Acute and Critical Care

Original Articles

Pulmonary
Cinematic virtual reality for anxiety management in mechanically ventilated patients: a feasibility and pilot study: Alexander C. Haley, David A. Wacker; Acute Crit Care. 2022;37(2):230-236. Published online February 4, 2022; DOI: https://doi.org/10.4266/acc.2021.00843

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Background
Mechanically ventilated patients experience anxiety for many reasons. Pharmacological treatments such as benzodiazepines are commonly employed to manage anxiety; however, these therapies often cause undesired side effects. Additional therapies for anxiety management are needed. We sought to determine whether cell phone-based virtual reality therapy could feasibly be used for anxiety management in mechanically ventilated patients.
Methods
Mechanically ventilated subjects underwent at least one session of virtual reality therapy in which they were shown a cinematic video of an outdoor green space or blue space with 360° visual range of motion. Goal session duration was 5 minutes. The primary outcome was incidence of predefined patient safety events, including self-extubation and accidental removal of tubes or lines.
Results
Ten subjects underwent a total of 18 virtual reality sessions. Fifteen sessions lasted the planned 5 minutes, one session was extended at participant request, and two sessions were terminated early at participant request. There were no occurrences of the predefined safety events, and no occurrences of cybersickness. Use of a visual analog scale to measure anxiety level was feasible for this pilot study, demonstrating feasibility of this scale for future, larger scale studies.
Conclusions
Virtual reality therapy shows potential as a means of managing anxiety in patients undergoing mechanical ventilation, and further rigorous exploration with this protocol is feasible.

Citations

Citations to this article as recorded by

Virtual Reality Therapy for People With Epilepsy and Related Anxiety: Protocol for a 3-Phase Pilot Clinical Trial
Hannah Gabrielle Gray, Danielle Tchao, Samantha Lewis-Fung, Susanna Pardini, Laurence R Harris, Lora Appel
JMIR Research Protocols.2023; 12: e41523. CrossRef

Nursing
Intensive care unit professionals during the COVID-19 pandemic in Spain: social and work-related variables, COVID-19 symptoms, worries, and generalized anxiety levels: Fernando J. García-Hedrera, Fernanda Gil-Almagro, F. Javier Carmona-Monge, Cecilia Peñacoba-Puente, Patricia Catalá-Mesón, Lilian Velasco-Furlong; Acute Crit Care. 2021;36(3):232-241. Published online August 31, 2021; DOI: https://doi.org/10.4266/acc.2021.00213

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Abstract PDF

Background
The severe acute respiratory syndrome coronavirus 2 outbreak has been identified as a pandemic and global health emergency. It presents as a severe acute respiratory disease. The rapid dissemination of the disease created challenges for healthcare systems and forced healthcare workers (HCWs) to deal with many clinical and nonclinical stresses. The aim of our research is to describe work conditions, symptoms experienced by HCWs, worries about contagion, and generalized anxiety symptoms and compare those findings across regions in Spain. Methods: This cross-sectional study was conducted using an online survey. Critical care units throughout Spain were included. The sample comprised HCWs working in intensive care units from March to May 2020. We assessed work variables, physical symptoms, worries about contagion, and anxiety (generalized anxiety disorder-7 questionnaire). Results: The final sample comprised 448 surveys. Among the respondents, 86.9% (n=389) were nursing professionals, and 84.8% (n=380) were women. All participants cared for coronavirus disease 2019 (COVID-19) patients during the study period. Workload during the pandemic in Madrid was judged to be higher than in other regions (P<0.01). The availability of personal protective equipment was found to be higher in Cataluña. The most frequently experienced symptom was headaches (78.1%). Worries about self-infection and the possibility of infecting others received mean scores of 3.11 and 3.75, respectively. Mean scores for generalized anxiety levels were 11.02, with 58.7% of the professionals presenting with generalized anxiety syndrome during the assessment. Conclusions: In this study, we found high levels of anxiety among HCWs caring directly for COVID-19 patients, which could produce long-term psychological alterations that still need to be assessed.

Citations

Citations to this article as recorded by

Cognitive appraisals and coping strategies of registered nurses in the emergency department combating COVID ‐19: A scoping review
Chia‐Hung Lin, Shu‐Fen Siao, You‐Jie Lin, Pin‐Hsien Hsin, Mack Shelley, Yen‐Han Lee
Journal of Nursing Scholarship.2023; 55(1): 79. CrossRef
The impact of the COVID-19 pandemic on intensive care unit workers: a nationwide survey
Sangeeta Mehta, Christopher Yarnell, Sumesh Shah, Peter Dodek, Jeanna Parsons-Leigh, Robert Maunder, Jessica Kayitesi, Catherine Eta-Ndu, Fran Priestap, Danielle LeBlanc, Jennifer Chen, Kimia Honarmand
Canadian Journal of Anesthesia/Journal canadien d'anesthésie.2022; 69(4): 472. CrossRef

Neurology
The Effects of a Delirium Notification Program on the Clinical Outcomes of the Intensive Care Unit: A Preliminary Pilot Study: Jaesub Park, Seung-Taek Oh, Sunyoung Park, Won-Jung Choi, Cheung Soo Shin, Se Hee Na, Jae-Jin Kim, Jooyoung Oh, Jin Young Park; Acute Crit Care. 2018;33(1):23-33. Published online February 6, 2018; DOI: https://doi.org/10.4266/acc.2017.00584

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Abstract PDF

Background
Delirium is common among intensive care unit (ICU) patients, so recent clinical guidelines recommended routine delirium monitoring in the ICU. But, its effect on the patient’s clinical outcome is still controversial. In particular, the effect of systems that inform the primary physician of the results of monitoring is largely unknown.
Methods
The delirium notification program using bedside signs and electronic chart notifications was applied to the pre-existing delirium monitoring protocol. Every patient was routinely evaluated for delirium, pain, and anxiety using validated tools. Clinical outcomes, including duration of delirium, ICU stay, and mortality were reviewed and compared for 3 months before and after the program implementation.
Results
There was no significant difference between the two periods of delirium, ICU stay, and mortality. However, anxiety, an important prognostic factor in the ICU survivor’s mental health, was significantly reduced and pain tended to decrease.
Conclusions
Increasing the physician’s awareness of the patient’s mental state by using a notification program could reduce the anxiety of ICU patients even though it may not reduce delirium. The results suggested that the method of delivering the results of monitoring was also an important factor in the success of the delirium monitoring program.

Citations

Citations to this article as recorded by

Adaptation and Validation of a Chart‐Based Delirium Detection Tool for the ICU (CHART‐DEL‐ICU)
Karla D. Krewulak, Carmen Hiploylee, E. W. Ely, Henry T. Stelfox, Sharon K. Inouye, Kirsten M. Fiest
Journal of the American Geriatrics Society.2021; 69(4): 1027. CrossRef

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