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 :To examine whether nurse practitioner (NP) integration into critical care teams is associated with lower intensive care unit (ICU) mortality in Japan.Methods :We conducted a multicenter retrospective cohort study of patients aged ≥15 years admitted to ICUs between April 1, 2023 and March 31, 2024. The exposure was admission to an ICU with sustained NP-integrated care. The primary outcome was ICU mortality, and secondary outcomes were ICU readmission, hospital mortality, and cumulative incidence of hospital discharge. Analytic restrictions were applied when structural non-overlap in hospital-level characteristics was identified across ICUs with and without NP integration. Propensity scores were then estimated using covariates; overlap weighting was applied to estimate average treatment effect in the overlap population (ATO). ATO-weighted odds ratios (ORs) were estimated using weighted mixed-effects logistic regression models. Finally, risk differences (RDs) and risk ratios (RRs) were estimated.Results :The analytic cohort included 5,902 patients admitted to 12 ICUs in non-academic, non-tertiary emergency hospitals (251–499 beds). Of these, 1,536 patients (26.0%) were admitted to ICUs with NP integration. NP integration was associated with lower ICU mortality (ATO-weighted OR, 0.42; 95% confidence interval [CI], 0.24–0.72), with marginal effects (RD, −0.03; 95% CI, −0.05 to −0.01; RR, 0.43; 95% CI, 0.25–0.73). NP integration was also associated with lower ICU readmission (ATO-weighted OR, 0.36; 95% CI, 0.20–0.64). No significant associations were observed for hospital mortality (ATO-weighted OR, 0.60; 95% CI, 0.28–1.31) or cumulative incidence of hospital discharge (subdistribution hazard ratio, 1.20; 95% CI, 0.83–1.72).Conclusions :NP integration into critical care teams was associated with lower ICU mortality and readmission.

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. We conducted a single-center ambidirectional cohort study from January to May 2022. A survey of patients was conducted by postal mail 2-2.5 years since 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. 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 ankle/foot (n=4, 44%). Neuropathic pain was present in four (44%) patients with new-onset chronic pain. New-onset chronic pain may occur for up to 2-2.5 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.