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Cited by 65Virtual Reality Applications and ImpactsIntensive Care Unit Cognitive DisordersMusic Therapy and Health

Feasibility of a virtual reality intervention in the intensive care unit

Open access
Jawed, Yameena T., Golovyan, Dmitriy, Lopez, David, Khan, Sikandar H., Wang, Sophia, Freund, Chauncey, Imran, Sundus, Hameed, Usman Bin +3 more·2021·Heart & Lung
DOI 10.1016/j.hrtlng.2021.05.007PMC PMC10266374
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Abstract

Background: Delirium prevention requires optimal management of pain and anxiety. Given the limitations of current pharmacologic interventions, evaluation of novel non-pharmacological interventions is required. Virtual reality (VR) stimulation may be a promising intervention because of its capability to reduce psychophysiological stress, pain, and anxiety and to restore cognitive and attentional capacities. Objective: To ascertain patients’ and providers’ perceptions of acceptability and safety of VR intervention in the intensive care unit (ICU). Methods: We enrolled a cohort of 15 ICU patients and 21 health care providers to administer a 15-minute session showing a relaxing beach scene with VR headsets and nature sound effects. Participants were then asked to rate their experiences on a Likert scale survey. Results: The majority of patients (86%, 12 of 14) rated the headsets as moderately to very comfortable. All had moderate or greater sense of presence in the virtual environment, and 79% (11 of 14) rated their overall experience at 3 or greater (5 indicating that they enjoyed it very much). Seventy-one percent (10 of 14) of the patients felt that their anxiety was better with VR, and 57% (8 of 14) did not notice a change in their pain or discomfort. All health care providers found the headset to be at least moderately comfortable and felt a moderate or greater sense of presence. All providers concluded that VR therapy should be available for their patients. Both groups experienced minimal side effects. Conclusion: In this prospective study of perceptions of VR therapy for ICU patients and health care providers, there was a high level of acceptance, with minimal side effects, for both groups despite their low levels of prior experience with virtual reality and video gaming. © 2021 Elsevier Inc.

Integrity signals

Registry

Crossref · 10.1016/j.hrtlng.2021.05.007

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

19 of 37 cited sources checked · 12 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Viewing water landscapes is linked to greater neural activation in the brain's attention area.

    “Viewing water landscapes were associated with increased neural activation in the attention area of the brain.14”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [14] Tang, 2017, Using functional Magnetic Resonance Imaging (fMRI) to analyze brain region activity when viewing landscapes, Landsc Urban Plan source

      Section 3.2.3 reports activation in attention-related regions for the “urban versus water” contrast. The Discussion (section 4) interprets viewing water after urban landscapes as enabling the attention system to rest, not as increasing activation in its attention area. No page numbers are available in our copy. (LLM, conf=0.86)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    A previous study of immersive HMD in an ICU setting excluded mechanically ventilated patients.

    “Another study involving immersive HMD in an ICU setting excluded mechanically ventilated patients.30”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [30] Ong, 2020, Improving the intensive care patient experience with virtual reality-a feasibility study, Crit Care Explor source
  • Premisecitation

    The proportion of mechanically ventilated patients (40%) was fairly representative of the national average of ICU beds receiving mechanical ventilation.

    “However, the mechanically ventilated population (40%) was fairly representative of the national average of ICU beds receiving mechanical ventilation.34”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [34] Wunsch, 2013, ICU occupancy and mechanical ventilator use in the United States, Crit Care Med source

      The Results section (‘Use of mechanical ventilation’; page not provided) reports that a mean of 39.5% of ICU patients were mechanically ventilated, supporting the cited 40% patient proportion. But it reports that 29.0% of ICU beds were occupied by ventilated patients, so 40% does not match the paper’s bed-based average. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
  • Findingown data

    Most providers worried about equipment malfunction, such as tangled headphone wires or lost equipment.

    “When asked about potential problems with implementation of VR in their ICU, most were concerned about malfunction of equipment, such as tangling of headphone wires or the loss of equipment.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.
  • Findingown data

    No major safety events occurred in the patient group.

    “No major safety events, such as earphones getting tangled with the intravenous catheters or headsets slipping onto the endotracheal tubes, occurred in the patient group.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.
  • May combine two claims. 30
  • Classified as probably not a substantial claim. 7
  • The quote only partly states this claim. 2

  • May combine two claims.

    Premisecitation

    Virtual reality stimulation may reduce psychophysiological stress, pain, and anxiety and may restore cognitive and attentional capacities.

    “Virtual reality (VR) stimulation may be a promising intervention because of its capability to reduce psychophysiological stress, pain, and anxiety and to restore cognitive and attentional capacities.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [7] Spiegel, 2019, Virtual reality for management of pain in hospitalized patients: a randomized comparative effectiveness trial, PLoS ONE source

      The Introduction describes VR as a treatment for pain and says it has been used to help treat anxiety disorders; the Discussion reports reduced inpatient pain in this trial. Neither section supports a reduction in psychophysiological stress or restoration of cognitive and attentional capacities. The Discussion describes attention as part of a proposed pain-distraction mechanism, not as a capacity restored by VR (page numbers not provided). (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [8] Tashjian, 2017, Virtual reality for management of pain in hospitalized patients: results of a controlled trial, JMIR Ment Health source

      The Discussion reports that a 15-minute VR intervention reduced pain in hospitalized patients compared with a distraction video, and the Introduction describes VR being used to treat anxiety disorders. Our copy does not support the claimed reduction in psychophysiological stress or restoration of cognitive and attentional capacities; the Discussion instead describes VR as occupying attention to distract from pain. The Results report no significant change in blood pressure or heart rate. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [9] Mosso-Vazquez, 2014, Virtual reality for pain management in cardiac surgery, Cyberpsychol Behav Soc Netw source

  • May combine two claims.

    Premisecitation

    Virtual reality has shown early effectiveness in lowering pain and anxiety in hospitalized and post-operative patients and is well tolerated for cognitive and motor rehabilitation.

    “VR has shown initial efficacy in hospitalized7, 8 and post-operative9 patients in reducing pain and anxiety,10 and it is well-tolerated by the patients when used for cognitive and motor rehabilitation.11”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [7] Spiegel, 2019, Virtual reality for management of pain in hospitalized patients: a randomized comparative effectiveness trial, PLoS ONE source
    • cites [8] Tashjian, 2017, Virtual reality for management of pain in hospitalized patients: results of a controlled trial, JMIR Ment Health source
    • cites [9] Mosso-Vazquez, 2014, Virtual reality for pain management in cardiac surgery, Cyberpsychol Behav Soc Netw source

  • May combine two claims.

    Premisecitation

    Viewing natural elements promotes physiological relaxation, lowers stress, improves mood, and aids recovery after a stressful event.

    “Previous studies have shown that viewing elements of nature promotes physiological relaxation,12 reduces stress, improves mood,13 and enhances the recovery process following a stressful event.15”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [12] Jo, 2019, Physiological benefits of viewing nature: a systematic review of indoor experiments, Int J Environ Res Public Health source
    • cites [13] Anderson, 2017, Relaxation with immersive natural scenes presented using virtual reality, Aerosp Med Hum Perform source
    • cites [15] Brown, 2013, Viewing nature scenes positively affects recovery of autonomic function following acute-mental stress, Environ Sci Technol source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The sense of presence questions were based on the Igroup Presence Questionnaire, which has been used in earlier VR research.

    “These questions were modeled after sense of presence surveys, such as the Igroup Presence Questionnaire,18 which has ben used in prior virtual reality research.18–20”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [18] Slater, 1993, Representations systems, perceptual position, and presence in immersive virtual environments, Presence source
    • cites [19] Hoffman, 2008, Virtual reality pain control during burn wound debridement in the hydrotank, Clin J Pain source
    • cites [20] Gerber, 2019, Perception and performance on a virtual reality cognitive stimulation for use in the intensive care unit: a non-randomized trial in critically ill patients, Front Med (Lausanne) source

  • May combine two claims.

    Premisecitation

    Critically ill patients often receive analgesics and sedatives for pain and anxiety, and these drugs are linked to a higher risk of delirium.

    “Critically ill patients commonly receive analgesics and sedatives for management of pain and anxiety,5,6 and these medicines themselves are associated with an increased risk of delirium.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [5] Tate, 2012, Anxiety and agitation in mechanically ventilated patients, Qual Health Res source
    • cites [6] Pandharipande, 2005, Narcotic-based sedation regimens for critically ill mechanically ventilated patients, Critical Care source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    VR has been shown to reduce preoperative anxiety and can serve as a pleasant distraction during outpatient procedures.

    “VR has shown to decrease preoperative anxiety20 and can serve as a pleasant distraction during outpatient procedures.21”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [20] Gerber, 2019, Perception and performance on a virtual reality cognitive stimulation for use in the intensive care unit: a non-randomized trial in critically ill patients, Front Med (Lausanne) source

      Citation 21 is attached to the claim about pleasant distraction during outpatient procedures, not the separate preoperative-anxiety claim. The Discussion (Acceptance, Comfort, and Recollection; page unavailable) says patients appreciated VR and that it distracted them from the stressful ICU, but the study did not examine outpatient procedures. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [21] Slater, 1997, A framework for immersive virtual environments (FIVE): speculations on the role of presence in virtual environments, Presence source

  • May combine two claims.

    Premisecitation

    Visual exposure to natural environments relaxes patients and can protect against environmental stressors.

    “We used a natural VR landscape experience since previous research studies have suggested that visual exposure to natural environments has a relaxing effect on patients and can protect against environmental stressors.13, 31”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [13] Anderson, 2017, Relaxation with immersive natural scenes presented using virtual reality, Aerosp Med Hum Perform source
    • cites [31] Gerber, 2017, Visuo-acoustic stimulation that helps you to relax: a virtual reality setup for patients in the intensive care unit, Sci Rep source

      The Introduction says prior research suggests that visual exposure to natural environments protects against environmental stressors and has restorative effects. The Discussion (Principal Results) reports a relaxing effect from virtual nature exposure, but the participants were healthy; the Limitations section says it remains unclear whether the findings generalize to critically ill patients. The claim's patient-specific wording therefore goes beyond this paper's findings. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In ICU patients, common reasons for stopping VR therapy include fatigue, extreme sleepiness, and confusion.

    “Turon et al. reported fatigue (50%), extreme sleepiness (20%), and confusion (10%) to be common reasons for discontinuing VR therapy sessions in ICU patients.29”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [29] Turon, 2017, Feasibility and safety of virtual-reality-based early neurocognitive stimulation in critically ill patients, Ann Intensive Care source

  • May combine two claims.

    Premisecitation

    Prior literature reports minimal risk of cybersickness and major adverse events, consistent with this study's findings.

    “In our review of the literature for various studies, the risk of cybersickness and major adverse events reported is minimal and is in line with the findings of our study.7, 31”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [7] Spiegel, 2019, Virtual reality for management of pain in hospitalized patients: a randomized comparative effectiveness trial, PLoS ONE source
    • cites [31] Gerber, 2017, Visuo-acoustic stimulation that helps you to relax: a virtual reality setup for patients in the intensive care unit, Sci Rep source

      The Results (Analysis of immersion, presence, sickness and usability) report low sickness ratings, and the Discussion (Questionnaire) describes cybersickness symptoms as negligible in 37 healthy participants. The paper does not report a rate of major adverse events or establish minimal risk across the broader literature; it also cautions that generalization to critically ill patients is unclear. Page numbers are unavailable in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Evidence shows VR-based neurocognitive intervention is feasible, safe, and tolerable in critically ill patients with the goal of improving neurocognitive outcomes.

    “Moreover, evidence demonstrates that virtual reality-based neurocognitive intervention is feasible, safe, and tolerable in critically ill patients with a goal of improving neurocognitive outcomes.29”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [29] Turon, 2017, Feasibility and safety of virtual-reality-based early neurocognitive stimulation in critically ill patients, Ann Intensive Care source

  • May combine two claims.

    Premisecitation

    HMD-based VR allows more natural visual exploration and greater immersion than a desktop screen.

    “Contrary to the desktop screen, HMD provides a more natural visual exploration and allows for greater immersion.31”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [31] Gerber, 2017, Visuo-acoustic stimulation that helps you to relax: a virtual reality setup for patients in the intensive care unit, Sci Rep source

  • May combine two claims.

    Findingown data

    Two providers had slight dizziness, and one provider had slight dizziness, nausea, and headache.

    “Two providers had slight dizziness, and 1 provider had all 3 symptoms of slight dizziness, nausea, and headache.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    One patient removed the headset early because of tiredness and declined the postintervention survey.

    “One patient removed the headset prematurely stating that he or she was too tired and declined to complete the postintervention survey.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • May combine two claims.

    Findingown data

    RASS scores did not change significantly after the intervention; mean baseline RASS was -0.3 (SD 0.62) before and -0.1 (SD 0.35) after.

    “The RASS score did not change significantly after the intervention; the mean baseline RASS score was −0.3 (SD 0.62) preintervention and −0.1 (SD 0.35) postintervention.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • May combine two claims.

    Findingown data

    Two providers reported image quality issues with the VR display and found the on-screen menu distracting.

    “Two providers felt that the virtual reality display had image quality issues (such as flickering) and that the menu on the screen during the session was distracting.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • May combine two claims.

    Findingown data

    Twelve of 15 patients (80%) completed the 15-minute VR session, and 3 (20%) tolerated it for less than 5 minutes.

    “A total of 12 patients (12/15, 80%) completed the 15-minute VR intervention session, and 3 (20%) tolerated it for less than 5 minutes.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • The quote only partly states this claim.

    Findingown data

    Eighty-six percent of providers had a moderate or greater sense of involvement.

    “Among bedside clinicians, 86% had moderate or greater sense of involvement (the awareness devoted to the virtual environment)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Only one patient had previous VR experience.

    “Only one patient had prior VR experience.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • May combine two claims.

    Findingown data

    VR was well tolerated, with minimal nausea (n=1), dizziness (n=2), and headaches (n=0) reported by patients.

    “VR intervention was well tolerated with minimal nausea (n = 1), dizziness (n = 2), and headaches (n = 0) reported by patients.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • May combine two claims.

    Findingown data

    Of 3 patients, 2 had delirium on the CAM-ICU on the intervention day and remained delirious afterward.

    “Of 3 patients, 2 had delirium based on the CAM-ICU assessment on the day of the intervention and remained delirious after the intervention.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • May combine two claims.

    Findingown data

    Sixty percent of patients wanted more VR sessions, 13.3% were unsure, and 26.7% did not want more sessions.

    “Of the patients, 60% looked forward to additional VR sessions, 13.3% were uncertain, and 26.7% did not look forward to more sessions.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • May combine two claims.

    Findingown data

    ICU providers found the equipment well-functioning and easy to use.

    “providers in the ICU found the equipment to be well-functioning and easy to use”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • May combine two claims.

    Findingown data

    In this study, the VR session was shortened for 1 patient with fatigue and 2 patients (13%) with delirium.

    “In our study, we had to shorten the VR session with 1 patient who complained of fatigue and 2 patients (13%) who had delirium.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • May combine two claims.

    Interpretationown data

    In this prospective study, VR therapy for ICU patients and providers had high acceptance and minimal side effects in both groups, despite low prior VR and video gaming experience.

    “In this prospective study of perceptions of VR therapy for ICU patients and health care providers, there was a high level of acceptance, with minimal side effects, for both groups despite their low levels of prior experience with virtual reality and video gaming.”
    • Also stated in: § Discussion · plain
      “Both groups showed a high level of acceptance of the VR intervention despite low levels of prior experience with virtual reality and video gaming technologies among the ICU patients.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Delirium may have contributed to the patient's inability to tolerate VR.

    “The delirium may have contributed to the patient’s inability to tolerate VR.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • May combine two claims.

    Interpretationown data

    Administering VR is challenging in delirious patients, and preliminary findings suggest its benefit may be greater for delirium prevention than treatment.

    “Administering VR is challenging in delirious patients, and our preliminary findings suggest that its benefit may be better for delirium prevention (that is before the patients develop delirium) than for delirium treatment.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • May combine two claims.

    Interpretationown data

    The patients who declined more VR sessions included those with delirium and those who felt VR did not reduce their anxiety or pain.

    “This group comprised those patients who were delirious and others who felt VR intervention did not decrease their anxiety or pain level.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • May combine two claims.

    Study design and conductown data

    The study lacked randomization and standardized scales, had a small sample size, and enrolled fewer mechanically ventilated patients.

    “The limitations of our study include the lack of randomization, the lack of standardized scales to evaluate patient experiences in the VR environment, the relatively small sample size (which may limit generalization of the findings of this study), and the lower enrollment of mechanically ventilated patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Preventing and treating ICU delirium requires optimal treatment of pain and anxiety, sometimes with high-risk medications such as benzodiazepines, which can worsen delirium.

    “Preventing and treating ICU delirium remains a major challenge and requires optimal treatment of pain4 and anxiety,32 sometimes with high-risk medications like benzodiazepines, which have shown to worsen delirium.33”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [4] Morrison, 2003, Relationship between pain and opioid analgesics on the development of delirium following hip fracture, J Gerontol Ser A source
    • cites [32] Pakrad, 2020, Preoperative anxiety and depression increases the incidence of delirium after coronary artery bypass graft surgery, J PeriAnesthesia Nurs source
    • cites [33] Yamamoto, 2020, Incidence, risk factors, and outcomes for sepsis-associated delirium in patients with mechanical ventilation: a sub-analysis of a multicenter randomized controlled trial, J Crit Care source

  • May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    The small sample size limits generalization, and the findings need evaluation in larger cohorts.

    “However, given the small sample size of our study, our findings will need further evaluation in larger cohorts.”
    • Also stated in: § Discussion · hedged
      “the relatively small sample size (which may limit generalization of the findings of this study)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    VR intervention is safe, compatible with ICU infrastructure, and does not interfere with life support equipment.

    “it shows that VR intervention is safe, compatible with the ICU infrastructure, and does not interfere with life support equipment”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Screening and enrollment data were not captured, which could be a challenge in larger trials.

    “Although screening and enrollment was not a particular challenge in this study, screening and enrollment data was not captured, and this could pose a challenge in larger trials.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Administration of VR distraction therapy in the ICU appears feasible, does not interfere with life support equipment, and does not cause significant adverse events.

    “Administration of VR distraction therapy in the ICU appears feasible, does not interfere with life support equipment, and does not result in significant adverse events.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Pain reduction is positively correlated with the VR presence levels reported by subjects.

    “Hoffman et al. showed that pain reduction positively correlates with the VR presence levels reported by the subjects.19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Hoffman, 2008, Virtual reality pain control during burn wound debridement in the hydrotank, Clin J Pain source

  • May combine two claims.

    Interpretationown data

    VR with nature scene content can be used safely with no interference to life support equipment, only mild adverse effects, and high acceptance by patients and ICU providers.

    “Our study demonstrated that VR with nature scene content can be safely used with no interference to life support equipment, with risk of only mild adverse effects, and with a high level of acceptance by patients and ICU providers.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.
35 of 35

  • The paper relies on this without support.

    Optimal management of pain and anxiety is necessary for delirium prevention.

    “Delirium prevention requires optimal management of pain and anxiety.”

  • The paper relies on this without support.

    Effective pharmacologic interventions to prevent or treat ICU delirium are lacking.

    “Given the lack of effective pharmacologic interventions to prevent or treat delirium, hospitals need non-pharmacological interventions that are safe, feasible, and easy to implement in the busy ICU environment.”

  • The paper relies on this without support.

    Prior VR studies have not fully addressed implementation challenges in mechanically ventilated medical ICU patients or demonstrated acceptance by ICU staff.

    “However, prior VR intervention studies have not completely addressed specific challenges of implementing VR intervention in mechanically ventilated patients in the medical ICU nor demonstrated its acceptance by ICU staff, which is imperative for its successful implementation.”

  • The paper relies on this without support.

    Scarce data exist on immersive HMD-based VR intervention in critically ill patients during ICU stay.

    “Despite the therapeutic potential of VR, scarce data are currently available on the use of immersive HMD-based VR intervention in critically ill patients during their ICU stay.”

  • The paper relies on this without support.

    The survey designed for this study validly measures patients' and providers' perceptions of acceptability and safety.

    “Perceptions of ICU providers and patients were obtained through a survey specifically designed for this study (Supplement Tables A.1 and A.2).”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Future-session responses appear to include a patient who declined the survey

    Minor

    One of the 15 patients declined the postintervention survey, leaving at most 14 respondents. The reported future-session percentages correspond to 9, 2, and 4 of 15 patients, so they account for all 15 despite that missing survey.

1 of 1

Cites

Flagged first, then by citations

3 of the 34 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Prothero, 1995, Widening the field-of-view increases the sense of presence in immersive virtual environments, Human Interface Technol Laboratory Techn Report

Cited by

Sorted by citations

Related

Authors
Jawed, Y. T., Golovyan, D., Lopez, D., Khan, S. H., Wang, S., Freund, C., Imran, S., Hameed, U. B., Smith, J. P., Kok, L., & Khan, B. A.
Affiliations
  • Indiana University Indianapolis (US)
  • Western Connecticut Health Network (US)
  • Regenstrief Institute (US)
  • Aga Khan University (PK)
  • University Medical Center Utrecht (NL)
Corresponding author
  • Jawed, Yameena T.
  • Wang, Sophia
  • Freund, Chauncey
  • Imran, Sundus
  • Smith, Joseph P.
  • Khan, Babar A.
ORCID
Venue
Heart & Lung
Publisher
Elsevier BV
Published
2021-11
Volume
50
Issue
6
Pages
748-753
ISSN
0147-9563 (ISSN-L)
DOI
10.1016/j.hrtlng.2021.05.007
PMC
PMC10266374
OpenAlex
W3178425049
Semantic Scholar
5bbf0b1824b22a3fb6a9c869d344ef24e3d892ee
Cited by
65
References
34
Citations by year
2026: 20 · 2025: 16 · 2024: 16 · 2023: 6 · 2022: 6 · 2021: 1
FWCI
4.45
Type
journal article
Language
en
Open access
Licence
Locations
  • Heart & Lung (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
  • eCommons - AKU (Aga Khan University) (submittedVersion)
Funders
National Institute on Aging (K23AG043476)
Topics
  • Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Social Sciences › Psychology › Social Psychology › Music Therapy and Health
Keywords
virtual reality, intensive care unit, delirium prevention, non-pharmacological treatment, pain, anxiety, patient acceptability, healthcare provider perceptions, presence, adverse effects, nature soundscape
MeSH terms
Virtual Reality, Feasibility Studies, Humans, Intensive Care Units, Prospective Studies, Virtual Reality Exposure Therapy

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Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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