Virtual Reality Hypnosis for Anxiety and Pain Management in Intensive Care Units. A Prospective Randomized Trial Among Cardiac Surgery Patients.

Rousseaux, Floriane; Dardenne, Nadia; Massion, Paul; Ledoux, Didier; Faymonville, Marie-Élisabeth; Nyssen, Anne‐Sophie; Vanhaudenhuyse, Audrey

doi:10.21203/rs.3.rs-60523/v1

Cited by 4 publications

(7 citation statements)

References 29 publications

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“…Among RCTs, one assessed the type of computer-generated video (urban versus mountain world versus a video displayed on the bedroom-TV screen) on 45 patients, reporting a better restoration feeling with the mountain world [48], consistently with findings of the present study that highlights a different impact of VR related to device characteristics. Three RCTs included 48(24/group) [49], 100(25/group) [50], and 200(100/group) [51] post-cardiac surgery patients. VR improved significantly sleep [49] and relaxation [50] but failed to improve anxiety and pain at rest [50] or during chest drain removal [51].…”

Section: Table 2 (Continued)mentioning

confidence: 99%

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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)mentioning

confidence: 99%

“…Three RCTs included 48(24/group) [49], 100(25/group) [50], and 200(100/group) [51] post-cardiac surgery patients. VR improved significantly sleep [49] and relaxation [50] but failed to improve anxiety and pain at rest [50] or during chest drain removal [51]. In the latter study, VR was compared to nitrous oxide.…”

Section: Table 2 (Continued)mentioning

confidence: 99%

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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show abstract

“…Among RCTs, one assessed the type of computergenerated video (urban versus mountain world versus a video displayed on the bedroom-TV screen) on 45 patients, reporting a better restoration feeling with the mountain world [47], consistently with ndings of the present study that highlights a different impact of VR related to devices' characteristics. Three RCTs included 48(24/group) [48], 100(25/group) [49] and 200(100/group) [50] post-cardiac surgery patients. Among them, one reported a signi cant higher subjective sleep quality and objective sleep e ciency after VR compared to usual sleep protocol (eyemask and earplug if desired) [48]; one was negative on pain, anxiety, fatigue (but positive on relaxation) after VR, hypnosis alone or associated with VR, compared to standard daily care [49]; one failed to prove non-inferiority of VR compared to nitrousoxyde for the management of pain and anxiety during chest-drain removal, that is the care-procedure known as the most painful in the ICU [51], deserving the most effective analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…Three RCTs included 48(24/group) [48], 100(25/group) [49] and 200(100/group) [50] post-cardiac surgery patients. Among them, one reported a signi cant higher subjective sleep quality and objective sleep e ciency after VR compared to usual sleep protocol (eyemask and earplug if desired) [48]; one was negative on pain, anxiety, fatigue (but positive on relaxation) after VR, hypnosis alone or associated with VR, compared to standard daily care [49]; one failed to prove non-inferiority of VR compared to nitrousoxyde for the management of pain and anxiety during chest-drain removal, that is the care-procedure known as the most painful in the ICU [51], deserving the most effective analgesia. Another negative RCT investigated the impact of VR on PICS in 89 patients with COVID-19 [52].…”

Section: Discussionmentioning

confidence: 99%

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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“…[9,10]. However, there were no significant differences in the pre-defined outcome measures (anxiety, pain, fatigue, relaxation, physiological parameters, and opioid use) [11]. Further studies are required to investigate potential beneficial effects, and costeffectiveness.…”

Section: Virtual Reality From the Patient's Perspective Alleviating S...mentioning

confidence: 92%

Virtual and augmented reality in critical care medicine: the patient’s, clinician’s, and researcher’s perspective

Bruno

Wolff²,

Wernly³

et al. 2022

Crit Care

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Virtual reality (VR) and augmented reality (AR) are aspiring, new technologies with increasing use in critical care medicine. While VR fully immerses the user into a virtual three-dimensional space, AR adds overlaid virtual elements into a real-world environment. VR and AR offer great potential to improve critical care medicine for patients, relatives and health care providers. VR may help to ameliorate anxiety, stress, fear, and pain for the patient. It may assist patients in mobilisation and rehabilitation and can improve communication between all those involved in the patient’s care. AR can be an effective tool to support continuous education of intensive care medicine providers, and may complement traditional learning methods to acquire key practical competences such as central venous line placement, cardiopulmonary resuscitation, extracorporeal membrane oxygenation device management or endotracheal intubation. Currently, technical, human, and ethical challenges remain. The adaptation and integration of VR/AR modalities into useful clinical applications that can be used routinely on the ICU is challenging. Users may experience unwanted side effects (so-called “cybersickness”) during VR/AR sessions, which may limit its applicability. Furthermore, critically ill patients are one of the most vulnerable patient groups and warrant special ethical considerations if new technologies are to be introduced into their daily care. To date, most studies involving AR/VR in critical care medicine provide only a low level of evidence due to their research design. Here we summarise background information, current developments, and key considerations that should be taken into account for future scientific investigations in this field. Graphical abstract

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Virtual Reality Hypnosis for Anxiety and Pain Management in Intensive Care Units. A Prospective Randomized Trial Among Cardiac Surgery Patients.

Cited by 4 publications

References 29 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)

Virtual and augmented reality in critical care medicine: the patient’s, clinician’s, and researcher’s perspective

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