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.

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.

Objectives Mental health problems after discharge from the intensive care unit (ICU) interfere with physical recovery and seriously affect daily life. Social support has been suggested to be associated with mental health but has not been sufficiently characterised. This study aimed to evaluate the association of social support before ICU admission with mental health after ICU discharge. Design Prospective cohort study. Setting Medical–surgical ICU of a hospital in Japan. Participants Patients admitted to the ICU for more than 48 hours were surveyed on social support prior to ICU admission, and 3 months after discharge from the ICU, mental health questionnaires were mailed to the patient. Primary outcome measures Post-traumatic stress disorder (PTSD)-related symptoms were measured using the Impact of Event Scale-Revised, and anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale. Results A total of 153 patients were enrolled; the prevalence of PTSD-related symptoms, anxiety and depressive symptoms 3 months after discharge from the ICU was 11.3%, 14.0% and 24.6%, respectively. Multivariate analysis using linear regression models adjusted for age, sex and years of education for PTSD-related symptoms, anxiety and depressive symptoms revealed that social support (β=−0.018, 95% CI: −0.029 to 0.006, p=0.002) and female sex (β=0.268, 95% CI: 0.005 to 0.531, p=0.046) were independent factors associated with the severity of depressive symptoms. In addition, sex differences were observed in the association between depressive symptoms and social support (p for interaction=0.056). Conclusions Higher social support before ICU admission was not associated with PTSD symptoms after ICU discharge, although it may be associated with a lower prevalence depressive symptoms after ICU discharge. Therefore, it is important to provide necessary social support when needed.

Introduction: The death of a patient can cause families long-term psychological effects. Providing high-quality family conferences (FCs) and fostering an ethical climate are essential to reduce the psychological burden on patients, families, and health care professionals. Aim: To clarify the barriers and practices regarding FCs and the ethical climate in the intensive care unit (ICU) from the perspectives of intensivists and nurses. Methods: We conducted interviews based on an interview guide and analyzed the narrative data of participants using thematic analysis. Participants were intensivists and nurses working in ICUs in Japan who had experience in ICU practice and were involved in FCs. Results: Core themes of lack of communication, lack of education, climate where it is difficult to speak up, differences in opinion and thinking among intensivists and attending physicians, differences in opinion and thinking among professions and individuals, and ethical dilemma were found as barriers for physicians and nurses in FCs and the ethical climate in the ICU. For FC and ethical climate related practices of intensivists and nurses in the ICU, core themes were facilitating communication, promoting education, understanding and respect for other professions and individuals, and addressing ethical matters. Conclusions: This study enabled us to organize the barriers and practices of intensivists and nurses in FCs and the ethical climate in ICUs. These results allow us to consider interventions to build better FCs and ethical climate in ICUs, which may contribute to reducing the psychological burden on patients, families, and health care professionals.

Mental health problems after discharge from ICU interfere with physical recovery and seriously affect daily life. Social support has been suggested to be associated with mental health but has not been sufficiently characterized. This study aimed to evaluate the association of social support before ICU admission with mental health after ICU discharge. In this prospective cohort study, patients who admitted to the ICU for more than 48 h were surveyed on social support prior to ICU admission, and 3 months after discharge from the ICU, mental health questionnaires were mailed. 153 patients were enrolled; the prevalence of PTSD, anxiety, and depression, 3 months after discharge from the ICU was 11.3, 14.0, and 24.6%, respectively. Multivariate analysis using linear regression models adjusted for confounding by age, sex, and years of education for PTSD, anxiety, and depression revealed that social support women were independent factors associated with depressive symptoms. Additionally, gender differences were observed in depressive symptoms and social support associations. Social support prior to ICU admission was not associated with PTSD symptoms after ICU discharge. Higher social support before ICU admission may be associated with lower depressive symptoms after ICU discharge. It is important to provide necessary social support when needed.