Virtual reality as a novel therapy to prevent post operative derilium in intensive care unit

• Project/Area Number: 20K17858
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 55060:Emergency medicine-related
• Research Institution: Mie University
• Principal Investigator: 江角 亮 三重大学, 医学部附属病院, リサーチアソシエイト (50813028)
• Project Period (FY): 2020-04-01 – 2024-03-31
• Project Status: Granted (Fiscal Year 2022)
• Budget Amount: ¥4,290,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥990,000); Fiscal Year 2022: ¥390,000 (Direct Cost: ¥300,000、Indirect Cost: ¥90,000); Fiscal Year 2021: ¥2,080,000 (Direct Cost: ¥1,600,000、Indirect Cost: ¥480,000); Fiscal Year 2020: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000)
• Keywords: Virtual Reality / ICUせん妄 / 外傷 / 仮想現実感 / 鎮痛 / 睡眠障害 / clock gene / ICDSC / バーチャルリアリティ / せん妄 / バーチャルリアリティと教育 / 術後ICUせん妄 / PICS / 認知機能

Outline of Research at the Start

手術後に患者がICUへ入室すると、環境変化、睡眠サイクルの乱れが引き起こされ、術後せん妄発生率が上昇する。いったんせん妄を発症すると患者の死亡率の上昇など予後悪化につながる。　　本研究では、ICUで行える環境改善の現実的限界を、没入型VRの強力な仮想現実感で乗り越えることを目指す。
VRのストレス軽減効果が、術後ICU患者で認める睡眠障害（量と質の低下）を改善し、術後せん妄の発症を予防することを臨床研究で検証することを目的とする。

Outline of Annual Research Achievements

ICUに入室する患者の32.3％は、入室中に原疾患とその治療の影響でICUせん妄に苦しんでいるといわれる。ひとたび，せん妄が起きるとICU滞在時間も延長して死亡率も上昇する。しかしながらICUせん妄の予防や治療方法は確立していない。
仮想現実（VR：Virtual Reality）技術は、患者へのリラックス効果3)やICUでの痛み、睡眠導入効果に有用とされ臨床応用されはじめているが、ICUせん妄への効果はほとんど明らかではない。本研究では外傷後にICUに入室する患者を対象に、VRをもちいてICUせん妄発症を予防できるか検証する。
結果１：ICU入室患者を対象に、VRを用いることで外傷患者の痛みを軽減することが可能であった。
結果２：また、VR前後の心拍変動解析を行い、VRにより副交感神経を活性化し、リラックス効果を誘導した。以上より、鎮痛作用と副交感神経活性作用によりICUせん妄予防効果が得られると予想された。コロナ禍の影響もありまだ症例数が少ないため、ICUせん妄発生率の改善効果はまだ証明できていないが、今後症例数を増やして検証する。

Current Status of Research Progress

4: Progress in research has been delayed.

Reason

COVID-19患者受け入れに伴う集中治療室の及び救急患者の入室制限により思ったより外傷患者の受け入れ数が少ないため、研究が遅れている。今後コロナ禍解消に伴い外傷患者の受け入れが増えることでプライマリーアウトカムの評価が可能になると考える。

Strategy for Future Research Activity

VRの治療効果は鎮痛作用と副交感神経活性化作用の2つがあると予想している。そのため、ICUせん妄発生率をプライマリーアウトカム、セカンダリーアウトカムを鎮痛作用と副交感神経活性化作用にして解析を進めていく。

Research Products

• [Journal Article] Continuous High Positive-End Expiratory Pressure May Worsen Renal Function in Patients With Acute Respiratory Distress Syndrome: Retrospective Analyses of a Nationwide, Multicenter Observational Study in Japan (2023)
  • Author(s): Yokoyama Kazuto、Kaneko Tadashi、Ieki Yohei、Ito Asami、Kawamoto Eiji、Suzuki Kei、Ishikura Ken、Imai Hiroshi
  • Journal Title: Cureus Volume: 15 Pages: 35233-35233
  • DOI: 10.7759/cureus.35233
  • Peer Reviewed / Open Access
• [Journal Article] MicroRNA Profiles in Intestinal Epithelial Cells in a Mouse Model of Sepsis (2023)
  • Author(s): Caidengbate Siqingaowa、Akama Yuichi、Banerjee Anik、Mokmued Khwanchanok、Kawamoto Eiji、Gaowa Arong、McCullough Louise D.、Shimaoka Motomu、Lee Juneyoung、Park Eun Jeong
  • Journal Title: Cells Volume: 12 Issue: 5 Pages: 726-726
  • DOI: 10.3390/cells12050726
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Esophageal Perforation Accompanying Mediastinitis in Blunt Trauma in a Patient with Thoracic Osteophytes (2022)
  • Author(s): Suzuki Kei、Yoshida Haruna、Esumi Ryo、Ieki Yohei、Yamamoto Akira、Ohi Masaki、Kaneko Tadashi、Imai Hiroshi
  • Journal Title: Internal Medicine Volume: 61 Issue: 17 Pages: 2601-2605
  • DOI: 10.2169/internalmedicine.8930-21
  • NAID: 130008158363
  • ISSN: 0918-2918, 1349-7235
  • Year and Date: 2022-09-01
  • Peer Reviewed / Open Access
• [Journal Article] Conservative medical management combined with follow-up multidetector computed tomography of tracheobronchial injury caused by penetrating injuries: A case report (2022)
  • Author(s): Takahashi Tsuyoshi、Kaneko Tadashi、Hane Atsuya、Ito Asami、Kawamoto Eiji、Suzumura Misato、Ueda Koki、Shinoda Mari、Ito Atsushi、Imai Hiroshi
  • Journal Title: Trauma Case Reports Volume: 42 Pages: 100710-100710
  • DOI: 10.1016/j.tcr.2022.100710
  • Peer Reviewed / Open Access
• [Journal Article] Sequential organ failure assessment score as a predictor of the outcomes of patients hospitalized for classical or exertional heatstroke (2022)
  • Author(s): Yokoyama Kazuto、Kaneko Tadashi、Ito Asami、Ieki Yohei、Kawamoto Eiji、Suzuki Kei、Ishikura Ken、Imai Hiroshi、Kanda Jun、Yokobori Shoji
  • Journal Title: Scientific Reports Volume: 12 Issue: 1 Pages: 16373-16373
  • DOI: 10.1038/s41598-022-20878-1
  • Peer Reviewed / Open Access
• [Journal Article] Possible Metastatic Stage-Dependent ILC2 Activation Induces Differential Functions of MDSCs through IL-13/IL-13Rα1 Signaling during the Progression of Breast Cancer Lung Metastasis (2022)
  • Author(s): Ito Atsushi、Akama Yuichi、Satoh-Takayama Naoko、Saito Kanako、Kato Takuma、Kawamoto Eiji、Gaowa Arong、Park Eun Jeong、Takao Motoshi、Shimaoka Motomu
  • Journal Title: Cancers Volume: 14 Issue: 13 Pages: 3267-3267
  • DOI: 10.3390/cancers14133267
  • Peer Reviewed / Open Access
• [Journal Article] miRNA-200c-3p targets talin-1 to regulate integrin-mediated cell adhesion. (2021)
  • Author(s): Obeng G, Park EJ, Appiah MG, Kawamoto E, Gaowa A, Shimaoka M.
  • Journal Title: Sci Rep. Volume: 11 Issue: 1 Pages: 21597-21597
  • DOI: 10.1038/s41598-021-01143-3
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Substrate stiffness modulates endothelial cell function via the YAP-Dll4-Notch1 pathway (2021)
  • Author(s): Matsuo Eri、Okamoto Takayuki、Ito Atsushi、Kawamoto Eiji、Asanuma Kunihiro、Wada Koichiro、Shimaoka Motomu、Takao Motoshi、Shimamoto Akira
  • Journal Title: Experimental Cell Research Volume: 408 Issue: 1 Pages: 112835-112835
  • DOI: 10.1016/j.yexcr.2021.112835
  • Peer Reviewed / Open Access
• [Journal Article] Recombinant soluble thrombomodulin accelerates epithelial stem cell proliferation in mouse intestinal organoids and promotes the mucosal healing in colitis (2021)
  • Author(s): Gaowa A, Park EJ, Kawamoto E, Qin Y, Shimaoka M.
  • Journal Title: J Gastroenterol Hepatol. Volume: 36 Issue: 11 Pages: 3149-3157
  • DOI: 10.1111/jgh.15656
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Cytoskeletal Actin Structure in Osteosarcoma Cells Determines Metastatic Phenotype via Regulating Cell Stiffness, Migration, and Transmigration (2021)
  • Author(s): Kita Kouji、Asanuma Kunihiro、Okamoto Takayuki、Kawamoto Eiji、Nakamura Koichi、Hagi Tomohito、Nakamura Tomoki、Shimaoka Motomu、Sudo Akihiro
  • Journal Title: Current Issues in Molecular Biology Volume: 43 Issue: 3 Pages: 1255-1266
  • DOI: 10.3390/cimb43030089
  • Peer Reviewed / Open Access
• [Journal Article] Elevated Plasma Soluble PD-L1 Levels in Out-of-Hospital Cardiac Arrest Patients (2021)
  • Author(s): Sumiyoshi Miho、Kawamoto Eiji、Nakamori Yuki、Esumi Ryo、Ikejiri Kaoru、Shinkai Toru、Akama Yuichi、Ito-Masui Asami、Imai Hiroshi、Gaowa Arong、Park Eun Jeong、Shimaoka Motomu
  • Journal Title: Journal of Clinical Medicine Volume: 10 Issue: 18 Pages: 4188-4188
  • DOI: 10.3390/jcm10184188
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Endothelial connexin-integrin crosstalk in vascular inflammation (2021)
  • Author(s): Okamoto Takayuki、Park Eun Jeong、Kawamoto Eiji、Usuda Haruki、Wada Koichiro、Taguchi Akihiko、Shimaoka Motomu
  • Journal Title: Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease Volume: 1867 Issue: 9 Pages: 166168-166168
  • DOI: 10.1016/j.bbadis.2021.166168
  • Peer Reviewed / Open Access
• [Journal Article] Prevalence and predictors of direct discharge home following hospitalization of patients with serious adverse events managed by the rapid response system in Japan: a multicenter, retrospective, observational study (2021)
  • Author(s): Takashi Hongo, Hiromichi Naito, Toshifumi Fujiwara, Takaki Naito, Yosuke Homma, Yoshihisa Fujimoto, Morooka Takaya, Yuji Yamamori, Taka-Aki Nakada, Tsuyoshi Nojima, Atsunori Nakao, Shigeki Fujitani
  • Journal Title: Acute Medicine & Surgery Volume: 8 Issue: 1 Pages: 1-8
  • DOI: 10.1002/ams2.690
  • Peer Reviewed / Open Access
• [Journal Article] Cellular and exosomal regulations of sepsis-induced metabolic alterations (2021)
  • Author(s): Appiah G. Michael, Park Eun Jeong, Akama Y, Nakamori Y, Kawamoto E, Gaowa A, Shimaoka M
  • Journal Title: International Journal of Molecular Sciences Volume: 22 Issue: 15 Pages: 8295-8295
  • DOI: 10.3390/ijms22158295
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Sociometric wearable devices for studying human behavior in corporate and healthcare workplaces (2021)
  • Author(s): Ito-Masui Asami、Kawamoto Eiji、Esumi Ryo、Imai Hiroshi、Shimaoka Motomu
  • Journal Title: BioTechniques Volume: 71 Issue: 1 Pages: 392-399
  • DOI: 10.2144/btn-2020-0160
  • Peer Reviewed / Open Access
• [Journal Article] Irisin supports integrin-mediated cell adhesion of lymphocytes. (2021)
  • Author(s): Myint PK, Ito A, Appiah MG, Obeng G, Darkwah S, Kawamoto E, Gaowa A, Park EJ, Shimaoka M
  • Journal Title: Biochem Biophys Rep. Volume: 26 Pages: 100977-100977
  • DOI: 10.1016/j.bbrep.2021.100977
  • Peer Reviewed / Open Access
• [Journal Article] Ligand-competent fractalkine receptor is expressed on exosomes. (2021)
  • Author(s): Park EJ, Myint PK, Appiah MG, Worawattananutai P, Inprasit J, Prajuabjinda O, Soe ZY, Gaowa A, Kawamoto E, Shimaoka M.
  • Journal Title: Biochem Biophys Rep. Volume: 26 Pages: 100932-100932
  • DOI: 10.1016/j.bbrep.2021.100932
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Randomized trial of granulocyte colony-stimulating factor for spinal cord injury (2021)
  • Author(s): Koda Masao、Hanaoka Hideki、Fujii Yasuhisa、Hanawa Michiko、et al.
  • Journal Title: Brain Volume: 144 Issue: 3 Pages: 789-799
  • DOI: 10.1093/brain/awaa466
  • Peer Reviewed / Open Access
• [Journal Article] The Spike Glycoprotein of SARS-CoV-2 Binds to β1 Integrins Expressed on the Surface of Lung Epithelial Cells. (2021)
  • Author(s): Park EJ, Myint PK, Appiah MG, Darkwah S, Caidengbate S, Ito A, Matsuo E, Gaowa a, Shimaoka M. Kawamoto E,
  • Journal Title: Viruses Volume: 13 Issue: 4 Pages: 645-645
  • DOI: 10.3390/v13040645
  • Peer Reviewed / Open Access
• [Journal Article] The characteristics, types of intervention, and outcomes of postoperative patients who required rapid response system intervention: A nationwide database analysis (2021)
  • Author(s): Yoshiki Sento, Masayasu Arai, Yuji Yamamori, Shinsuke Fujiwara, Masahiro Tamashiro, Eiji Kawamoto, Takaki Naito, Kazuaki Atagi, Shigeki Fujitani, Satoshi Osaga, Kazuya Sobue, on behalf of the In-Hospital Emergency Study Group
  • Journal Title: Journal of Anesthesia Volume: 35 Issue: 2 Pages: 222-231
  • DOI: 10.1007/s00540-021-02900-4
  • Peer Reviewed / Open Access
• [Journal Article] Internet-based Individualized Cognitive Behavioral Therapy for Shift Work Sleep Disorder (Empowered by Wellbeing Prediction): A Pilot Study Protocol. (2021)
  • Author(s): Ito-Masui A, Sakamoto R, Yu H,, Sano A, Motomura E, Tanii H, Sakano S, Esumi R, Imai H, Shimaoka M
  • Journal Title: J JMIR Res Protoc. Volume: 10(3) Issue: 3 Pages: e24799-e24799
  • DOI: 10.2196/24799
  • Peer Reviewed / Open Access
• [Journal Article] Veno-arterial extracorporeal membrane oxygenation and targeted temperature management in tricyclic antidepressant-induced cardiac arrest (2021)
  • Author(s): Ikejiri Kaoru、Akama Yuichi、Ieki Yohei、Kawamoto Eiji、Suzuki Kei、Yokoyama Kazuto、Ishikura Ken、Imai Hiroshi
  • Journal Title: Medicine Volume: 100 Issue: 9 Pages: e24980-e24980
  • DOI: 10.1097/md.0000000000024980
  • Peer Reviewed / Open Access
• [Journal Article] Sepsis Induces Deregulation of IL-13 Production and PD-1 Expression in Lung Group 2 Innate Lymphoid Cells. (2021)
  • Author(s): Akama Y, Park EJ, Satoh-Takayama N, Gaowa A, Ito A, Kawamoto E, Darkwah S, Appiah MG, Myint PK, Ohno H, Imai H, Shimaoka M.
  • Journal Title: Shock Volume: 55 Issue: 3 Pages: 357-370
  • DOI: 10.1097/shk.0000000000001647
  • Peer Reviewed / Open Access
• [Journal Article] Remodeling of Bone Marrow Niches and Roles of Exosomes in Leukemia. (2021)
  • Author(s): Yamaguchi T, Kawamoto E, Gaowa A, Park EJ, Shimaoka M.
  • Journal Title: Int J Mol Sci. Volume: 22 Issue: 4 Pages: 1881-1881
  • DOI: 10.3390/ijms22041881
  • Peer Reviewed / Open Access
• [Journal Article] The Lectin-Like Domain of Thrombomodulin Inhibits β1 Integrin-Dependent Binding of Human Breast Cancer-Derived Cell Lines to Fibronectin. (2021)
  • Author(s): Kawamoto E, Nago N, Okamoto T, Gaowa A, Masui-Ito A, Akama Y, Darkwah S, Appiah MG, Myint PK, Obeng G, Ito A, Caidengbate S, Esumi R, Yamaguchi T, Park EJ, Imai H, Shimaoka M.
  • Journal Title: Biomedicines Volume: 9 Issue: 2 Pages: 162-162
  • DOI: 10.3390/biomedicines9020162
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Potential Roles of Muscle-Derived Extracellular Vesicles in Remodeling Cellular Microenvironment: Proposed Implications of the Exercise-Induced Myokine, Irisin (2021)
  • Author(s): Darkwah Samuel、Park Eun Jeong、Myint Phyoe Kyawe、Ito Atsushi、Appiah Michael G.、Obeng Gideon、Kawamoto Eiji、Shimaoka Motomu
  • Journal Title: Frontiers in Cell and Developmental Biology Volume: 9 Pages: 1-1
  • DOI: 10.3389/fcell.2021.634853
  • Peer Reviewed / Open Access
• [Journal Article] Challenges in Diagnosing Comatose Patients with Ethylene Glycol Poisoning (2021)
  • Author(s): Esumi Ryo、Suzuki Kei、Ishikura Ken、Imai Hiroshi
  • Journal Title: The American Journal of Medicine Volume: 134 Issue: 2 Pages: e127-e128
  • DOI: 10.1016/j.amjmed.2020.06.039
  • Peer Reviewed / Open Access
• [Journal Article] Methods to Study Integrin Functions on Exosomes (2020)
  • Author(s): Kawamoto Eiji、Park Eun Jeong、Shimaoka Motomu
  • Journal Title: Methods in Molecular Biology Volume: 2217 Pages: 265-281
  • DOI: 10.1007/978-1-0716-0962-0_15
  • ISBN: 9781071609613, 9781071609620
  • Peer Reviewed / Open Access
• [Journal Article] Social Network Analysis of Intensive Care Unit Health Care Professionals Measured by Wearable Sociometric Badges: Longitudinal Observational Study (2020)
  • Author(s): Kawamoto Eiji、Ito-Masui Asami、Esumi Ryo、Ito Mami、Mizutani Noriko、Hayashi Tomoyo、Imai Hiroshi、Shimaoka Motomu
  • Journal Title: Journal of Medical Internet Research Volume: 22 Issue: 12 Pages: e23184-e23184
  • DOI: 10.2196/23184
  • Peer Reviewed / Open Access
• [Journal Article] Virtual reality as a non-pharmacologic analgesic for fasciotomy wound infections in acute compartment syndrome: a case report (2020)
  • Author(s): Esumi Ryo、Yokochi Ayumu、Shimaoka Motomu、Kawamoto Eiji
  • Journal Title: Journal of Medical Case Reports Volume: 14 Issue: 1 Pages: 46-46
  • DOI: 10.1186/s13256-020-02370-4
  • Peer Reviewed / Open Access
• [Journal Article] How ICU Patient Severity Affects Communicative Interactions Between Healthcare Professionals: A Study Utilizing Wearable Sociometric Badges (2020)
  • Author(s): Kawamoto Eiji、Ito-Masui Asami、Esumi Ryo、Imai Hiroshi、Shimaoka Motomu
  • Journal Title: Frontiers in Medicine Volume: 7 Pages: 606987-606987
  • DOI: 10.3389/fmed.2020.606987
  • Peer Reviewed / Open Access
• [Presentation] ICUにおける分散型リーダーシップ構造促進がスタッフのソーシャル・ネットワーク構造と幸福度へ与える影響 (2023)
  • Author(s): 江角亮、川本英嗣、伊藤亜紗実、伊藤真実、山本貴恵、林智世、今井寛、島岡要
  • Organizer: 日本集中治療医学会、デジタルポスター、Ai・機械、2023年3月2日
• [Presentation] COVID-19減少時期での当院ドクターヘリ感染対策 (2020)
  • Author(s): 江角 亮, 金子 唯, 池尻 薫, 新貝 達, 新美 太祐, 家城 洋平, 鈴木 圭, 石倉 健, 今井 寛
  • Organizer: 日本航空医療学会雑誌
• [Presentation] 地方大学病院での外傷カンファレンスを通じた診療体制づくりの試み (2020)
  • Author(s): 江角 亮, 家城 洋平, 赤間 悠一, 新貝 達, 金子 唯, 今井 寛, 石倉 健
  • Organizer: 日本外傷学会雑誌
• [Presentation] 多発外傷に合併する大動脈損傷に対して根治術までに長期安静を要し た一例 (2020)
  • Author(s): 江角亮, 金子唯, 奥野郁斗, 池尻薫, 伊藤亜紗実, 川本英嗣, 石倉健, 今井寛
  • Organizer: 日本救急医学会 中部地方総会学術集会
• [Presentation] バーチャルリアリティを利用した集中治療室 (ICU) 外傷患者のせん妄予防 (2020)
  • Author(s): 江角亮, 川本英嗣, 奥野郁斗, 池尻薫, 赤間悠一, 伊藤亜紗実, 新貝達, 家城洋平, 新美太祐 鈴木圭, 横山和人, 金子唯, 石倉健, 今井寛 島岡要
  • Organizer: 日本集中治療医学会東海北陸支部学術集会
• [Presentation] 病院前12誘導心電図伝送による緊急カテーテルチームのワークライフバランス改善の可能性について 三重ACSレジストリより (2020)
  • Author(s): 石倉 健, 奥野 郁斗, 池尻 薫, 江角 亮, 赤間 悠一, 伊藤 亜紗実, 新貝 達, 鈴木 圭, 金子 唯, 今井 寛
  • Organizer: 日本救急医学会雑誌
• [Presentation] 日本集中治療医学会学術集会 (2020)
  • Author(s): 伊藤亜紗実, 川本英嗣, 奥野郁斗, 江角亮, 岩下義明, 鈴木圭, 加藤隆史, 行光昌宏, 今井寛, 島岡要
  • Organizer: ウェアラブルセンサーを用いたECMO患者の治療を行う医療従事者の職種間コミュニケーション定量化の検証
• [Presentation] 日本集中治療医学会学術集会 (2020)
  • Author(s): 赤間悠一, 赤間悠一, 朴恩正, 佐藤尚子, 川本英嗣, 川本英嗣, 伊藤亜紗実, 伊藤亜紗実, 伊藤温志, 伊藤温志, 江角亮, 池尻薫, 今井寛, 島岡要, OSUCHOWSKI Marcin
  • Organizer: 敗血症性肺傷害における2型自然リンパ球の機能解析