Usage of immersive virtual reality as a relaxation method in an intensive care unit.

INTRODUCTION: The usage of immersive virtual reality (iVR) in the context of an intensive care unit (ICU) is scarce. Our objective was to assess the feasibility of the usage of iVR in critical patients with or without mechanical ventilation (MV) and to determine the anxiety degree before and after each session. METHODS: Analytical, descriptive, prospective, and cross-sectional research. Pilot test with 20 patients from a polyvalent ICU of a tertiary hospital. Adult patients were included, either connected or not to MV, watchful and calmed (RASS -1/+1) and without delirium (negative CAM-ICU). Oculus Go (Facebook Technologies, LLC) iVR glasses were the model used. The relaxation strategy consisted in the visualization of an experience of 15 min with scenes related to nature and fantasy, relaxing music with a plot. The sessions were individual, with the patient monitored in a fowler position or seated. The anxiety degree before and after each session was evaluated following a reduced version of the Spanish "Cuestionario de Ansiedad Estado-Rasgo (STAI-e)" and they were analysed using T samples coupled (statistical significance when p-value was <0.05). RESULTS: Incorporation of 20 patients with an average age of 63.9 years old (60% men). A total of 34 sessions of iVR were conducted. 32% patients mechanically ventilated, 32% high-flow oxygen therapy, 36% other breathing supports. 80% of the sessions were completed without serious side effects. A significant decrease in the anxiety degree was observed after each iVR session: first session mean change -2.68 (SD = 2.75), p = 0.000; second session mean change -1.86 (SD = 1.57), p = 0.021; third session mean change -1.67 (SD = 1.63), p = 0.054. CONCLUSION: The usage of iVR in the context of an ICU is feasible, even with patients mechanically ventilated. iVR reduces the anxiety degree in the critic patient, which suggests that "digital therapies" can be effective to improve the emotional state during their stay in the ICU.

Time of elevation of head of bed for patients receiving mechanical ventilation and its related factors. / Tiempo de elevación del cabezal de la cama del paciente con ventilación mecánica y factores relacionados.

INTRODUCTION: The semirecumbent position is a widespread recommendation for the prevention of pneumonia associated with mechanical ventilation. AIMS: To identify the time of elevation of head of bed for patients under mechanical ventilation and the factors related to such elevation in an intensive care unit. MATERIALS AND METHODS: An observational, descriptive cross-sectional study. Conducted in an intensive care unit of a tertiary hospital from April to June 2015. The studied population were mechanically ventilated patients. Daily hours in which patients remained with the head of the bed elevated (≥30°), socio-demographic data and clinical variables were recorded. RESULTS: 261 head elevation measurements were collected. The average daily hours that patients remained at ≥30° was 16h28' (SD ±5h38'), equivalent to 68.6% (SD ±23.5%) of the day. Factors related to elevations ≥30° for longer were: enteral nutrition, levels of deep sedation, cardiac and neurocritical diagnostics. Factors that hindered the position were: sedation levels for agitation and abdominal pathologies. Sex, age and ventilation mode did not show a significant relationship with bed head elevation. CONCLUSIONS: Although raising the head of the bed is an easy to perform, economical and measurable preventive measure, its compliance is low due to specific factors specific related o the patient's clinical condition. Using innovations such as continuous measurement of the head position helps to evaluate clinical practice and allows to carry out improvement actions whose impact is beneficial to the patient.

[Individualised care plan during extracorporeal membrane oxygenation. A clinical case]. / Plan de cuidados individualizado durante oxigenación con membrana extracorpórea. Caso clínico.

An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy.