing, 33.8% of ICUs and nurses did not facilitate weaning from MV. Nurses always titrated sedative dosage in 44.5% of ICUs. Nurse staffing might be inadequate in all ICUs, especially for the management of patients with severe respiratory failure. The proportion of competent nurses to care for severe respiratory failure in ICUs should be considered when determining the workforce of nurses.
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Affiliation(s)
- Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Kita 11 Nishi 13, Chuo-ku, Sapporo 060-0011, Japan
- Correspondence:
| | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Toyoake 470-1192, Japan;
| | - Miya Hamamoto
- Intensive Care Unit, Tosei General Hospital, 160 Nishioiwake, Seto 489-8642, Japan;
| | - Mitsuhiro Tamoto
- Intensive Care Unit, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan;
| | - Takeharu Miyamoto
- Department of Nursing, Faculty of Health Sciences, Junshin Gakuen University, 1-1-1 Chikushigaoka, Minami-ku, Fukuoka 815-1510, Japan;
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, 6-11 Omika, Hitachi 319-1295, Japan;
| | - Yumi Ito
- Department of Nursing, Faculty of Health Sciences, Kyorin University, 6-20-2 Shinkawa, Mitaka 181-8611, Japan;
| | - Etsuko Moro
- Intensive Care Unit, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke 329-0498, Japan;
| | - Junko Tatsuno
- Department of Nursing, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu 802-8555, Japan;
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake 470-1192, Japan;
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Hamamoto M, Unoki T, Tamoto M, Sakuramoto H, Kawai Y, Miyamoto T, Ito Y, Moro E, Tatsuno J, Nishida O. Survey on the actual number of nurses required for critical patients with COVID-19 in Japanese intensive care units: Preliminary report. Jpn J Nurs Sci 2021; 18:e12424. [PMID: 34085380 PMCID: PMC8237006 DOI: 10.1111/jjns.12424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/24/2021] [Accepted: 03/27/2021] [Indexed: 01/25/2023]
Abstract
Determining the number of nurses required for patients with coronavirus disease receiving mechanical ventilation and/or veno-veno extracorporeal membrane oxygenation is important to provide quality care. Therefore, we conducted this cross-sectional survey of 725 intensive care units in Japan. Data from 152 units with experience of managing patients with coronavirus disease who required tracheal intubation were analyzed. The median number of nurses required for a patient receiving mechanical ventilation or veno-veno extracorporeal membrane oxygenation was two. This number was more than that according to the Japanese standard determined by government. We conclude that more nursing staff is required for caring for patients critically ill with coronavirus disease in intensive care units.
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Affiliation(s)
- Miya Hamamoto
- Department of NursingTosei General HospitalSetoJapan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of NursingSapporo City UniversitySapporoJapan
| | | | - Hideaki Sakuramoto
- Department of Adult Health NursingCollege of Nursing, Ibaraki Christian UniversityHitachiJapan
| | - Yusuke Kawai
- Department of NursingFujita Health University HospitalToyoakeJapan
| | - Takeharu Miyamoto
- Department of Nursing, Faculty of Health SciencesJunshin Gakuen UniversityFukuokaJapan
| | - Yumi Ito
- Department of Nursing, Faculty of Health SciencesKyorin UniversityMitakaJapan
| | - Etsuko Moro
- Department of NursingJichi Medical University HospitalShimotsukeJapan
| | - Junko Tatsuno
- Department of NursingKokura Memorial HospitalKitakyusyuJapan
| | - Osamu Nishida
- Department of Anesthesiology & Critical Care MedicineFujita Health University School of MedicineToyoakeJapan
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Unoki T, Sakuramoto H, Uemura S, Tsujimoto T, Yamaguchi T, Shiba Y, Hino M, Kuribara T, Fukuda Y, Nagao T, Kitayama M, Shirasaka M, Haruna J, Satoi Y, Masuda Y. Prevalence of and risk factors for post-intensive care syndrome: Multicenter study of patients living at home after treatment in 12 Japanese intensive care units, SMAP-HoPe study. PLoS One 2021; 16:e0252167. [PMID: 34043682 PMCID: PMC8158919 DOI: 10.1371/journal.pone.0252167] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
Few studies have examined the epidemiology of post-intensive care syndrome in Japan. This study investigated the mental health and quality of life of patients living at home in Japan after intensive care unit (ICU) discharge. Additionally, we examined whether unplanned admission to the ICU was associated with more severe post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms. An ambidirectional cohort study was conducted at 12 ICUs in Japan. Patients who stayed in the ICU for > 3 nights and were living at home for 1 year afterward were included. One year after ICU discharge, we retrospectively screened patients and performed a mail survey on a monthly basis, including the Impact of Event Scale—Revised (IER-S), the Hospital Anxiety Depression Scale (HADS), and the EuroQOL—5 Dimension (EQ-5D-L) questionnaires. Patients’ characteristics, delirium and coma status, drugs used, and ICU and hospital length of stay were assessed from medical records. Descriptive statistics and multilevel linear regression modeling were used to examine our hypothesis. Among 7,030 discharged patients, 854 patients were surveyed by mail. Of these, 778 patients responded (response rate = 91.1%). The data from 754 patients were analyzed. The median IES-R score was 3 (interquartile range [IQR] = 1‒9), and the prevalence of suspected PTSD was 6.0%. The median HADS anxiety score was 4.00 (IQR = 1.17‒6.00), and the prevalence of anxiety was 16.6%. The median HADS depression score was 5 (IQR = 2‒8), and the prevalence of depression was 28.1%. EQ-5D-L scores were lower in our participants than in the sex- and age-matched Japanese population. Unplanned admission was an independent risk factor for more severe PTSD, anxiety, and depressive symptoms. Approximately one-third of patients in the general ICU population experienced mental health issues one year after ICU discharge. Unplanned admission was an independent predictor for more severe PTSD symptoms.
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Affiliation(s)
- Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
- * E-mail:
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Ibaraki, Japan
| | - Sakura Uemura
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Takahiro Tsujimoto
- Nursing Practice and Career Support Center, Nara Medical University Hospital, Kashihara City, Nara, Japan
| | - Takako Yamaguchi
- Intensive Care Unit, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Yuko Shiba
- Intensive Care Unit, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Mayumi Hino
- Intensive Care Unit, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
| | - Tomoki Kuribara
- Intensive Care Unit of Advanced Emergency Medical Service Center, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Yuko Fukuda
- Intensive Care Unit, Jichi Medical University Hospital, Yakushiji Shimotsuke-shi, Tochigi, Japan
| | - Takumi Nagao
- Intensive Care Unit, Sakakibara Heart Institute, Fuchu-shi, Tokyo, Japan
| | - Mio Kitayama
- Nursing Department Heart Center, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan
| | - Masako Shirasaka
- Intensive Care Unit & Cardiac Care Unit, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Junpei Haruna
- Intensive Care Unit, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Yosuke Satoi
- Intensive Care Unit, Naha City Hospital, Naha, Okinawa, Japan
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
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25
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Yoshino Y, Unoki T, Sakuramoto H, Ouchi A, Hoshino H, Matsuishi Y, Mizutani T. Association between intensive care unit delirium and delusional memory after critical care in mechanically ventilated patients. Nurs Open 2021; 8:1436-1443. [PMID: 33387449 PMCID: PMC8046113 DOI: 10.1002/nop2.760] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/12/2020] [Accepted: 11/16/2020] [Indexed: 01/21/2023] Open
Abstract
AIM To determine the relationship between the delirium of patients with mechanical ventilation during intensive care unit (ICU) stay and delusional memory after ICU discharge. DESIGN Prospective cohort study. METHODS Delirium in adult patients who received mechanical ventilation for more than 24 hr was assessed twice daily using the Confusion Assessment Method for the ICU. Delusional memories were evaluated using the ICU Memory Tool 5-10 days after ICU discharge. The associations between the presence of delirium during the ICU stay and delusional memories were evaluated. RESULTS Of 60 enrolled patients, 62% had delirium during their ICU stay, and 68% experienced delusional memories 5-10 days after discharge. Delirium during ICU stay was an independent factor to experience delusional memories following discharge. Preventing delirium during ICU stay might reduce delusional memory. We recommend that patients with delirium during their ICU stay should be carefully followed up after discharge from the ICU.
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Affiliation(s)
- Yasuyo Yoshino
- Kanto Gakuin University College of Nursing, Yokohama, Japan
| | - Takeshi Unoki
- Department of Adult Health Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Akira Ouchi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Haruhiko Hoshino
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yujiro Matsuishi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Egi M, Ogura H, Yatabe T, Atagi K, Inoue S, Iba T, Kakihana Y, Kawasaki T, Kushimoto S, Kuroda Y, Kotani J, Shime N, Taniguchi T, Tsuruta R, Doi K, Doi M, Nakada T, Nakane M, Fujishima S, Hosokawa N, Masuda Y, Matsushima A, Matsuda N, Yamakawa K, Hara Y, Sakuraya M, Ohshimo S, Aoki Y, Inada M, Umemura Y, Kawai Y, Kondo Y, Saito H, Taito S, Takeda C, Terayama T, Tohira H, Hashimoto H, Hayashida K, Hifumi T, Hirose T, Fukuda T, Fujii T, Miura S, Yasuda H, Abe T, Andoh K, Iida Y, Ishihara T, Ide K, Ito K, Ito Y, Inata Y, Utsunomiya A, Unoki T, Endo K, Ouchi A, Ozaki M, Ono S, Katsura M, Kawaguchi A, Kawamura Y, Kudo D, Kubo K, Kurahashi K, Sakuramoto H, Shimoyama A, Suzuki T, Sekine S, Sekino M, Takahashi N, Takahashi S, Takahashi H, Tagami T, Tajima G, Tatsumi H, Tani M, Tsuchiya A, Tsutsumi Y, Naito T, Nagae M, Nagasawa I, Nakamura K, Nishimura T, Nunomiya S, Norisue Y, Hashimoto S, Hasegawa D, Hatakeyama J, Hara N, Higashibeppu N, Furushima N, Furusono H, Matsuishi Y, Matsuyama T, Minematsu Y, Miyashita R, Miyatake Y, Moriyasu M, Yamada T, Yamada H, Yamamoto R, Yoshida T, Yoshida Y, Yoshimura J, Yotsumoto R, Yonekura H, Wada T, Watanabe E, Aoki M, Asai H, Abe T, Igarashi Y, Iguchi N, Ishikawa M, Ishimaru G, Isokawa S, Itakura R, Imahase H, Imura H, Irinoda T, Uehara K, Ushio N, Umegaki T, Egawa Y, Enomoto Y, Ota K, Ohchi Y, Ohno T, Ohbe H, Oka K, Okada N, Okada Y, Okano H, Okamoto J, Okuda H, Ogura T, Onodera Y, Oyama Y, Kainuma M, Kako E, Kashiura M, Kato H, Kanaya A, Kaneko T, Kanehata K, Kano K, Kawano H, Kikutani K, Kikuchi H, Kido T, Kimura S, Koami H, Kobashi D, Saiki I, Sakai M, Sakamoto A, Sato T, Shiga Y, Shimoto M, Shimoyama S, Shoko T, Sugawara Y, Sugita A, Suzuki S, Suzuki Y, Suhara T, Sonota K, Takauji S, Takashima K, Takahashi S, Takahashi Y, Takeshita J, Tanaka Y, Tampo A, Tsunoyama T, Tetsuhara K, Tokunaga K, Tomioka Y, Tomita K, Tominaga N, Toyosaki M, Toyoda Y, Naito H, Nagata I, Nagato T, Nakamura Y, Nakamori Y, Nahara I, Naraba H, Narita C, Nishioka N, Nishimura T, Nishiyama K, Nomura T, Haga T, Hagiwara Y, Hashimoto K, Hatachi T, Hamasaki T, Hayashi T, Hayashi M, Hayamizu A, Haraguchi G, Hirano Y, Fujii R, Fujita M, Fujimura N, Funakoshi H, Horiguchi M, Maki J, Masunaga N, Matsumura Y, Mayumi T, Minami K, Miyazaki Y, Miyamoto K, Murata T, Yanai M, Yano T, Yamada K, Yamada N, Yamamoto T, Yoshihiro S, Tanaka H, Nishida O. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020). Acute Med Surg 2021; 8:e659. [PMID: 34484801 PMCID: PMC8390911 DOI: 10.1002/ams2.659] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.
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Unoki T, Sakuramoto H, Sato R, Ouchi A, Kuribara T, Furumaya T, Tatsuno J, Wakabayashi Y, Tado A, Hashimoto N, Inagaki N, Sasaki Y. Adverse Effects of Personal Protective Equipment Among Intensive Care Unit Healthcare Professionals During the COVID-19 Pandemic: A Scoping Review. SAGE Open Nurs 2021; 7:23779608211026164. [PMID: 34212076 PMCID: PMC8216406 DOI: 10.1177/23779608211026164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/11/2021] [Accepted: 05/28/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To avoid exposure to SARS-COV-2, healthcare professionals use personal protective equipment (PPE) while treating COVID-19 patients. Prior studies have revealed the adverse effects (AEs) of PPE on healthcare workers (HCWs); however, no review has focused on the AEs of PPE on HCWs in intensive care units (ICUs). This review aimed to identify the AEs of PPE on HCWs working in ICUs during the COVID-19 pandemic. METHODS A scoping review was conducted. MEDLINE, CINAHL, the World Health Organization (WHO) global literature on COVID-19, and Igaku-chuo-zasshi (a Japanese medical database), Google Scholar, medRxiv, and Health Research Board (HRB) open research were searched from January 25-28, 2021. The extracted data included author(s) name, year of publication, country, language, article title, journal name, publication type, study methodology, population, outcome, and key findings. RESULTS The initial search identified 691 articles and abstracts. Twenty-five articles were included in the analysis. The analysis comprised four key topics: studies focusing on PPE-related headache, voice disorders, skin manifestations, and miscellaneous AEs of PPE. The majority of AEs for HCWs in ICUs were induced by prolonged use of masks. CONCLUSION The AEs of PPE among HCWs in ICUs included heat, headaches, skin injuries, chest discomfort, and dyspnea. Studies with a focus on specific diseases were on skin injuries. Moreover, many AEs were induced by prolonged use of masks.
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Affiliation(s)
- Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo City University, Sapporo, Japan
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Ryuhei Sato
- Department of Critical Care Nursing, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Tomoki Kuribara
- Department of Adult Health Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Tomomi Furumaya
- High Care Unit of Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
| | - Junko Tatsuno
- Department of Nursing, Kokura Memorial Hospital, Kitakyusyu, Japan
| | - Yuki Wakabayashi
- Department of Nursing, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Asami Tado
- Faculty of Medicine and Health Sciences, Yamaguchi University, Ube, Japan
| | - Naoya Hashimoto
- Department of Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, Japan
| | - Noriko Inagaki
- Faculty of Nursing, Setsunan University, Hirakata, Japan
| | - Yoshiko Sasaki
- Department of Disaster and Critical Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - from the Committee and working group of COVID-19 Task Force of the Japan Academy of Critical Care Nursing
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo City University, Sapporo, Japan
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
- Department of Critical Care Nursing, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Adult Health Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
- High Care Unit of Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
- Department of Nursing, Kokura Memorial Hospital, Kitakyusyu, Japan
- Department of Nursing, Kobe City Medical Center General Hospital, Kobe, Japan
- Faculty of Medicine and Health Sciences, Yamaguchi University, Ube, Japan
- Department of Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, Japan
- Faculty of Nursing, Setsunan University, Hirakata, Japan
- Department of Disaster and Critical Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Tatsuno J, Unoki T, Sakuramoto H, Hamamoto M. Effects of social support on mental health for critical care nurses during the coronavirus disease 2019 (COVID-19) pandemic in Japan: A web-based cross-sectional study. Acute Med Surg 2021; 8:e645. [PMID: 33868689 PMCID: PMC8035953 DOI: 10.1002/ams2.645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 11/12/2022] Open
Abstract
AIM The aim of this study was to examine whether high social support has a protective effect on mental health for critical care nurses during the coronavirus disease 2019 (COVID-19) pandemic. METHODS This cross-sectional anonymous web-based survey was conducted from November 5 to December 5, 2020, in Japan and included critical care nurses. The invitation was distributed via mailing lists. RESULTS Of the 334 responses that were obtained, 64.4% were from female respondents, and their mean age was 37.4. Of the total, 269 (80.5%) were taking care of COVID-19 patients at the time the study was conducted. Participants with post-traumatic stress disorder (PTSD) symptoms were found to be older (P < 0.05), and those with an education level of a 4-year college degree or higher had fewer PTSD symptoms (P < 0.05). Those experiencing anxiety and depressive symptoms had lower social support scores. Having a 4-year college degree and higher (odds ratio [OR] 0.622, 95% confidence interval [CI] 0.39-0.99) was significantly associated with a lower probability of PTSD. Social support scores and the female sex were not associated with PTSD. Regarding anxiety symptoms, being female and having lower social support were independently associated with a higher probability. Regarding depression symptoms, lower social support was independently associated with a higher probability (OR 0.953, 95% CI 0.93-0.97). CONCLUSION It was found that social support was not associated with PTSD; however, it was associated with depression and anxiety symptoms for intensive care nurses during the COVID-19 pandemic.
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Affiliation(s)
- Junko Tatsuno
- Department of NursingKokura Memorial HospitalKitakyushuFukuokaJapan
| | - Takeshi Unoki
- Department of Acute and Critical Care NursingSchool of NursingSapporo City UniversitySapporoHokkaidoJapan
| | - Hideaki Sakuramoto
- Department of Adult Health NursingCollege of NursingIbaraki Christian UniversityHitachiIbarakiJapan
| | - Miya Hamamoto
- Department of NursingTosei General HospitalSetoAichiJapan
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Unoki T, Matsuishi Y, Tsujimoto T, Yotsumoto R, Yamada T, Komatsu Y, Kashiwakura D, Yamamoto N. Translation, reliability and validity of Japanese version the TeamSTEPPS® teamwork perceptions questionnaire. Nurs Open 2021; 8:115-122. [PMID: 33318818 PMCID: PMC7729797 DOI: 10.1002/nop2.609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/27/2020] [Accepted: 07/23/2020] [Indexed: 11/10/2022] Open
Abstract
Aim This study aimed to translate the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) into Japanese and assess its validity and reliability. Design Translation of the T-TPQ and a cross-sectional survey. Methods Following a forward and back translation of the questionnaire, content validity was assessed by an expert panel using item-level content validity index. Construct validity was assessed by a confirmatory factor analysis. Further, intraclass correlation coefficient was estimated by test-retest methods. Results A total of 587 healthcare professionals responded to the translated T-TPQ. The item-level content validity index ranged between 0.8 and 1.0, indicating an acceptable content validity. The multiple fit indices showed an acceptable fitting model. Fifty-one healthcare professionals participated in the test-retest method. Intraclass correlation coefficients for all dimensions ranged from 0.838 to 0.957, indicating acceptable test-retest reliability. Our findings suggest that the Japanese version of the T-TPQ has acceptable validity and reliability.
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Affiliation(s)
- Takeshi Unoki
- Department of Adult Health NursingSchool of NursingSapporo City UniversitySapporoJapan
| | - Yujiro Matsuishi
- Pediatric Intensive Care UnitUniversity of Tsukuba HospitalTsukubaJapan
| | | | | | - Toru Yamada
- Department of NursingToho University Omori Medical CenterTokyoJapan
| | - Yuka Komatsu
- Stroke Care UnitKyorin University HospitalMitakaJapan
| | - Daisaku Kashiwakura
- Department of Adult Health NursingSchool of NursingSapporo City UniversitySapporoJapan
| | - Norimasa Yamamoto
- Master’s CourseGraduate School of NursingSapporo City UniversitySapporoJapan
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Unoki T, Tamura Y, Nakayama T, Kametani M, Minami Y, Konami Y, Suzuyama H, Inoue M, Yuhu T, Kodama K, Yamamuro M, Taguchi E, Sawamura T, Nakao K, Sakamoto T. Combined use of VA-ECMO and IMPELLA (ECPELLA) as a possible strategy to improve outcomes in patients who underwent E-CPR. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Extracorporeal Cardio-Pulmonary Resuscitation (E-CPR) is an effective tool for patients with refractory cardiac arrest (CA). Since VA-ECMO provides strong afterload, IABP is often used to increase left ventricular load. Recently, in Japan, the effectiveness of VA-ECMO in combination with IMPELLA, a forward flow mechanical circulatory support device (ECPELLA) is gaining attention.
Purpose
We investigated usefulness of ECPELLA in patients with refractory CA.
Method
We reviewed 133 patients that had E-CPR from January 2012 through January 2020 {mean age: 67±15 years, male 65%, Out of hospital Cardiac Arrest (OHCA) 35%, Acute coronary Syndrome (ACS) 54%}. We divided these patients into ECMO with IMPELLA (ECPELLA group), ECMO with IABP (IABP group) and ECMO alone (ECMO alone group). The primary endpoint is 30-day survival and good neurological prognosis defined as CPC (cerebral performance categories) 1 or 2.
Result
During the study period, of the 133 patients, there were 20 in the ECPELLA group, 78 in the IABP group, 35 in the ECMO alone group. There were no significant differences in age in all three groups. There were more males, shockable rhythm, OHCA and ACS in the ECPELLA and IABP groups compared to the ECMO alone group. But there was no significant difference between the ECPELLA and IABP groups. Compared with other groups, ECPELLA had the shortest time from cardiac arrest to ECMO placement. Regarding endpoints, the rate of 30-day survival and favorable neurological prognosis were higher in the ECPELLA group, followed by the IABP group and then the ECMO alone group. (ECPELLA: 55% vs. IABP: 23% vs. ECMO alone: 9%; P=0.0009, ECPELLA: 35% vs. IABP: 13% vs. ECMO alone: 9%; P=0.04) Next, Kaplan Meier analysis was performed to analyze 30-day all-cause mortality. The ECPELLA group had a significantly higher survival rate (P=0.01 by log-rank test). Multivariate cox proportional hazard analysis including the age, OHCA, shockable rhythm, ACS, Collapse-to-ECMO under 60 min revealed that the age (hazard ratio [HR], 1.28 (10 years increase), 95% confidence interval [CI], 1.08–1.53, P=0.004) and Collapse-to-ECMO under 60 min (HR, 0.37, 95% CI, 0.21–0.68, P=0.001) or ECPELLA (HR, 0.46, 95% CI, 0.20–0.694, P=0.03) were significantly associated with mortality.
Conclusion
ECPELLA used with E-CPR is an effective tool to improve mortality and neurologic status.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Unoki
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Y Tamura
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - T Nakayama
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - M Kametani
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Y Minami
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Y Konami
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - H Suzuyama
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - M Inoue
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - T Yuhu
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - K Kodama
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - M Yamamuro
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - E Taguchi
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - T Sawamura
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - K Nakao
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - T Sakamoto
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
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Wada H, Unoki T, Suzuki M, Matsuda M, Ajiro Y, Shinozaki T, Sakagami S, Yonezawa K, Shimizu M, Funada J, Takenaka T, Kotani K, Abe M, Akao M, Hasegawa K. Impact of glucose tolerance status on the relationship between vascular endothelial growth factor D and mortality in patients with suspected coronary artery disease: a subanalysis of the ANOX study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vascular endothelial growth factor D (VEGF-D) is a secreted glycoprotein that can act as lymphangiogenic and angiogenic growth factors through binding to its specific receptors, VEGFR-3 and VEGFR-2. VEGF-D signaling via VEGFR-3 plays an important role in lipoprotein metabolisms which may contribute to coronary artery disease (CAD). We recently reported that serum levels of VEGF-D are independently associated with mortality in patients with suspected or known CAD. However, the impact of glucose tolerance status on the relationship between VEGF-D and mortality in patients with suspected CAD is unclear.
Methods
Serum VEGF-D levels were measured in 1,717 patients with suspected CAD undergoing elective coronary angiography, enrolled in the development of novel biomarkers related to angiogenesis or oxidative stress to predict CV events (ANOX) study, and followed up for 3 years. After excluding 67 patients with no HbA1c data, 1,650 patients were divided into 3 groups according to the glucose tolerance status: diabetes (DM, n=693), prediabetes (preDM, n=541) defined as an HbA1c of 5.7 to 6.4%, and normal glucose tolerance (NGT, n=416) defined as an HbA1c of 5.6% or less. The outcomes were total death, CV death, and major adverse CV events (MACE) defined as a composite of CV death, nonfatal myocardial infarction, and nonfatal stroke.
Results
During the follow-up, 80 DM, 45 preDM, and 30 NGT patients died from any cause, 24 DM, 13 preDM, and 12 NGT died from CV disease, and 54 DM, 30 preDM, and 19 NGT developed MACE. After adjustment for established risk factors, VEGF-D levels were significantly associated with total death (hazard ratio [HR] for 1-SD increase, 1.28; 95% confidence interval [CI], 1.12–1.47), but not with CV death (HR, 1.20; 95% CI, 0.93–1.52) or MACE (HR, 1.23; 95% CI, 0.997–1.48) in DM; VEGF-D levels were not significantly associated with total death (HR, 0.97; 95% CI, 0.70–1.34), CV death (HR, 1.39; 95% CI, 0.92–2.11), or MACE (HR, 1.09; 95% CI, 0.74–1.50) in preDM; VEGF-D levels were not significantly associated with total death (HR, 1.34; 95% CI, 0.98–1.84), CV death (HR, 1.32; 95% CI, 0.78–2.13), or MACE (HR, 1.01; 95% CI, 0.66–1.46) in NGT. Even after incorporation of N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin I, and high-sensitivity C-reactive protein into a model with established risk factors, the addition of VEGF-D levels further improved the prediction of total death (P=0.040 for continuous net reclassification improvement [NRI], P=0.007 for integrated discrimination improvement [IDI]), but not that of CV death or MACE in DM, while it did not significantly improved the prediction of total death, CV death, or MACE either in preDM or in NGT.
Conclusions
The VEGF-D level was independently associated with total death in DM, but not in preDM or in NGT. The relationship between VEGF-D and total mortality may depend on the presence of DM in patients with suspected CAD.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): The ANOX study is supported by a Grant-in-Aid for Clinical Research from the National Hospital Organization.
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Affiliation(s)
- H Wada
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - T Unoki
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - M Suzuki
- National Hospital Organization Saitama Hospital, Wako, Japan
| | - M Matsuda
- National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Y Ajiro
- National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - T Shinozaki
- National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - S Sakagami
- National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - K Yonezawa
- National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - M Shimizu
- National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - J Funada
- National Hospital Organization Ehime Medical Center, Toon, Japan
| | - T Takenaka
- National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - K Kotani
- Jichi Medical University, Shimotsuke, Japan
| | - M Abe
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - M Akao
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - K Hasegawa
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Okada Y, Unoki T, Matsuishi Y, Egawa Y, Hayashida K, Inoue S. Reply to the comment. J Intensive Care 2020; 8:22. [PMID: 32191227 PMCID: PMC7068915 DOI: 10.1186/s40560-020-00438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/18/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Yohei Okada
- 1Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Syogoin Kawaramachi 54, Sakyo, Kyoto, 606-8507 Japan.,2Preventive Services, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Unoki
- 3School of Nursing, Sapporo City University, Sapporo, Japan
| | - Yujiro Matsuishi
- 4Emergency and Intensive Care Laboratory, University of Tsukuba, Ibaraki, Japan.,5Pediatric Intensive Care Unit, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yuko Egawa
- 6Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
| | - Kei Hayashida
- 7The Feinstein Institutes for Medical Research, Department of Emergency Med-Cardiopulmonary, North Shore University Hospital, Northwell Health System, New York, USA
| | - Shigeaki Inoue
- 8Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
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Ouchi A, Sakuramoto H, Unoki T, Yoshino Y, Hosino H, Koyama Y, Enomoto Y, Shimojo N, Mizutani T, Inoue Y. Effects of Manual Rib Cage Compressions on Mucus Clearance in Mechanically Ventilated Pigs. Respir Care 2020; 65:1135-1140. [PMID: 32047123 DOI: 10.4187/respcare.07249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Manual rib cage compression is a chest physiotherapy technique routinely used in clinical practice. However, scientific evidence remains scarce on the effects of manual rib cage compression on airway clearance and oxygenation in mechanically ventilated patients. METHODS Anesthetized pigs were intubated via the trachea and mechanically ventilated. To create atelectasis, artificial mucus was infused into the airway. Each pig was randomly assigned to 1 of 2 groups: closed suctioning alone (control group, 7 pigs), or manual rib cage compression combined with closed suctioning (manual rib cage compression group, 8 pigs). Hard and brief rib cage compression synchronized with early expiratory phase was tested. Mucus clearance and oxygenation were assessed after the intervention. Sequential changes of hemodynamics were assessed after the intervention. RESULTS During hard manual rib cage compression, the mean ± SD peak expiratory flow increased to 44 ± 7 L/min compared with 31 ± 7 L/min without treatment (P < .001). Manual rib cage compression combined with endotracheal suctioning increased mucus clearance compared with closed suctioning alone (mucus amounts, 5.5 [3.4-9.4] g vs 0.7 [0.5-2.0] g; P = .004); however, it did not improve gas exchange and radiologic findings. There were no significant differences in hemodynamic variables between the 2 groups. CONCLUSIONS Our findings indicated that hard and brief manual rib cage compression combined with closed suctioning was safe and led to improvement of mucus clearance; however, no effectiveness was confirmed with regard to oxygenation and ventilation.
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Affiliation(s)
- Akira Ouchi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Ibaraki, Japan
| | - Takeshi Unoki
- Department of Adult Health Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Yasuyo Yoshino
- Department of Nursing, Kanto Gakuin University College of Nursing, Yokohama, Kanagawa, Japan
| | - Haruhiko Hosino
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yasuaki Koyama
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nobutake Shimojo
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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Unoki T, Tamoto M, Ouchi A, Sakuramoto H, Nakayama A, Katayama Y, Miyazaki S, Yamada T, Fujitani S, Nishida O, Tabah A. Personal protective equipment use by health-care workers in intensive care units during the COVID-19 pandemic in Japan: comparative analysis with the PPE-SAFE survey. Acute Med Surg 2020; 7:e584. [PMID: 33042559 PMCID: PMC7537292 DOI: 10.1002/ams2.584] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/05/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022] Open
Abstract
Aim We investigated personal protective equipment (PPE) use and supply shortage, training, and adverse events among health-care workers (HCWs) in the intensive care unit (ICU) during the coronavirus disease (COVID-19) pandemic in Japan and compared the results with an international survey that used the same methodology. Methods This Web-based survey was carried out from 14 April to 6 May, 2020, in Japan and included HCWs directly involved in ICU management of COVID-19 patients. A survey invitation was emailed using the Japanese Society of Intensive Care Medicine's mailing list. Results We analyzed 460 valid responses from among 976 responses. The N95/FFP2 mask (77%) was the most frequently used, although half of our respondents reported reuse of single-use N95/FFP2 masks. The median duration (1 h) of uninterrupted PPE use per shift was less than that in the international study. The most common PPE-related adverse event was experiencing intense heat (75%). Logistic regression analysis revealed that being a nurse was independently associated with experiencing intense heat. Conclusion Shortage of PPE and frequent mask reuse were prevalent during the COVID-19 pandemic in Japan. Intense heat is the most significant symptom, especially for nurses, even with short-duration PPE use. Strategies to protect HCWs from dehydration and intense heatstroke are needed.
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Affiliation(s)
- Takeshi Unoki
- Department of Acute and Critical Care NursingSchool of NursingSapporo City UniversitySapporoJapan
| | | | - Akira Ouchi
- Department of Adult Health NursingCollege of NursingIbaraki Christian UniversityHitachiIbarakiJapan
| | - Hideaki Sakuramoto
- Department of Adult Health NursingCollege of NursingIbaraki Christian UniversityHitachiIbarakiJapan
| | - Asami Nakayama
- Department of NursingDokkyo Medical University HospitalMibuTochigiJapan
| | - Yukiko Katayama
- Department of NursingNihonkai General HospitalSakataYamagataJapan
| | - Satoko Miyazaki
- Department of NursingTokai University HospitalIseharaKanagawaJapan
| | - Toru Yamada
- Department of NursingToho University Omori Medical CenterTokyoJapan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care MedicineSt. Marianna University School of MedicineMiyamaeKanagawaJapan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care MedicineFujita Health University School of MedicineToyoakeAichiJapan
| | - Alexis Tabah
- Intensive Care UnitFaculty of MedicineRedcliffe HospitalUniversity of QueenslandBrisbaneAustralia
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Unoki T, Hamamoto M, Sakuramoto H, Shirasaka M, Moriyasu M, Zeng H, Fujitani S. Influence of mutual support and a culture of blame among staff in acute care units on the frequency of physical restraint use in patients undergoing mechanical ventilation. Acute Med Surg 2019; 7:e479. [PMID: 31988791 PMCID: PMC6971454 DOI: 10.1002/ams2.479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/28/2019] [Indexed: 11/08/2022] Open
Abstract
Aim Reducing the use of physical restraint in intensive care units is challenging, and little is known about the influence of culture on physical restraint use in this setting. The present study aims to verify the hypothesis that mutual support and a culture of blame among staff are associated with higher physical restraint use for mechanically ventilated patients. Methods We undertook a survey of nurses in intensive care units caring for mechanically ventilated patients in acute care units. The perceived frequency of physical restraint, mutual support, and culture of blame were measured. We predefined a high frequency physical restraint use group and compared the institutional characteristics, human resources, mutual support, and culture of blame between this group and the others (the control). Results Three hundred and thirty-three responses were analyzed. The mean number of beds per nurse was not significantly different between the groups; the mean and percentage of positive responses about mutual support and a culture of blame were significantly lower in the high frequency physical restraint use group. After adjusting variables in a multivariable regression analysis, a less positive response about the culture of blame was the only independent factor to predict high frequency physical restraint use. Conclusion The study suggests that changing the culture of blame, rather than increasing the number of nurses, is important for reducing physical restraint use.
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Affiliation(s)
- Takeshi Unoki
- Department of Adult Health Nursing School of Nursing Sapporo City University Sapporo Japan
| | - Miya Hamamoto
- Intensive Care Unit Tosei General Hospital Seto Japan
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing College of Nursing Ibaraki Christian University Hitachi Japan
| | - Masako Shirasaka
- Intensive Care Unit and Coronary Care Unit Japanese Red Cross Fukuoka Hospital Fukuoka Japan
| | - Megumi Moriyasu
- Department of Nursing Kitasato University Hospital Sagamihara Japan
| | - Hong Zeng
- Stroke Care Unit Junshin Hospital Hyogo Japan
| | - Shigeki Fujitani
- Emergency Medicine and Critical Care Medicine School of Medicine St. Marianna Medical University Kawasaki Japan
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Okada Y, Unoki T, Matsuishi Y, Egawa Y, Hayashida K, Inoue S. Early versus delayed mobilization for in-hospital mortality and health-related quality of life among critically ill patients: a systematic review and meta-analysis. J Intensive Care 2019; 7:57. [PMID: 31867111 PMCID: PMC6902574 DOI: 10.1186/s40560-019-0413-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/05/2019] [Indexed: 01/06/2023] Open
Abstract
Background This systematic review and meta-analysis of randomized clinical trials aimed to investigate the efficacy of early mobilization among critically ill adult patients. Methods We searched CENTRAL, MEDLINE, and Igaku-Chuo-Zasshi (a Japanese bibliographic database) databases until April 2019 and included randomized control trials to compare early mobilization started within 1 week of intensive care unit (ICU) admission and earlier-than-usual care with the usual care or mobilization initiated later than the intervention. Two authors independently extracted the data of the included studies and assessed their quality. The primary outcomes were in-hospital mortality, length of ICU/hospital stay, and health-related quality of life (QOL). Results Among 1085 titles/abstracts screened, 11 studies (including 1322 patients) were included in the meta-analysis, which was conducted using the random-effects model. The pooled relative risk for in-hospital mortality comparing early mobilization to usual care (control) was 1.12 (95% CI [confidence interval]: 0.80 to 1.58, I 2 = 0%). The pooled mean differences for duration of ICU and hospital stay were -1.54 (95% CI: -3.33 to 0.25, I 2 = 90%) and -2.86 (95% CI: -5.51 to -0.21, I 2 = 85%), respectively. The pooled mean differences at 6 months post-discharge, as measured by the Short Form 36-Item Health Survey and Euro-QOL EQ-5D, were 4.65 (95% CI: -16.13 to 25.43, I 2 = 86%) for physical functioning and 0.29 (95% CI: -11.19 to 11.78, I 2 = 66%) for the visual analog scale. Conclusions Our study indicated no apparent differences between early mobilization and usual care in terms of in-hospital mortality and health-related QOL. Detailed larger studies are warranted to evaluate the impact of early mobilization on in-hospital mortality and health-related QOL in critically ill patients. Trial registration PROSPERO (identifier CRD42019139265).
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Affiliation(s)
- Yohei Okada
- 1Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Syogoin Kawaramachi 54, Sakyo, Kyoto, 606-8507 Japan.,2Preventive Services, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Unoki
- 3School of Nursing, Sapporo City University, Sapporo, Japan
| | - Yujiro Matsuishi
- Emergency and Intensive Care Laboratory, Pediatric Intensive Care Unit, University of Tsukuba Hospital, University of Tsukuba, Ibaraki, Japan
| | - Yuko Egawa
- 5Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
| | - Kei Hayashida
- 6The Feinstein Institutes for Medical Research, Department of Emergency Med-Cardiopulmonary, North Shore University Hospital, Northwell Health System, Manhasset, USA
| | - Shigeaki Inoue
- 7Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
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Unoki T, Suzuki M, Matsuda M, Ajiro Y, Shinozaki T, Sakagami S, Yonezawa K, Shimizu M, Funada J, Takenaka T, Wada K, Abe M, Akao M, Hasegawa K, Wada H. P3639Vascular endothelial growth factor-C and mortality in patients with suspected but no history of coronary heart disease: a subanalysis of the ANOX study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The lymphatic system has been suggested to play an important role in cholesterol metabolism and cardiovascular disease. Recently, we demonstrated that serum levels of vascular endothelial growth factor-C (VEGF-C), a central player of lymphangiogenesis, are inversely and independently associated with the risk of all-cause mortality in patients with suspected or known coronary heart disease (CHD). However, the prognostic value of VEGF-C in patients with suspected but no history of CHD is still unclear.
Methods
Serum VEGF-C levels were measured in 1,717 patients with suspected but no history of CHD undergoing elective coronary angiography, enrolled in the development of novel biomarkers related to angiogenesis or oxidative stress to predict cardiovascular events (ANOX) study, and followed up for 3 years. The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, and major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.
Results
During the follow-up, 161 patients died from any cause, 50 died from cardiovascular disease, and 104 developed MACE. After adjustment for established risk factors, VEGF-C levels were significantly and inversely associated with all-cause death (hazard ratio [HR] for 1-SD increase, 0.69; 95% confidence interval [CI], 0.58–0.83) and cardiovascular death (HR, 0.72; 95% CI, 0.52–0.998), but not with MACE (HR, 0.91; 95% CI, 0.74–1.13). Even after incorporation of N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin-I, and high-sensitivity C-reactive protein into a model with established risk factors, the addition of VEGF-C levels further improved the prediction of all-cause death (continuous net reclassification improvement [NRI], 0.282; 95% CI, 0.121–0.443; P<0.001; integrated discrimination improvement [IDI], 0.009; 95% CI, 0.003–0.016; P=0.005), but not that of cardiovascular death (NRI, 0.178; 95% CI, r=−0.103–0.458; P=0.214; IDI, 0.004; 95% CI, r=−0.002–0.009; P=0.194) or MACE (NRI, 0.037; 95% CI, r=−0.162–0.235; P=0.717; IDI, 0.000; 95% CI, r=−0.0004–0.0005; P=0.872).
Conclusions
In patients with suspected but no history of CHD undergoing elective coronary angiography, a low VEGF-C value may predict all-cause mortality independent of established risk factors and cardiovascular biomarkers.
Acknowledgement/Funding
The ANOX study is supported by a Grant-in-Aid for Clinical Research from the National Hospital Organization
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Affiliation(s)
- T Unoki
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - M Suzuki
- National Hospital Organization Saitama National Hospital, Saitama, Japan
| | - M Matsuda
- National Hospital Organization Kure Medical Center, Kure, Japan
| | - Y Ajiro
- National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - T Shinozaki
- National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - S Sakagami
- National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - K Yonezawa
- National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - M Shimizu
- National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - J Funada
- National Hospital Organization Ehime Medical Center, Toon, Japan
| | - T Takenaka
- National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - K Wada
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - M Abe
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - M Akao
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - K Hasegawa
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - H Wada
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Unoki T, Suzuki M, Matsuda M, Ajiro Y, Shinozaki T, Sakagami S, Yonezawa K, Shimizu M, Funada J, Takenaka T, Morita Y, Abe M, Akao M, Hasegawa K, Wada H. 5195Growth differentiation factor-15 and mortality in suspected or known coronary heart disease patients with diabetes: a subanalysis of the ANOX study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes is a risk factor for coronary heart disease (CHD), but further risk stratification in patients with diabetes is necessary to improve the prediction and prevention of cardiovascular events and deaths. Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine, which plays an important role in the regulation of the inflammatory response, growth and cell differentiation. Elevated GDF-15 was found in various diseases including diabetes and stable CHD, and was reported to predict mortality and cardiovascular events in general or established CHD population. However, the prognostic value of GDF-15 in suspected or known CHD patients with diabetes is unknown.
Methods
Serum GDF-15 levels were measured in 1,087 suspected or known CHD patients with diabetes undergoing elective coronary angiography, enrolled in the development of novel biomarkers related to angiogenesis or oxidative stress to predict cardiovascular events (ANOX) study, and followed up for 3 years. The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, and major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.
Results
During the follow-up, 147 patients died from any cause, 47 died from cardiovascular disease, and 94 developed MACE. After adjustment for established risk factors, GDF-15 levels were significantly associated with all-cause death (hazard ratio [HR] for 1-SD increase, 1.66; 95% confidence interval [CI], 1.48–1.86), cardiovascular death (HR, 1.63; 95% CI, 1.34–1.99), and MACE (HR, 1.41; 95% CI, 1.20–1.65). Even after incorporation of N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin-I, and high-sensitivity C-reactive protein into a model with established risk factors, the addition of GDF-15 levels further improved the prediction of all-cause death (continuous net reclassification improvement [NRI], 0.344; 95% CI, 0.172–0.517; P<0.001; integrated discrimination improvement [IDI], 0.049; 95% CI, 0.026–0.072; P<0.001), but not that of cardiovascular death (NRI, −0.013; 95% CI, −0.300–0.274; P=0.931; IDI, 0.023; 95% CI, 0.003–0.043; P=0.026) or MACE (NRI, 0.059; 95% CI, −0.151–0.268; P=0.583; IDI, 0.005; 95% CI, −0.004–0.015; P=0.244).
Conclusions
In suspected or known CHD patients with diabetes undergoing elective coronary angiography, elevated GDF-15 levels may predict all-cause mortality independent of established risk factors and cardiovascular biomarkers.
Acknowledgement/Funding
The ANOX study is supported by a Grant-in-Aid for Clinical Research from the National Hospital Organization.
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Affiliation(s)
- T Unoki
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - M Suzuki
- National Hospital Organization Saitama National Hospital, Saitama, Japan
| | - M Matsuda
- National Hospital Organization Kure Medical Center, Kure, Japan
| | - Y Ajiro
- National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - T Shinozaki
- National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - S Sakagami
- National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - K Yonezawa
- National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - M Shimizu
- National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - J Funada
- National Hospital Organization Ehime Medical Center, Toon, Japan
| | - T Takenaka
- National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Y Morita
- National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - M Abe
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - M Akao
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - K Hasegawa
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - H Wada
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Inoue S, Hatakeyama J, Kondo Y, Hifumi T, Sakuramoto H, Kawasaki T, Taito S, Nakamura K, Unoki T, Kawai Y, Kenmotsu Y, Saito M, Yamakawa K, Nishida O. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg 2019; 6:233-246. [PMID: 31304024 PMCID: PMC6603316 DOI: 10.1002/ams2.415] [Citation(s) in RCA: 236] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022] Open
Abstract
Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long-term prognoses. Post-intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long-term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS-p) and the mental status of their family (PICS-F). Intensive care unit-acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow-up from the time of ICU admission to the time of discharge. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.
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Affiliation(s)
- Shigeaki Inoue
- Department of Disaster and Emergency and Critical Care Medicine Kobe University Graduate School of Medicine Kobe Hyogo Japan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine Yokohama City Minato Red Cross Hospital Yokohama Kanagawa Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan
| | - Toru Hifumi
- Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing College of Nursing Ibaraki Christian University Hitachi Japan
| | - Tatsuya Kawasaki
- Department of Pediatric Critical Care Shizuoka Children's Hospital Shizuoka Japan
| | - Shunsuke Taito
- Department of Clinical Practice and Support Division of Rehabilitation Hiroshima University Hospital Hiroshima Japan
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine Hitachi General Hospital Hitachi Ibaraki Japan
| | - Takeshi Unoki
- Department of Adult Health Nursing School of Nursing Sapporo City University Sapporo Japan
| | - Yusuke Kawai
- Department of Nursing Fujita Health University Hospital Toyoake Aichi Japan
| | - Yuji Kenmotsu
- Department of Nursing Tokai University Hachioji Hospital Hachioji Tokyo Japan
| | - Masafumi Saito
- Department of Disaster and Emergency and Critical Care Medicine Kobe University Graduate School of Medicine Kobe Hyogo Japan
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka City Osaka Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine Fujita Health University School of Medicine Toyoake Aichi Japan
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Unoki T, Sakuramoto H, Ouchi A, Fujitani S. Physical restraints in intensive care units: a national questionnaire survey of physical restraint use for critically ill patients undergoing invasive mechanical ventilation in Japan. Acute Med Surg 2018; 6:68-72. [PMID: 30652000 PMCID: PMC6328904 DOI: 10.1002/ams2.380] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/19/2018] [Indexed: 11/07/2022] Open
Abstract
Aims Physical restraints are often used for patients undergoing mechanical ventilation to protect important medical equipment. However, they have adverse physical and psychological effects and could pose ethical hazards. Physical restraint use varies by country, but so far there is little understanding of the frequency of physical restraint use among intensive care unit (ICU) patients in Japan. The present study aims to describe the frequency of physical restraint use among Japanese patients undergoing mechanical ventilation. Additionally, it attempts to verify the hypothesis that insufficient human resources have increased the frequency of physical restraints. Methods We undertook a cross-sectional online open anonymous survey of ICU nurses using a self-administered questionnaire to examine the use of physical restraints for patients undergoing invasive mechanical ventilation in Japan. Results We obtained 175 responses, of which 46 were excluded. Of the respondents, 43% reported that physical restraints were used for more than 75% of mechanically ventilated patients. Intensive care units with a higher frequency of physical restraint use had a significantly greater number of beds per nurse compared to those with a lower frequency; however, after adjusting for the number of beds in the ICU and hospital type in a logistic regression analysis, the number of beds per nurse was no longer significantly related to the use of physical restraints. Conclusions Physical restraints are commonly used among patients undergoing mechanical ventilation in Japan. A systematic approach to reducing physical restraint use among mechanically ventilated patients is needed.
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Affiliation(s)
- Takeshi Unoki
- Department of Adult Health Nursing School of Nursing Sapporo City University Sapporo Japan
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing College of Nursing Ibaraki Christian University Hitachi Japan
| | - Akira Ouchi
- Intensive Care Unit University of Tsukuba Hospital Tsukuba Japan
| | - Shigeki Fujitani
- Emergency Medicine and Critical Care Medicine School of Medicine St. Marianna Medical University Kawasaki Japan
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Unoki T, Suzuki M, Matsuda M, Ajiro Y, Shinozaki T, Sakagami S, Yonezawa K, Shimizu M, Funada J, Takenaka T, Morita Y, Abe M, Akao M, Hasegawa K, Wada H. P2520Vascular endothelial growth factor-C and mortality in patients with diabetes and suspected coronary artery disease: from the ANOX study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Unoki
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - M Suzuki
- National Hospital Organization Saitama National Hospital, Saitama, Japan
| | - M Matsuda
- National Hospital Organization Kure Medical Center, Kure, Japan
| | - Y Ajiro
- National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - T Shinozaki
- National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - S Sakagami
- National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - K Yonezawa
- National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - M Shimizu
- National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - J Funada
- National Hospital Organization Ehime Medical Center, Toon, Japan
| | - T Takenaka
- National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Y Morita
- National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - M Abe
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - M Akao
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - K Hasegawa
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - H Wada
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Kumagai Y, Unoki T, Abiko Y, Toyama T. Methylmercury activates and disrupts the Akt/CREB/Bcl-2 signal transduction pathway in SH-SY5Y cells. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.06.1874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wada M, Minamisono T, Akamatsu A, Okabe M, Morita T, Handa Y, Unoki T. Serum lipid and lipoprotein abnormalities in major clinical entities of renal disease. Contrib Nephrol 2015; 9:61-8. [PMID: 668389 DOI: 10.1159/000401433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
More than half of the patients with glomerulonephritis, nephrotic syndrome and renovascular hypertension showed obviously abnormal profiles of serum lipoproteins (Lps). The abnormal profiles returned to normal or near-normal when the disease was ameliorated or corrected surgically. A unique Lp profile (broad midband pattern, BMP) was observed in approximately 89% of uremic patients on hemodialysis therapy. The results of the current investigations indicated that the BMP could probably be formed by the accumulation of catabolic remnants of VLDL.
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Sakuramoto H, Shimojo N, Jesmin S, Unoki T, Kamiyama J, Oki M, Miya K, Kawano S, Mizutani T. Repeated open endotracheal suctioning causes gradual desaturation but does not exacerbate lung injury compared to closed endotracheal suctioning in a rabbit model of ARDS. BMC Anesthesiol 2013; 13:47. [PMID: 24308643 PMCID: PMC3878988 DOI: 10.1186/1471-2253-13-47] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 11/25/2013] [Indexed: 12/01/2022] Open
Abstract
Background Although endotracheal suctioning induces alveolar derecruitment during mechanical ventilation, it is not clear whether repeated endotracheal suctioning exacerbates lung injuries. The present study aimed to determine whether repeated open endotracheal suctioning (OS) exacerbates lung injury compared to closed endotracheal suctioning (CS) during mechanical ventilation in an animal model of acute respiratory distress syndrome (ARDS). Methods Briefly, thirty six Japanese white rabbits were initially ventilated in pressure-controlled mode with a constant tidal volume (6 mL/kg). Then, lung injury was induced by repeated saline lavage. The rabbits were divided into four groups, namely: a) OS; b) CS; c) control with ARDS only; d) and healthy control (HC) without ARDS. Animals in all the groups were then ventilated with positive end expiratory pressure (PEEP) at 10 cm H2O. CS was performed using 6 French-closed suctioning catheters connected to endotracheal tube under the following conditions: a) a suctioning time and pressure of 10 sec and 140 mm Hg, respectively; and b) a suction depth of 2 cm (length of adapter) plus tracheal tube. OS was performed using the same conditions described for CS, except the ventilator was disconnected from the animals. Each endotracheal suctioning was performed at an interval of 30 min. Results PaO2/FIO2 (P/F) ratio for CS, control and HC groups remained at >400 for 6 hours, whereas that of the OS group progressively declined to 300 (p < 0.05), with each suctioning. However, no difference was observed either in lung injury score (histology) or in the expression pattern of inflammatory cytokines (tumor necrosis factor-α and interleukin-6) after 6 hours between the OS and CS groups in the circulatory as well as the pulmonary tissues. Conclusions Progressive arterial desaturation under conditions of repeated endotracheal suctioning is greater in OS than in CS time-dependently. However, OS does not exacerbate lung injury during mechanical ventilation when observed over a longer time span (6 hours) of repeated endotracheal suctioning, based on morphological and molecular analysis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Taro Mizutani
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
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Takabayashi K, Unoki T, Ogawa H, Esato M, Chun YH, Tsuji H, Wada H, Hasegawa K, Abe M, Akao M. Clinical characteristics of atrial fibrillation patients with anemia: from the Fushimi AF registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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46
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Akao M, Ogawa H, Unoki T, Iguchi M, Abe M, Esato M, Chun YH, Tsuji H, Wada H, Hasegawa K. Clinical characteristics of patients with lone atrial fibrillation in Japan: from the Fushimi AF registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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47
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Iguchi M, Wada H, Akao M, Ura S, Masunaga N, Ishii M, Unoki T, Abe M, Shimatsu A, Hasegawa K. Soluble vascular endothelial growth factor receptor-2 serves as a predictor of cardiovascular events in patients with chronic heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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48
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Ogawa H, Unoki T, Ishii M, Esato M, Chun YH, Tsuji H, Wada H, Hasegawa K, Abe M, Akao M. Female gender was not associated with the history of thromboembolism in patients with atrial fibrillation: from the Fushimi AF registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Unoki T, Grap MJ, Sessler CN, Best AM, Wetzel P, Hamilton A, Mellott KG, Munro CL. Autonomic nervous system function and depth of sedation in adults receiving mechanical ventilation. Am J Crit Care 2009; 18:42-50; quiz 51. [PMID: 19116404 DOI: 10.4037/ajcc2009509] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The effect of the depth of sedation on the function of the autonomic nervous system is not well known. OBJECTIVES To describe the effect of level of sedation on heart rate variability as a marker of the function of the autonomic nervous system in patients receiving mechanical ventilation. METHODS This pilot study was part of a larger study in which sedation level was measured continuously for up to 24 hours. The sample consisted of 14 patients receiving mechanical ventilation. The R-R interval was measured continuously via electrocardiography. Sedation level was determined by using the Patient State Index and was categorized as deep (<60) or light (=60). Continuous heart rate data of 5 to 10 minutes for each sedation level for each patient were analyzed. RESULTS Parasympathetic activity as indicated by root mean square of successive difference of the R-R interval, the high-frequency component, and the percentage of differences of successive N-N intervals (intervals due to normal sinus depolarization) that differed more than 50 milliseconds was significantly lower for deep sedation than for light sedation. The markers indicating sympathetic activity, including the low-frequency component and the ratio of the low-frequency component to the high-frequency component, did not differ significantly between the 2 levels of sedation. Most patients were receiving benzodiazepines. CONCLUSIONS Deep sedation may be associated with depression of parasympathetic function in patients receiving mechanical ventilation. Use of benzodiazepines most likely contributed to this finding.
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Affiliation(s)
- Takeshi Unoki
- Department of Adult Nursing, School of Nursing, St Luke's College of Nursing, Tokyo, Japan.
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50
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Unoki T, Serita A, Grap MJ. Automatic tube compensation during weaning from mechanical ventilation: evidence and clinical implications. Crit Care Nurse 2008; 28:34-43. [PMID: 18669705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Takeshi Unoki
- School of Nursing at St. Luke's College of Nursing, Tokyo, Japan.
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