Elsevier

Heart & Lung

Volume 50, Issue 6, November–December 2021, Pages 748-753
Heart & Lung

Feasibility of a virtual reality intervention in the intensive care unit

https://doi.org/10.1016/j.hrtlng.2021.05.007Get rights and content

Highlights

  • There was high level of acceptance of virtual reality (VR) distraction therapy by intensive care unit (ICU) patients and providers.

  • VR intervention was safe, compatible with the ICU infrastructure and did not interfere with life support.

  • The risk of cybersickness in critically ill patients with VR therapy was minimal.

  • Bedside care providers in the ICU found the equipment to be well-functioning and easy to use.

Abstract

Background

Delirium prevention requires optimal management of pain and anxiety. Given the limitations of current pharmacologic interventions, evaluation of novel non-pharmacological interventions is required. Virtual reality (VR) stimulation may be a promising intervention because of its capability to reduce psychophysiological stress, pain, and anxiety and to restore cognitive and attentional capacities.

Objective

To ascertain patients’ and providers’ perceptions of acceptability and safety of VR intervention in the intensive care unit (ICU).

Methods

We enrolled a cohort of 15 ICU patients and 21 health care providers to administer a 15-minute session showing a relaxing beach scene with VR headsets and nature sound effects. Participants were then asked to rate their experiences on a Likert scale survey.

Results

The majority of patients (86%, 12 of 14) rated the headsets as moderately to very comfortable. All had moderate or greater sense of presence in the virtual environment, and 79% (11 of 14) rated their overall experience at 3 or greater (5 indicating that they enjoyed it very much). Seventy-one percent (10 of 14) of the patients felt that their anxiety was better with VR, and 57% (8 of 14) did not notice a change in their pain or discomfort. All health care providers found the headset to be at least moderately comfortable and felt a moderate or greater sense of presence. All providers concluded that VR therapy should be available for their patients. Both groups experienced minimal side effects.

Conclusion

In this prospective study of perceptions of VR therapy for ICU patients and health care providers, there was a high level of acceptance, with minimal side effects, for both groups despite their low levels of prior experience with virtual reality and video gaming.

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.

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