VR Interventions to Reduce the Prevalence of Delirium in ICU Patients

Effects of Multi-model Virtual Reality Intervention Method to Reduce the Prevalence of Delirium in ICU Patients With Mechanical Ventilation

Delirium is an extremely common complication in mechanically ventilated ICU patients, which can decrease the patients' cognitive function, prolong hospitalization, and even increase mortality. But there is currently no validated treatment for delirium. Therefore, this study aims to build a multi-modal virtual reality (VR) intervention environment to conduct comprehensive interventions in psychological, physiological, and cognitive aspects for ICU mechanically intubated patients, which will be used to improve the hospitalization experience, reduce the prevalence of delirium, and decrease the duration of ICU stay of patients on mechanical ventilation.

Firstly, the investigators will explore the synergistic mechanism among the sense of presence in virtual environments (VEs), the factor of emotion induction, and the cognitive activation of the neural system for building a beneficial VE for the patients' mental health. On this basis, the investigators will provide the social connection for mechanical ventilation patients by applying cross-platform collaboration VR technology, thereby reducing the negative impact of social isolation, improving the psychological loneliness caused by the separation of family members and patients in the epidemic, and improving the mental health of patients. In terms of physiology, this study will use VR pain distraction technology to improve analgesia in ICU mechanically ventilated patients based on attention-shifting mechanisms. Finally, the investigators will use the paradigm of psychological relief, physiological analgesia, and neurocognitive activation to construct a comprehensive VR cognitive aided diagnosis and cognitive intervention system, and try to assist in the diagnosis and intervention of delirium.

Patients wear head-mounted displays and experience high immersive virtual environments for treatment.

The incidence of delirium is monitored and evaluated by the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The CAM-ICU has four items ((1) altered mental status/fluctuating course, (2)inattention, (3) altered level of consciousness, and (4) disorganized thinking) and each item has two factors (positive or negative). The physicians can diagnose the patients with delirium when the results of item (1), item (2), and item (3) or item (4) are positive.

The blood pressure(mmHg) will be collected from a bedside monitor after the intervention. Both Systolic and Diastolic Blood Pressure will be measured.

The oxygen saturation level (SpO2, %) will be collected from a bedside monitor after the intervention.

The activation of cranial nerve signals will be collected from a bedside monitor after the intervention.

The CPOT includes 4 items, facial expression, physical activity, muscle tone, and ventilation compliance or vocalization. Each item is rated 0-2 points, and the total scale is 0-8 points. The degree of pain is becoming more severe with the increase in total score.

The BPS includes 3 items: facial expression, upper extremity movement, ventilation compliance (intubated patients), or vocalization (non-intubated patients), each item is scored from 1 to 4, with a total score of 3 to 12. The degree of pain is becoming more severe with the increase in total score.

The number of acute cardiac events is assessed by analgesic drug dosage, which is recorded by the physicians and nurses.

The family satisfaction level is evaluated by the Family Satisfaction with the ICU Survey (FS-ICU), which can evaluate the family's satisfaction with care (FS-Care) and satisfaction with decision making (FS-DM). The results include the calculated score on the total instrument (FS-Total) and the calculated scores for the 2 subscales (FS-Care & FS-DM).

The HADS is a 14-item(1 - 4 points) measure designed to assess anxiety and depression symptoms in medical patients. The HADS produces two scales, one for anxiety (HADS-A) and one for depression (HADS-D). Scores higher than 11 on either scale indicate a definitive case.

The IES-R is designed as a measure of post-traumatic stress disorder (PTSD) symptoms, which includes three subscales, intrusion, avoidance, and hyperarousal. It has 22 items(0 - 4 points), and the total score ranges from 0 to 88 points. 0-8 stands for subclinical, 9-25 stands for mild, 26-43 stands for moderate, and 44-88 stands for severe.

The PHQ-9 is used for regular depression screenings and includes 9 questions(0 - 3 points). The higher the score, the more severe symptoms of depression.

PANAS is used to test positive and negative emotions in patients. It consists of 20 items (0-4 points) with 10 items for each emotion (0-40 total). The higher the score, the stronger the feeling.

Inclusion Criteria: Estimated duration of mechanical ventilation ≥ 72 hours. Aged ≥ 18 years old. Language: Chinese. Richmond Agitation Sedation Scale (RASS) ≥ -2. Exclusion Criteria: Severe visual or auditory impairment. Cognitive and consciousness impairment prior to ICU admission. Severe motion sickness. Head trauma or surgery that makes it impossible to wear VR devices.