Feasibility and safety of virtual-reality-based early neurocognitive stimulation in critically ill patients

Abstract

BackgroundGrowing evidence suggests that critical illness often results in significant long-term neurocognitive impairments in one-third of survivors. Although these neurocognitive impairments are long-lasting and devastating for survivors, rehabilitation rarely occurs during or after critical illness. Our aim is to describe an early neurocognitive stimulation intervention based on virtual reality for patients who are critically ill and to present the results of a proof-of-concept study testing the feasibility, safety, and suitability of this intervention.MethodsTwenty critically ill adult patients undergoing or having undergone mechanical ventilation for ≥24 h received daily 20-min neurocognitive stimulation sessions when awake and alert during their ICU stay. The difficulty of the exercises included in the sessions progressively increased over successive sessions. Physiological data were recorded before, during, and after each session. Safety was assessed through heart rate, peripheral oxygen saturation, and respiratory rate. Heart rate variability analysis, an indirect measure of autonomic activity sensitive to cognitive demands, was used to assess the efficacy of the exercises in stimulating attention and working memory.ResultsPatients successfully completed the sessions on most days. No sessions were stopped early for safety concerns, and no adverse events occurred. Heart rate variability analysis showed that the exercises stimulated attention and working memory. Critically ill patients considered the sessions enjoyable and relaxing without being overly fatiguing.ConclusionsThe results in this proof-of-concept study suggest that a virtual-reality-based neurocognitive intervention is feasible, safe, and tolerable, stimulating cognitive functions and satisfying critically ill patients. Future studies will evaluate the impact of interventions on neurocognitive outcomes. Trial registration Clinical trials.gov identifier: NCT02078206Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0303-4) contains supplementary material, which is available to authorized users.

Minimizing Asynchronies in Mechanical Ventilation: Current and Future Trends

“…47,48 Cognitive impairment in ICU patients deserves increased recognition and action from both clinicians and researchers. [48][49][50] In a 6-month observational study, Schmidt et al 51 assessed the prevalence of dyspnea in mechanically ventilated subjects in which 96 subjects were enrolled as soon as they could answer symptom-related questions assessing dyspnea caused by air hunger or respiratory effort, pain, and anxiety on visual analog scales. Interestingly, half of the subjects reported dyspnea, and dyspnea was associated with anxiety, assist/control ventilation, and increased heart rate.…”

Perception and Performance on a Virtual Reality Cognitive Stimulation for Use in the Intensive Care Unit: A Non-randomized Trial in Critically Ill Patients

“…The state-of-the-art therapy provided to critically ill patients focuses on physical rehabilitation, and there is currently no consensus on how to prevent cognitive impairments after ICU discharge (15,16). However, Turon et al showed that training of cognitive functions presented on a television screen is feasible and may be beneficial for critically ill patients (17).…”

Focus on long-term cognitive, psychological and physical impairments after critical illness

“…In a prospective, longitudinal study conducted in 315 patients being weaned from prolonged ventilation at a long-term acute-care hospital [15] 84.7% of survivors indicated willingness to undergo mechanical ventilation again. Clinical investigations of the effects of various interventions, including new technologies (e.g., early neurocognitive rehabilitation software [16]) are urgently required to improve long-term outcome after critical illness.…”