Scoping review of the use of virtual reality in intensive care units

Hill, James E.; Twamley, Jacqueline; Breed, Hetty; Kenyon, Roger; Casey, Rob; Zhang, Jennifer; Clegg, Andrew

doi:10.1111/nicc.12732

Cited by 15 publications

(13 citation statements)

References 67 publications

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“…The present study is the first randomized study about VR evaluating the improvement in overall patient baseline comfort in a mixed medical-surgical ICU, compared to music therapy and standard relaxation. A recent review on VR in ICU reported 21 studies, mostly of them being observational, non-comparative, feasibility studies [43], whose reports are consistent with the present study with a completion rate of 74%, (95%CI 51%-96.0%). In two proof-of-concept studies designed by the same group, heart rate and blood pressure decreased in 37 patients [44], while respiratory rate and discomfort decreased in 33 patients [45].…”

Section: Table 2 (Continued)supporting

confidence: 90%

Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross-over randomized controlled trial E-CHOISIR (Electronic-CHOIce of a System for Intensive care Relaxation)

et al. 2022

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Purpose To assess the impact of different electronic relaxation devices on common stressful patient symptoms experienced in intensive care unit (ICU). Methods Sixty critically ill patients were enrolled in four relaxation sessions using a randomized cross-over design: standard relaxation (TV/radio), music therapy (MUSIC-CARE©), and two virtual reality systems using either real motion pictures (DEEPSEN©) or synthetic motion pictures (HEALTHY-MIND©). The goal was to determine which device was the best to reduce overall patient discomfort intensity (0–10 Numeric Rating Scale (NRS); primary endpoint). Secondary endpoints were specific stressful symptoms (pain, anxiety, dyspnea, thirst, and lack of rest feeling) and stress response measured by Analgesia/Nociception Index (ANI). Multivariate mixed-effect analysis was used, taking into account patient characteristics and multiple measurements. Results Fifty patients followed the full research protocol, and ten patients did at least one research planned session of relaxation. HEALTHY-MIND© was associated with a significant decrease in overall discomfort, the primary endpoint (median NRS = 4[2–6] vs. 2[0–5]; p = 0.01, mixed-effect model), accompanied by a significant decrease in stress response (increase in ANI, secondary endpoint; p < 0.01). Regarding other secondary endpoints, each of the two virtual reality systems was associated with a decrease in anxiety (p < 0.01), while HEALTHY-MIND© was associated also with a decrease in pain (p = 0.001) and DEEPSEN© with a decrease in lack of rest (p = 0.01). Three incidents (claustrophobia/dyspnea/agitation) were reported among 109 virtual reality sessions. Cybersickness was rare (NRS = 0[0–0]). Conclusion Electronic relaxation therapy is a promising, safe, and effective non-pharmacological solution that can be used to improve overall discomfort in alert and non-delirious ICU patients. Its effectiveness depends on technical characteristics (virtual reality using a synthetic imagined world versus a real world or music therapy alone without virtual reality), as well as the type of symptoms.

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Section: Table 2 (Continued)supporting

confidence: 90%

Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross-over randomized controlled trial E-CHOISIR (Electronic-CHOIce of a System for Intensive care Relaxation)

et al. 2022

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“…The present study is the rst randomized study about VR evaluating the improvement of baseline patient's overall comfort in a mixed medical-surgical ICU, compared to music-therapy and standardrelaxation. A recent review on VR in ICU reported 21 studies, mostly of them being observational, noncomparative, feasibility studies [42], whose reports are consistent with the present study with a completion rate of 74%, (95%CI: 51%-96.0%). In two proof-of-concept studies designed by the same group, heart-rate and blood-pressure decreased in 37 patients [43], while respiratory rate and discomfort decreased in 33 patients [44].…”

Section: Discussionsupporting

confidence: 90%

Discomfort Improvement for Critically-ill Patients using Electronical Relaxation Devices: results of the Cross Over Randomized Controlled Trial E-CHOISIR (Electronical-CHOIce of a System for Intensive care Relaxation)

Merliot-Gailhoustet¹,

Raimbert²,

Garnier³

et al. 2022

Preprint

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Purpose: To assess the impact of different electronical-relaxation devices on common patients’ stressful symptoms experienced in Intensive-Care-Unit (ICU).Methods: Sixty critically-ill patients were enrolled in four relaxation-sessions using a randomized cross-over design: standard-relaxation (TV/radio), music-therapy (MUSIC-CARE©), and two virtual-reality systems using either real-motion pictures (DEEPSEN©) or synthetic-motion pictures (HEALTHY-MIND©). The goal was to determine which device was the best to improve overall patient discomfort’s intensity (0-10 Numeric-Rating-Scale (NRS); primary endpoint). Secondary endpoints were specific stressful symptoms (pain, anxiety, dyspnea, thirst, and lack-of-rest-feeling), and stress-response measured by Analgesia/Nociception-Index (ANI). Multivariate mixed-effect analysis was used taking into account patient’s characteristics and multiple measurements.Results: Fifty patients followed the full research-protocol, and ten patients did at least one research-planned session of relaxation. HEALTHY-MIND© was associated with a significant decrease of overall discomfort, the primary endpoint (median NRS=4[2-6] vs. 2[0-5]; p=0.01, mixed-effect model), confirmed by a significant decrease of stress-response (increase of ANI, secondary endpoint; p<0.01). Regarding other secondary endpoints, each of the two virtual-reality systems was associated with a decrease of anxiety (p<0,01), while HEALTHY-MIND© was associated also with a decrease of pain (p=0.001) and DEEPSEN© with a decrease of lack-of-rest (p=0.01). Three incidents (claustrophobia/dyspnea/agitation) were reported among 109 virtual-reality sessions. Cybersickness was rare (NRS=0[0-0]).Conclusion: Electronical relaxation therapy is a promising, safe and effective non-pharmacological solution that can be used to improve overall discomfort in ICU patients. Its effectiveness depends on technical characteristics (real or synthetic imagined world, association or not with music-therapy), as well as the type of symptoms.

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“…Web‐based interventions, such as video conferencing and text messages, have been alternatives to providing interhuman contact, information and support 55,56 . Virtual reality could have great potential in the clinical ICU environment 33,57 . E‐health applications, such as integrated health apps and home self‐monitoring, might be beneficial for individuals who can proactively check their health by means of regularly completed short digital questionnaires recording expected symptoms, thus raising awareness or reducing deterioration through timely professional support.…”

Section: Discussionmentioning

confidence: 99%

A study protocol to develop and test an e‐health intervention in follow‐up service for intensive care survivors' relatives

Mol

Kompanje

Bommel

et al. 2023

Nursing in Critical Care

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BackgroundThe negative impact on long‐term health‐related outcomes among relatives of critically ill patients in the intensive care unit (ICU) has been well described. High‐quality ICU specialized follow‐up care, which is easily accessible with digital innovation and which is designed by and with relevant stakeholders (i.e., ICU patients' relatives and nurses), should be considered to reduce these impairments in the psychological and social domains.AimThe programme's aim is to develop and test an e‐health intervention in a follow‐up service to support ICU patients' relatives. Here, the protocol for the overall study programme will be described.Study DesignThe overall study comprises a mixed‐methods, multicentre research design with qualitative and quantitative study parts. The study population is ICU patients' adult relatives and ICU nurses. The main outcomes are the experiences of these stakeholders with the newly developed e‐health intervention. There will be no predefined selection based on age, gender, and level of education to maximize diversity throughout the study programme. After the participants provide informed consent, data will be gathered through focus groups (n = 5) among relatives and individual interviews (n = 20) among nurses exploring the needs and priorities of a digital follow‐up service. The findings will be explored further for priority considerations among members of the patient/relative organization (aiming n = 150), which will serve as a basis for digital prototypes of the e‐health intervention. Assessment of the intervention will be followed during an iterative process with investigator‐developed questionnaires. Finally, symptoms of anxiety and depression will be measured with the 14‐item Dutch version of the ‘Hospital Anxiety and Depression Scale’, and symptoms of posttraumatic stress will be measured with the 21‐item Dutch version of the ‘Impact of Events Scale‐Revised’ to indicate the effectiveness of digital support among ICU patients' relatives.Relevance to Clinical PracticeThe e‐health intervention to be developed during this research programme can possibly bridge the gap in integrated ICU follow‐up care by providing relevant information, self‐monitoring and stimulating self‐care among ICU patients' relatives.

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Scoping review of the use of virtual reality in intensive care units

Cited by 15 publications

References 67 publications

Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross-over randomized controlled trial E-CHOISIR (Electronic-CHOIce of a System for Intensive care Relaxation)

Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross-over randomized controlled trial E-CHOISIR (Electronic-CHOIce of a System for Intensive care Relaxation)

Discomfort Improvement for Critically-ill Patients using Electronical Relaxation Devices: results of the Cross Over Randomized Controlled Trial E-CHOISIR (Electronical-CHOIce of a System for Intensive care Relaxation)

A study protocol to develop and test an e‐health intervention in follow‐up service for intensive care survivors' relatives

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