Abstract
Background/Aim: Using a within-subjects, within-wound care design, this pilot study tested for the first time, whether immersive virtual reality (VR) can serve as an adjunctive non-opioid analgesic for children with large severe burn wounds during burn wound cleaning in the ICU, in a regional burn center in the United States, between 2014–2016.Methods: Participants included 48 children from 6 years old to 17 years of age with >10% TBSA burn injuries reporting moderate or higher worst pain during no VR on Day 1. Forty-four of the 48 children were from developing Latin American countries. Patients played adjunctive SnowWorld, an interactive 3D snowy canyon in virtual reality during some portions of wound care, vs. No VR during comparable portions of the same wound care session (initial treatment condition randomized). Using Graphic Rating scales, children's worst pain ratings during “No VR” (treatment as usual pain medications) vs. their worst pain during “Yes VR” was measured during at least 1 day of wound care, and was measured for up to 10 study days the patient used VR.Results: VR significantly reduced children's “worst pain” ratings during burn wound cleaning procedures in the ICU on Day 1. Worst pain during No VR = 8.52 (SD = 1.75) vs. during Yes VR = 5.10 (SD = 3.27), t(47) = 7.11, p < 0.001, SD = 3.33, CI = 2.45–4.38, Cohen's d = 1.03 (indicating large effect size). Patients continued to report the predicted pattern of lower pain and more fun during VR, during multiple sessions.Conclusion: Immersive virtual reality can help reduce the pain of children with large severe burn wounds during burn wound cleaning in the Intensive Care Unit. Additional research and development is recommended.
Highlights
Acute pain is a frequent medical problem world wide, but children with large severe burn injuries (e.g., 40% Total Body Surface Area (TBSA)) experience some of the most painful procedures in medicine
The current study introduced for the first time, a new portable water-friendly Virtual reality (VR) system customized for the unique needs of pediatric patients with large severe burn injuries during wound care in the intensive care unit hydrotank
Using VR in the ICU hydrotank room was challenging and required creating custom equipment, in the current study, on Day 1, patients reported significant reductions in worst pain, children spent less time thinking about their pain during VR, children reported significant reductions in pain unpleasantness, and the children reported 27% higher ratings of fun during wound care during virtual reality
Summary
Acute pain is a frequent medical problem world wide, but children with large severe burn injuries (e.g., 40% TBSA) experience some of the most painful procedures in medicine. 1664) “In developing countries, access to opioids is very limited. Patients in Latin American often have limited access to opioids for pain control (used for both analgesia and anesthesia). Even in the U.S.A., there are currently shortages of pharmaceutical medical opioid analgesics needed for acute pain control during medical procedures (Davis et al, 2018). Because of a large increase in opioid related overdose deaths unrelated to burn patients (Chen et al, 2019), there is growing political and legal pressure to further reduce reliance on opioids for pain control in the U.S.A
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