Turon Marc, Fernandez-Gonzalo Sol, Jodar Mercè, Gomà Gemma, Montanya Jaume, Hernando David, Bailón Raquel, de Haro Candelaria, Gomez-Simon Victor, Lopez-Aguilar Josefina, Magrans Rudys, Martinez-Perez Melcior, Oliva Joan Carles, Blanch Lluís
Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Institut d'Investigació i Innovació Parc Taulí (I3PT), Fundació Parc Taulí, Sabadell, Spain.
Ann Intensive Care. 2017 Dec;7(1):81. doi: 10.1186/s13613-017-0303-4. Epub 2017 Aug 2.
Growing 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.
Twenty 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.
Patients 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.
The 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: NCT02078206.
越来越多的证据表明，危重病常常会导致三分之一的幸存者出现严重的长期神经认知障碍。尽管这些神经认知障碍对幸存者来说是长期存在且具有破坏性的，但在危重病期间或之后很少进行康复治疗。我们的目的是描述一种基于虚拟现实的针对危重病患者的早期神经认知刺激干预措施，并展示一项概念验证研究的结果，该研究测试了这种干预措施的可行性、安全性和适用性。
20名接受或已接受机械通气≥24小时的成年危重病患者在重症监护病房（ICU）住院期间清醒且警觉时，每天接受20分钟的神经认知刺激治疗。治疗过程中各阶段练习的难度逐渐增加。在每次治疗前、治疗期间和治疗后记录生理数据。通过心率、外周血氧饱和度和呼吸频率评估安全性。心率变异性分析是一种对认知需求敏感的自主神经活动间接测量方法，用于评估练习对刺激注意力和工作记忆的效果。
患者在大多数日子里都成功完成了治疗。没有因安全问题提前终止治疗，也未发生不良事件。心率变异性分析表明，这些练习刺激了注意力和工作记忆。危重病患者认为治疗过程愉快且轻松，不会过度疲劳。
这项概念验证研究的结果表明，基于虚拟现实的神经认知干预是可行、安全且可耐受的，能够刺激认知功能并让危重病患者感到满意。未来的研究将评估干预措施对神经认知结局的影响。试验注册Clinical trials.gov标识符：NCT02078206。
