Dear editor:
Due to the impact of the epidemic, many medical institutions have strictly restricted intensive care unit (ICU) visits. Studies have shown that this may increase the incidence of delirium in patients (Pun et al., 2021). Some institutions are trying to open up visiting channels for patients at the end of life, but it seems that no institution has paid attention to the psychological problems of ICU patients during the recovery period (Mendiola et al., 2021). We use the fifth generation plus virtual reality (5G+VR) equipment to establish visitation channels, pay attention to the psychological state of ICU patients, hoping to comfort their hearts and promote recovery (Figure 1).
FIGURE 1.
(a–d) Patients were communicating with their families through the 5G+VR robot
Delirium is a common complication in the ICU, and its incidence can reach more than one third of all patients. Research evidence in recent years has shown that delirium is related to the hospital mortality, length of stay, duration of mechanical ventilation and costs (Neto et al., 2012). We believe that during the pandemic, whether it is a critically ill patient with COVID‐19 or caused by other reasons, due to the restriction of family visits, the incidence of delirium will increase significantly. Research by Westphal and his colleagues showed that lack of family visits is a risk factor for patients with delirium (Westphal et al., 2018). The PADIS guidelines suggest that a diversified combination of strategies should be used for the prevention and treatment of delirium (Devlin et al., 2018).
We conducted a cohort study between January 2021 and June 2021 to investigate the application of 5G+VR visiting in ICU. For patients and their families who requested 5G+VR visits, we announced the visitation rules during the epidemic and assessed whether the patients were able to communicate with their families. After the equipment use instruction and education, family members and patients were arranged to visit with 5G+VR robots prepared in advance, so that family members could participate in the rehabilitation process of patients. We collected information on patients who entered the surgical ICU due to surgery. The hospital anxiety depression scale (HADS), confusion assessment method of the intensive care unit (CAM‐ICU) and revised impact of event scale (IES‐R) scales before and after the visit were evaluated.
A total of 141 patients who were extubated after major surgery entered the study and 71 of these patients completed the full 5G+VR visitation process with their families, as shown in Table 1. The mean age in the 5G+VR group was 50.86 17.71 and the mean age in the no visitation group was 52.86 17.96 (p = 0.507). There was no significant difference in the number of female and male participants (p = 0.959), the acute physiology and chronic health evaluation II (APACHE II) score (p = 0.997) and the length of ICU stay (p = 0.682) between the two groups. After 5G+VR visitations, the patients' HADS scores decreased significantly (△HADS, 6.00 [3.00–11.00] vs. 4.00 [1.00–5.00], p = 0.001), along with a significant reduction in the proportion of delirium (1.41% vs. 10.00%, p = 0.027).
TABLE 1.
General characteristics of 5G+VR group and no visitation group
| Variables | 5G+VR group (n = 71) | No visitation group (n = 70) | p value |
|---|---|---|---|
| Age (years) | 50.86 ± 17.71 | 52.86 ± 17.96 | 0.507 |
| Sex (male, %) | 52, 73.24% | 51, 72.86% | 0.959 |
| APACHE II a | 6.00 (5.00–7.00) | 6.00 (4.00–7.00) | 0.997 |
| Length of ICU stay (days) a | 6.00 (4.00–8.00) | 6.00 (4.00–7.00) | 0.682 |
| Delirium before intervention (CAM‐ICU positive, n/%) | 9, 12.68% | 10, 14.29% | 0.780 |
| Delirium after intervention (CAM‐ICU positive, n/%) | 1, 1.41% | 7, 10.00% | 0.027 |
| HADS before intervention a | 11.00 (6.00–14.00) | 11.00 (5.00–14.00) | 0.883 |
| HADS after intervention a | 3.00 (2.00–6.00) | 6.00 (1.75–10.00) | 0.004 |
| △HADS a | 6.00 (3.00–11.00) | 4.00 (1.00–5.00) | 0.001 |
| IES‐R after leaving ICU a | 14.00 (9.00–22.00) | 15.50 (10.00–23.00) | 0.493 |
Note: △HADS, HADS before intervention‐HADS after intervention. Bold text is for statistical p‐values less than 0.05.
Abbreviations: 5G+VR, the fifth generation plus virtual reality; APACHE II, acute physiology and chronic health evaluation II; CAM‐ICU, confusion assessment method of the intensive care unit; HADS, hospital anxiety depression scale; ICU, intensive care unit; IES‐R, the revised impact of event scale.
Nonnormally distributed variable: median (interquartile range).
For people who do not know about intensive care, lying in the ICU is a very scary thing. Without the visit and company of family members, psychological disorders may occur, which affects the prognosis. Our department adopted a 5G+VR system to establish communication between patients and their families (Figure 1a) due to restricted visitation opportunities in the ICU as a result of epidemic control measures. This is in line with redirection and cognitive stimulation approaches in care guidelines. Unlike traditional video chatting, the VR technology provides a 360 panoramic view (Figure 1b) to enhance sense of reality and help the patient's temporal and spatial orientation. During the visit, the user can turn his/her head to the direction he/she wants to look at, and talk through the microphone at the same time, as if communicating face‐to‐face with his family (Figure 1c,d).
The application of the 5G+VR system in the ICU can not only meet the visiting needs of family members and patients during this special period of the epidemic but also reduce the occurrence of delirium. This may reduce the nursing workload and the need for analgesic and sedative drugs. Communicating in such a visual way allows family members, who are in a state of confusion, to better understand what is happening to the patient, while informing them of the many efforts made by the caregivers to help the patient recover from the disease.
ETHICS APPROVAL AND CONSENT TO PARTICIPATE
All procedures performed in this letter were approved by the ethics committee of West China Hospital.
CONSENT FOR PUBLICATION
The use of the photo has been approved by the patient and family members.
CONFLICT OF INTEREST
We declare no competing interests.
AUTHOR CONTRIBUTIONS
CH and XJ conducted the visiting plan. MH prepared the manuscript. XL and TZ conducted the photo collection. CH and MH reviewed and finalized the manuscript.
ACKNOWLEDGEMENT
No applicable.
DATA AVAILABILITY STATEMENT
Not applicable.
REFERENCES
- Devlin, J. W. , Skrobik, Y. , Gélinas, C. , Needham, D. M. , Slooter, A. J. C. , Pandharipande, P. P. , Watson, P. L. , Weinhouse, G. L. , Nunnally, M. E. , Rochwerg, B. , Balas, M. C. , Van den Boogaard, M. , Bosma, K. J. , Brummel, N. E. , Chanques, G. , Denehy, L. , Drouot, X. , Fraser, G. L. , Harris, J. E. , … Alhazzani, W. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825–e873. 10.1097/CCM.0000000000003299 [DOI] [PubMed] [Google Scholar]
- Mendiola, B. , Gomez, C. , Furst, C. , & Rasmussen‐Winkler, J. (2021). Facilitating virtual visitation in critical care units during a pandemic. Holistic Nursing Practice, 35(2), 60–64. 10.1097/HNP.0000000000000432 [DOI] [PubMed] [Google Scholar]
- Neto, A. S. , Nassar, A. P. Jr. , Cardoso, S. O. , Manetta, J. A. , Pereira, V. G. , Espósito, D. C. , Damasceno, M. C. , & Slooter, A. J. (2012). Delirium screening in critically ill patients: A systematic review and meta‐analysis. Critical Care Medicine, 40(6), 1946–1951. 10.1097/CCM.0b013e31824e16c9 [DOI] [PubMed] [Google Scholar]
- Pun, B. T. , Badenes, R. , Heras La Calle, G. , et al. (2021). Prevalence and risk factors for delirium in critically ill patients with COVID‐19 (COVID‐D): A multicentre cohort study. The Lancet. Respiratory Medicine, 9(3), 239–250. 10.1016/S2213-2600(20)30552-X [DOI] [PMC free article] [PubMed] [Google Scholar]
- Westphal, G. A. , Moerschberger, M. S. , Vollmann, D. D. , Inácio, A. C. , Machado, M. C. , Sperotto, G. , Cavalcanti, A. B. , & Koenig, Á. (2018). Effect of a 24‐h extended visiting policy on delirium in critically ill patients. Intensive Care Medicine, 44(6), 968–970. 10.1007/s00134-018-5153-5 [DOI] [PubMed] [Google Scholar]
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Data Availability Statement
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