Yutaka Matsuura

Adequate sleep is vital for recovery in patients with critical illness, yet sleep in intensive care units (ICUs) is widely disrupted. Although various non-pharmacological strategies have been proposed, evidence remains inconsistent, and the most effective intervention for improving ICU sleep has not been clearly established. In this review, we evaluated the effectiveness of non-pharmacological interventions for sleep promotion and identified the most effective strategies for improving sleep quality among ICU patients. Studies implementing non-pharmacological sleep-promoting interventions and evaluating sleep quality in ICU patients were identified using MEDLINE and Cumulative Index to Nursing and Allied Health Literature. The protocol was registered in PROSPERO (CRD420251184156). Thirty-six studies encompassing 16 intervention types were included. A Bayesian network meta-analysis demonstrated significant improvements for aromatherapy, eye mask, eye mask and earplugs, music therapy, and multicomponent intervention compared with control groups. Surface under the cumulative ranking curves indicated that music therapy (94.9%) had the highest probability of being the most effective intervention, followed by aromatherapy (76.2%). These interventions may improve sleep by reducing environmental disturbances and stabilizing autonomic and neurotransmitter activity.

Delirium is a common complication in surgical patients following operative procedures; it often occurs in patients undergoing lower-extremity surgery. It is essential to identify and prevent the risk factors for postoperative delirium (POD) in these cases. We aimed to determine the risk factors for POD in patients who underwent lower-extremity surgery through a systematic review and meta-analysis. We included observational studies identifying risk factors for POD in patients undergoing orthopedic surgery. Data sources included the Cumulative Index to Nursing and Allied Health Literature and MEDLINE. We extracted the variables related to delirium that were analyzed by two or more studies meeting the eligibility criteria. A random-effects model was used to calculate the pooled odds ratio, standardized mean difference, and 95% confidence interval. Data were considered significant when p < 0.05. Twenty-seven studies with a total sample size of 9,044 were evaluated. Our meta-analysis revealed 20 risk factors for patients with POD undergoing orthopedic surgery, including age, cognitive scores, various preoperative laboratory values (such as serum albumin, C-reactive protein, and thyroid hormones), length of hospital stay, surgery and anesthesia duration, blood transfusion, and previous health conditions such as dementia and cardiovascular disease. Gathering preoperative and postoperative data was crucial for identifying high-risk patients for POD. In addition, preventive measures targeting POD risk factors could reduce its occurrence after orthopedic surgery.

Background: Delirium is a common complication among patients in the intensive care unit (ICU). It is important to prevent the occurrence of delirium in critically ill patients.Aim: This review aimed to evaluate the efficacy of non‐pharmacological interventions and determine what combination of these is effective in preventing delirium among Intensive Care Unit patients.Study Design: A systematic review and meta‐analysis. This review follows the guidelines of the Preferred Reporting Items for Systematic reviews and Meta Analysis statements for Network Meta‐Analysis (PRISMA‐NMA). Data sources included the Cumulative Index to Nursing & Allied Health Literature., MEDLINE, and Cochrane library databases. The integrated data were investigated with odds ratio (OR) and 95% confidence interval (95% CI), using the random‐effects Mantel–Haenszel model. Data were considered significant when p < 0.05. Furthermore, to reveal what combination of care is effective, we performed a network meta‐analysis estimated OR, 95% CI.Results: We identified three randomized controlled trials and eight controlled before‐after trials (11 in total, with 2549 participants). The pooled data from 11 trials of multicomponent intervention had a significant effect on delirium prevention (OR 0.58, 95% CI 0.44–0.76, p < 0.001). As a result of network meta‐analysis, two bundles were effective compared to the control group in reducing the incidence of delirium: a) the combination of sleep promotion (SP), cognitive stimulation (CS), early mobilization (EM), pain control (PC), and assessment (AS) (OR 0.47, 95% CI 0.35–0.64, p < 0.002), and b) the combination of SP and CS (OR 0.46, 95% CI 0.28–0.75, p < 0.001).Conclusion: This study revealed that non‐pharmacological interventions, particularly multicomponent interventions, helped to prevent delirium in critically ill patients. In the network meta‐analysis, the most effective care combination for reducing incidence of delirium was found to be multicomponent intervention, which comprises SP‐CS‐EM‐PC‐AS, and SP‐CS.Relevance to Clinical Practice: These findings reveal an efficient combination of multicomponent interventions for preventing delirium, which may be a very important prerequisite in planning care programs in the future.

It has been reported that rhythmic jaw movements (RJMs) spontaneously occur in ketamine‐anesthetized animals. The present study investigated the physiological processes that occur during the cortical, cardiac, and respiratory events which contribute to the genesis of RJMs in animals after supplemental ketamine injections. Fourteen guinea pigs were prepared to allow electroencephalographic, electrocardiographic, and electromyographic activities to be recorded from the digastric muscle, measurement of jaw movements, and nasal expiratory airflow under ketamine‐xylazine anesthesia. Rhythmic jaw movements spontaneously occurred with rhythmic digastric muscle contractions, 23–29 minutes after injection of supplemental ketamine (12.5 and 25.0 mg kg^–1, intravenously). The cycle length of RJMs did not differ significantly between the two doses of ketamine (mean±SD: 12.5 mg kg^–1, 326.5 ± 60.0 ms; 25 mg kg^–1, 278.5 ± 45.1 ms). Following injection of ketamine, digastric muscle activity, heart and respiratory rates, and cortical beta power significantly decreased, while cortical delta and theta power significantly increased. These changes were significantly larger in animals given 25.0 mg kg^–1 of ketamine than in those given 12.5 mg kg^–1. With the onset of RJMs, the levels of these variables returned to pre‐injection levels, regardless of the dose of ketamine administered. These results suggest that, following supplemental ketamine injections, spontaneous RJMs occur during a specific period when the pharmacological effects of ketamine wear off, and that these RJMs are characterized by stereotypical changes in cardiac, respiratory, and cortical activities.

Idiopathic perforation of the gallbladder without cholecystitis, tumor or injury, is extremely rare and only 25 cases of this disorder have been reported in the Japanese literature. An 80-year-old woman was admitted to the hospital because of abdominal pain. Computed tomography revealed massive ascites and swelling of the pancreatic head. She was diagnosed as having terminal stage cancer of the pancreatic head. Because of Increasing ascites volume, percutaneus abdominal drainage was carried out. Biliary ascites was drained. After improvement of her general condition, ERCP was carried out. As ERCP showed no pancreatic lesion, operation was carried out. Perforation was found in neck of the gallbladder. Cholecystectomy was carried out. No inflammatory or oncogenic lesion was observed on the surgical specimen. Histologically, no venous thrombosis was found, and cell infiltration was mild.