Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
Department of Statistics, CNRS, Institut Montpelliérain Alexander Grothendieck (IMAG), University of Montpellier La Colombière Hospital, University of Montpellier, Montpellier, France.
Crit Care. 2022 Sep 3;26(1):263. doi: 10.1186/s13054-022-04136-4.
To assess the impact of different electronic relaxation devices on common stressful patient symptoms experienced in intensive care unit (ICU).
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.
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]).
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.
评估不同电子放松设备对重症监护病房（ICU）常见应激症状的影响。
60 名危重症患者采用随机交叉设计进行 4 次放松：标准放松（电视/收音机）、音乐疗法（MUSIC-CARE©）、使用真实电影（DEEPSEN©）或合成电影（HEALTHY-MIND©）的两种虚拟现实系统。目标是确定哪种设备最能减轻患者整体不适强度（0-10 数字评分量表（NRS）；主要终点）。次要终点为特定应激症状（疼痛、焦虑、呼吸困难、口渴和缺乏休息感）和应激反应，采用镇痛/伤害感受指数（ANI）测量。采用多变量混合效应分析，考虑患者特征和多次测量。
50 名患者完成了完整的研究方案，10 名患者至少完成了一次计划中的放松研究。HEALTHY-MIND©与整体不适的显著降低相关，这是主要终点（中位数 NRS=4[2-6] vs. 2[0-5]；p=0.01，混合效应模型），同时应激反应显著降低（ANI 增加，次要终点；p<0.01）。关于其他次要终点，两种虚拟现实系统中的每一种都与焦虑的降低相关（p<0.01），而 HEALTHY-MIND©还与疼痛的降低相关（p=0.001），DEEPSEN©与缺乏休息的降低相关（p=0.01）。109 次虚拟现实治疗中报告了 3 例事件（幽闭恐惧症/呼吸困难/烦躁不安）。电子游戏病很少见（NRS=0[0-0]）。
电子放松疗法是一种有前途、安全且有效的非药物解决方案，可用于改善警觉且无谵妄的 ICU 患者的整体不适。其有效性取决于技术特征（使用合成想象世界的虚拟现实与真实世界或不使用虚拟现实的音乐疗法）以及症状类型。
