Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross-over randomized controlled trial E-CHOISIR (Electronic-CHOIce of a System for Intensive care Relaxation)

Lili Merliot-Gailhoustet; Chloé Raimbert; Océane Garnier; Julie Carr; Audrey De Jong; Nicolas Molinari; Samir Jaber; Gerald Chanques

doi:10.1186/s13054-022-04136-4

Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross-over randomized controlled trial E-CHOISIR (Electronic-CHOIce of a System for Intensive care Relaxation)

Crit Care. 2022 Sep 3;26(1):263. doi: 10.1186/s13054-022-04136-4.

Authors

Lili Merliot-Gailhoustet¹, Chloé Raimbert¹, Océane Garnier¹, Julie Carr¹, Audrey De Jong¹, Nicolas Molinari², Samir Jaber¹, Gerald Chanques³

Affiliations

¹ Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
² Department of Statistics, CNRS, Institut Montpelliérain Alexander Grothendieck (IMAG), University of Montpellier La Colombière Hospital, University of Montpellier, Montpellier, France.
³ Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France. gerald.chanques@umontpellier.fr.

Abstract

Purpose: To assess the impact of different electronic relaxation devices on common stressful patient symptoms experienced in intensive care unit (ICU).

Methods: Sixty critically ill patients were enrolled in four relaxation sessions using a randomized cross-over design: standard relaxation (TV/radio), music therapy (MUSIC-CARE©), and two virtual reality systems using either real motion pictures (DEEPSEN©) or synthetic motion pictures (HEALTHY-MIND©). The goal was to determine which device was the best to reduce overall patient discomfort intensity (0-10 Numeric Rating Scale (NRS); primary endpoint). Secondary endpoints were specific stressful symptoms (pain, anxiety, dyspnea, thirst, and lack of rest feeling) and stress response measured by Analgesia/Nociception Index (ANI). Multivariate mixed-effect analysis was used, taking into account patient characteristics and multiple measurements.

Results: Fifty patients followed the full research protocol, and ten patients did at least one research planned session of relaxation. HEALTHY-MIND© was associated with a significant decrease in overall discomfort, the primary endpoint (median NRS = 4[2-6] vs. 2[0-5]; p = 0.01, mixed-effect model), accompanied by a significant decrease in stress response (increase in ANI, secondary endpoint; p < 0.01). Regarding other secondary endpoints, each of the two virtual reality systems was associated with a decrease in anxiety (p < 0.01), while HEALTHY-MIND© was associated also with a decrease in pain (p = 0.001) and DEEPSEN© with a decrease in lack of rest (p = 0.01). Three incidents (claustrophobia/dyspnea/agitation) were reported among 109 virtual reality sessions. Cybersickness was rare (NRS = 0[0-0]).

Conclusion: Electronic relaxation therapy is a promising, safe, and effective non-pharmacological solution that can be used to improve overall discomfort in alert and non-delirious ICU patients. Its effectiveness depends on technical characteristics (virtual reality using a synthetic imagined world versus a real world or music therapy alone without virtual reality), as well as the type of symptoms.

Keywords: Intensive care; Music therapy; Non-pharmacological therapies; Supportive care; Virtual reality.

Publication types

Randomized Controlled Trial

MeSH terms

Critical Care* / methods
Critical Illness* / therapy
Cross-Over Studies
Dyspnea
Electronics
Humans
Pain