Virtual Reality-Based Early Neurocognitive Stimulation in Critically Ill Patients: A Pilot Randomized Clinical Trial.

Guillem Navarra-Ventura,Raquel Bailón,David Hernando,Josefina López-Aguilar,Leonardo Sarlabous,Candelaria De Haro,Mercè Jodar,Gemma Gomà,Ana Ochagavía,Lluís Blanch,Sol Fernández-Gonzalo

doi:10.3390/jpm11121260

Abstract

This study focuses on the application of a non-immersive virtual reality (VR)-based neurocognitive intervention in critically ill patients. Our aim was to assess the feasibility of direct outcome measures to detect the impact of this digital therapy on patients’ cognitive and emotional outcomes. Seventy-two mechanically ventilated adult patients were randomly assigned to the “treatment as usual” (TAU, n = 38) or the “early neurocognitive stimulation” (ENRIC, n = 34) groups. All patients received standard intensive care unit (ICU) care. Patients in the ENRIC group also received adjuvant neurocognitive stimulation during the ICU stay. Outcome measures were a full neuropsychological battery and two mental health questionnaires. A total of 42 patients (21 ENRIC) completed assessment one month after ICU discharge, and 24 (10 ENRIC) one year later. At one-month follow-up, ENRIC patients had better working memory scores (p = 0.009, d = 0.363) and showed up to 50% less non-specific anxiety (11.8% vs. 21.1%) and depression (5.9% vs. 10.5%) than TAU patients. A general linear model of repeated measures reported a main effect of group, but not of time or group–time interaction, on working memory, with ENRIC patients outperforming TAU patients (p = 0.008, ηp2 = 0.282). Our results suggest that non-immersive VR-based neurocognitive stimulation may help improve short-term working memory outcomes in survivors of critical illness. Moreover, this advantage could be maintained in the long term. An efficacy trial in a larger sample of participants is feasible and must be conducted.

Highlights

Half of intensive care unit (ICU) survivors develop post-intensive care syndrome (PICS) [1], which comprises a set of acquired physical, cognitive, and emotional deficits that negatively affect the quality of life of patients and their families [2]
We developed the Early Neurocognitive Rehabilitation in Intensive Care (ENRIC) platform, an innovative non-immersive virtual reality (VR)-based early neurocognitive intervention designed for the ICU environment and the mechanical ventilation (MV) patient
We only found a main effect of group in the working memory index, with ENRIC patients outperforming TAU patients (p = 0.008, ηp 2 = 0.282)

Summary

Introduction

Half of intensive care unit (ICU) survivors develop post-intensive care syndrome (PICS) [1], which comprises a set of acquired physical, cognitive, and emotional deficits that negatively affect the quality of life of patients and their families [2]. The cognitive impairment associated with PICS resembles that of mild-to-moderate dementia [6] and may persist for years after discharge [7] This impairment can adopt different phenotypes depending on the severity of dysfunction and the cognitive domains affected, being especially pronounced in memory, executive functions, and processing speed [8]. Greater cognitive reserve, i.e., the brain’s resistance to pathological changes [9], may be a protective factor [10,11,12]

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