Remote Virtual Reality Exposure Therapy for Post-Intensive Care Syndrome

ABSTRACT

Background: Post-intensive care syndrome (PICS) affects up to half of ICU patients and comprises neuromuscular, cognitive, and psychiatric impairments that persist up to years after discharge (Inoue, 2019). PICS is often overlooked and under-diagnosed (Rawal, 2017), without clear evidence-based strategies for management. Data supporting interventions for symptoms of anxiety, depression, and post-traumatic stress after discharge is limited (Needham, 2012). Developing high-quality, evidence-based interventions for PICS would address this critical need. Methods: Shortly before discharge, patients are recruited from our neurological ICU who have been intubated for at least 24 hours and score 24–32 on the Impact of Event Scale - Revised (which indicates likely PTSD symptoms without a true diagnosis). Baseline Beck Depression Index and Telephone Interview for Cognitive Status questionnaires are also administered to each patient. Participants are then randomly assigned either to a virtual reality exposure therapy intervention or to a control group that receives no therapeutic intervention. VRET patients are given an online 360° video of an ICU room from the perspective of an intubated patient, complete with sounds and simulated clinical scenarios (rounds, intubation, suctioning, etc.). Intervention patients have unlimited access to the videos for six months, beginning one month after discharge. Follow-up IES-R, BDI, and TICS are administered at 1, 3, and 6 months to both groups. Results/Discussion: Our IRB approved this study in March 2021. Enrollment has begun with 3–5 feasibility patients, to be followed by 30 randomized patients starting in November. Our poster features a case discussion on our first patient's experiences with VRET. Given the novelty of remote VRET for post-ICU PTSD symptoms, our results will be an important contribution with the potential to change practice. Conclusion: This will be the first remote intervention for neuropsychiatric symptoms of PICS, and has far-reaching implications for inpatient and outpatient CL psychiatrists — particularly at a time when patients have grown increasingly accustomed to virtual interventions, and when ICU survivors have multiplied due to COVID-19. Should our VRET prove successful, it will open the eyes of intensivists and CL psychiatrists to a whole realm of remote, efficient, and accessible virtual reality therapies for patients who have undergone acute care. This will improve long-term outcomes, particularly for patients who may have difficulty seeing an outpatient psychiatrist or taking medications consistently. Finally, our study will help to raise awareness of the psychiatric sequelae of acute illness, and so enhance inpatient collaboration between psychiatry and many other specialties. References 1. Inoue S et al. Post-intensive care syndrome its pathophysiology, prevention, and future directions. Acute Med Surg. 2019;(3)233-246. 2. Needham DM et al. Improving long-term outcomes after discharge from intensive care unit report from a stakeholders’ conference. Crit Care Med. 2012;40(2)502-9. 3. Rawal G et al. Post-intensive Care Syndrome an Overview. J Transl Int Med. 2017;5(2)90-92.