Objectives: This study aimed to assess the impact of frequency of physiotherapy on activities of daily living (ADL) in mechanically ventilated patients, which was measured with Barthel index (BI) scores at hospital discharge. Methods: This was a retrospective multi-center observational study. Data were collected on two groups from January 2017 to March 2018. One group received physiotherapy 7 days a week (every-day group) and the other received physiotherapy only on weekdays (weekday group). Each participating facility used a common mobilization protocol. Results: There were 100 and 106 patients in the every-day group and weekday group, respectively. Although no statistically significant differences were observed in BI scores at hospital discharge（75 vs. 60, P=0.310）between the two groups, time of first physiotherapy session (2days vs. 3days, P<0.0001) and length of intensive care unit stay (8days vs. 10days, P=0.004) were shorter in the every-day group. Furthermore, the every-day group had a higher achievement rate for sitting on the edge of bed, and a lower incidence rate of delirium (41.0% vs. 28.3%, P<0.0001 and 24.0% vs. 45.3%, P=0.001, respectively). Results from a linear regression analysis revealed that the factor affecting BI scores was age, and the factors affecting delirium were involvement in the every-day group, age, and presence of a sedation protocol. Conclusions: There was no statistically significant differences between the two groups regarding BI scores at hospital discharge. Compared to the weekday group, the every-day group started physiotherapy earlier, had shorter length of stays in the ICU, had higher achievement rates for sitting on the edge of bed, and had lower delirium incidence rates.

A 40-year-old pregnant woman presented to our hospital with sudden onset of high-grade fever and severe abdominal pain. Her clinical course suggested haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome or placental abruption, and she underwent an emergency cesarean section. The patient’s recent medical history along with intraoperative findings suggested progressive perinatal group A streptococcal toxic shock syndrome (STSS). Empiric antimicrobial therapy, using ampicillin and clindamycin, was initiated while the surgery was still under way. She developed hemolytic anemia, acute kidney injury (AKI), and signs of concomitant thrombotic microangiopathy (TMA). Plasma exchange (PE) was initiated in the ICU. She was transferred to the ward on hospital day 7, and was discharged without any complications on hospital day 25. Immediate commencement of empiric antimicrobial therapy and intensive care management, including PE and renal replacement therapy, can help in recovering from severe STSS-induced illness.

We conducted a cross-sectional, online, open, anonymous survey among ICU/high care unit (HCU) nurses with a self-administered questionnaire to assess the implementation of the clinical practice guidelines related to pain, agitation, delirium, sleep promotion and ICU diary in Japan. We obtained 227 responses. Although 66.1% of the ICU/HCUs had implemented written target sedation goals, the goals reassessed on daily basis were only 22.9%. Routine use of a validated pain and delirium assessment tool for patients was reported in 75.7% and 86.3%. The use of an ICU diary was not common (22.5%). Recommended strategies, such as routinely reassessing the target sedation goals and using an ICU diary, were partially implemented. The results of this survey indicated that further efforts were required to meet the national standards.