Virtual reality and hypnosis for anxiety and pain management in intensive care units

Abstract

BACKGROUND Virtual reality and hypnosis are little studied in complex contexts, such as intensive care, where patients need significant physical and psychological assistance. OBJECTIVES To compare and combine hypnosis and virtual reality benefits on anxiety and pain on patients before and after cardiac surgery. DESIGN Prospective randomised controlled clinical trial. SETTING The study was conducted in the University Hospital of Liege (Belgium) from October 2018 to January 2020. PATIENTS One hundred patients (66 ± 11.5 years; 24 women, 76 men) were included. Participants were adults undergoing cardiac surgery. Exclusion criteria: psychiatric diseases, claustrophobia, acrophobia, hearing loss, visual impairment, extreme fatigue, confusion surgery cancelled. INTERVENTIONS Patients were randomly assigned to four arms (control; hypnosis; virtual reality; virtual reality hypnosis) and had 20 min of one of the techniques the day before and the day after surgery. MAIN OUTCOMES MEASURES Anxiety, pain, fatigue, relaxation, physiological parameters, and opioid use were evaluated before and after each session. RESULTS The main results did not show any significant differences between the groups. In all groups, anxiety decreased and pain increased from baseline to the postoperative day. Relaxation increased in all groups in the pre-operative ( P < 0.0001) and postoperative period ( P = 0.03). There were no significant differences for fatigue, physiological measures, or opioid use. CONCLUSION As there were no significant differences between groups for the measured variables, we cannot affirm that one technique is better than another. Additional studies are required to compare and evaluate the cost-effectiveness of these techniques for critical care patients and caregivers. TRIAL REGISTRATION ClinicalTrials.gov: NCT03820700. https://clinicaltrials.gov/ct2/show/NCT03820700 . Retrospectively registered on 29 January 2019.

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

“…[ 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 cost-effectiveness.…”

“…In conclusion, many studies suggest a positive effect of VR on stress, anxiety, and delirium in critically ill patients. To date, the largest, prospective, randomised-controlled trials in this area have shown neutral [ 11 ] or positive [ 3 ] results.…”

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)

“…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 ].…”

“…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.…”

Virtual reality in intensive care

“…Rousseaux et al in a randomised controlled trial of 100 patients, tested the use of "virtual reality hypnosis" in patients one day before and one day after cardiac surgery. In this small study, there were no significant differences with regards to the outcome measures (anxiety, pain, fatigue, relaxation, physiological parameters, and opioid use) [ 8 ]. A randomised controlled trial of 48 patients evaluated the positive effects of VR on the quality of sleep in ICU patients: VR resulted in a significantly better sleep quality, although total sleep time and light sleep time did not differ between the groups [ 9 ].…”