Feasibility of a virtual reality intervention in the intensive care unit
Introduction
Intensive care unit (ICU) delirium affects 45% to 87% of critically ill patients1,2 and is independently associated with an increased risk of long-term cognitive decline and increased health care costs.3 In the ICU setting, factors such as immobility, sensory impairment, pain, and agitation are thought to increase the risk of delirium.4 Critically ill patients commonly receive analgesics and sedatives for management of pain and anxiety,5,6 and these medicines themselves are associated with an increased risk of delirium. Given the lack of effective pharmacologic interventions to prevent or treat delirium, hospitals need non-pharmacological interventions that are safe, feasible, and easy to implement in the busy ICU environment. These therapies may also enhance existing delirium care bundles. Virtual reality (VR) is a promising technology that may fill this need and strengthen bedside care for ICU patients.
VR uses a Head-Mounted Display (HMD) and motion tracking hardware to deliver video or computer-generated imagery and sound to create an immersive environment. VR has shown initial efficacy in hospitalized7, 8 and post-operative9 patients in reducing pain and anxiety,10 and it is well-tolerated by the patients when used for cognitive and motor rehabilitation.11 VR may also be a useful adjunct for promoting mobility in critically ill patients who commonly undergo invasive procedures and experience pain and anxiety, which are known risk factors for delirium. However, prior VR intervention studies have not completely addressed specific challenges of implementing VR intervention in mechanically ventilated patients in the medical ICU nor demonstrated its acceptance by ICU staff, which is imperative for its successful implementation. As a result, we designed a pilot feasibility study to ascertain acceptability and determine the safety of VR therapy by ICU patients and diverse ICU providers.
Section snippets
Participants and setting
This pilot, feasibility, non-randomized, experimental study was conducted from April 2018 to January 2019 in a single-center, multisite academic health system comprising 2 referral hospitals. Eskenazi Hospital is a 327-bed public hospital with 36 combined surgical ICU (SICU) and medical ICU (MICU) beds and a 36-bed progressive/step-down ICU. Methodist Hospital is an 802-bed tertiary-care center with 120 ICU beds that is affiliated with Indiana University School of Medicine. The study was
ICU providers
Twenty-one hospital employees participated in the study: 9 physicians/nurse practitioners, 5 resident nurses, 5 respiratory therapists, and 2 physical therapists. Table 1 describes the participants’ clinical and sociodemographic characteristics. Providers had a mean age of 32.5 (SD 7.76) years, and 57.1% had prior experience using a VR device.
Discussion
In this feasibility study, we investigated the acceptability and safety of VR intervention in the ICU by critically ill patients as well as ICU providers representing various disciplines, including physicians, nurse practitioners, nurses, and respiratory therapists. Both groups showed a high level of acceptance of the VR intervention despite low levels of prior experience with virtual reality and video gaming technologies among the ICU patients. Overall, 78% of the patients rated their
Conclusion
Administration of VR distraction therapy in the ICU appears feasible, does not interfere with life support equipment, and does not result in significant adverse events. Its use as a novel non-pharmacologic intervention for reduction of pain, anxiety, and delirium is promising and warrants further research.
Declaration of Competing Interest
None declared.
Acknowledgements
We thank Jessica Smith for her help in english language editing and review services.
References (34)
- et al.
Using functional Magnetic Resonance Imaging (fMRI) to analyze brain region activity when viewing landscapes
Landsc Urban Plan
(2017) - et al.
Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support
J Biomed Inform
(2009) - et al.
The REDCap consortium: building an international community of software platform partners
J Biomed Inform
(2019) - et al.
Incidence, risk factors, and outcomes for sepsis-associated delirium in patients with mechanical ventilation: a sub-analysis of a multicenter randomized controlled trial
J Crit Care
(2020) - et al.
Delirium in the ICU: an overview
Ann Intensive Care
(2012) - et al.
Outcome of delirium in critically ill patients: systematic review and meta-analysis
Bmj
(2015) - et al.
The importance of delirium: economic and societal costs
J Am Geriatr Soc
(2011) - et al.
Relationship between pain and opioid analgesics on the development of delirium following hip fracture
J Gerontol Ser A
(2003) - et al.
Anxiety and agitation in mechanically ventilated patients
Qual Health Res
(2012) - et al.
Narcotic-based sedation regimens for critically ill mechanically ventilated patients
Critical Care
(2005)