Psychological sequelae in survivors of critical illness and the effect of intensive care unitspecific virtual reality

The Post-Intensive Care Syndrome (PICS) and Post-Intensive Care Syndrome (PICS-F) encompass the long-term consequences of ICU treatment for both the formerly critically ill patient as their relatives. For patients, these include impairments in their physical, cognitive or mental health state that arise after their critical illness and persist beyond acute care hospitalization. For relatives, these include impairments in the mental health state. For both patients and relatives, symptoms of PICS and PICS-F have a profound impact on quality of life. Although since the establishment of the term PICS and PICS-F in 2012 tremendous efforts have been made to quantify its sequelae and develop interventions to improve its outcomes, none have succeeded to robustly demonstrate a beneficial effect.
In the Rotterdam-Rijnmond region, symptoms of PICS are present in a considerable proportion, up to 59%, of patients, irrespective of the disease for which patients are admitted and symptoms persist for months after ICU discharge. Patients express a wish to receive visual information to make sense of what happened to them during their ICU stay. General practitioners (GPs) are the primary care physicians that patients return to most often and are often consulted by formed ICU patients, but they have a lack of familiarity with post-ICU sequelae, are inadequately informed about the ICU treatment but express a wish to be part of a multidisciplinary approach.
An innovative intervention using virtual reality (VR), intensive care unit-specific virtual reality (ICU-VR) has been developed to offer patients the treatment-related information of which they are in need and simultaneously virtually expose them to the ICU environment traumatizing them and help them put frightening, delusional memories into perspective. ICU-VR has been well tolerated in healthy volunteers and different cohorts of ICU patients and exposure to ICU-VR, both early after ICU discharge as later during a visit to an ICU follow-up clinic, appears feasible and acceptable, possibly resulting in increased satisfaction rates with ICU aftercare and improved psychological recovery. Ongoing research should definitely determine its clinical effect. Also, an altered version of ICU-VR to inform relatives of ICU patients about the ICU treatment is highly appreciated and safe to use, but did not influence psychological outcomes.
Lastly, the “Reporting of eArly-phase sTudies Evaluating applications using eXtended Reality” (RATE-XR) guideline represents an extensive international consensus effort and ensures comprehensive and standardized reporting of this early-phase evaluations of XR applications.