Feasibility and safety of virtual-reality-based early neurocognitive stimulation in critically ill patients

Marc Turon,Sol Fernandez-Gonzalo,Joan Carles Oliva,Victor Gomez-Simon,Gemma Gomà,Melcior Martinez-Perez,David Hernando,Mercè Jodar,Jaume Montanya,Josefina Lopez-Aguilar,Rudys Magrans,Lluís Blanch,Candelaria De Haro,Raquel Bailón

doi:10.1186/s13613-017-0303-4

Abstract

BackgroundGrowing 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.MethodsTwenty 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.ResultsPatients 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.ConclusionsThe 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

Highlights

Growing evidence suggests that critical illness often results in significant long-term neurocognitive impairments in one-third of survivors
This paper describes a virtual-reality-based early neurocognitive stimulation intervention in critically ill patients and presents preliminary results of a proof-ofconcept study to assess the feasibility and safety of the intervention, its tolerability in terms of difficulty and cognitive load, and the effectiveness of the cognitive exercises in stimulating the brain
Patients’ clinical and sociodemographic characteristics Between April 2014 and December 2014, 193 patients were admitted to the intensive care units (ICU); 148 met at least one exclusion criterion

Summary

Introduction

Growing evidence suggests that critical illness often results in significant long-term neurocognitive impairments in one-third of survivors. These neurocognitive impairments are long-lasting and devastating for survivors, rehabilitation rarely occurs during or after critical illness. Growing evidence suggests that critical illness often results in significant long-term morbidities. Rehabilitation strategies during the ICU stay have mainly involved physical interventions such as early mobilizations [13,14,15,16] to enhance functional recovery. Early rehabilitation strategies in the ICU have been extended beyond physical therapy to include cognitive interventions [19]

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