A comparison of interactive immersive virtual reality and still nature pictures as distraction-based analgesia in burn wound care.

PURPOSE: Non-pharmacologic adjuncts to opioid analgesics for burn wound debridement enhance safety and cost effectiveness in care. The current study explored the feasibility of using a custom portable water-friendly immersive VR hardware during burn debridement in adults, and tested whether interactive VR would reduce pain more effectively than nature stimuli viewed in the same VR goggles. METHODS: Forty-eight patients with severe burn injuries (44 adults and 4 children) had their burn injuries debrided and dressed in a wet wound care environment on Study Day 1, and 13 also participated in Study Day 2. INTERVENTION: The study used a within-subject design to test two hypotheses (one hypothesis per study day) with the condition order randomized. On Study Day 1, each individual (n = 44 participants) spent 5 min of wound care in an interactive immersive VR environment designed for burn care, and 5 min looking at still nature photos and sounds of nature in the same VR goggles. On Study Day 2 (n = 12 adult participants and one adolescent from Day 1), each participant spent 5 min of burn wound care with no distraction and 5 min of wound care in VR, using a new water-friendly VR system. On both days, during a post-wound care assessment, participants rated and compared the pain they had experienced in each condition. OUTCOME MEASURES ON STUDY DAYS 1 AND 2: Worst pain during burn wound care was the primary dependent variable. Secondary measures were ratings of time spent thinking about pain during wound care, pain unpleasantness, and positive affect during wound care. RESULTS: On Study Day 1, no significant differences in worst pain ratings during wound care were found between the computer-generated world (Mean = 71.06, SD = 26.86) vs. Nature pictures conditions (Mean = 68.19, SD = 29.26; t < 1, NS). On secondary measures, positive affect (fun) was higher, and realism was lower during computer-generated VR. No significant differences in pain unpleasantness or "presence in VR" between the two conditions were found, however. VR VS. NO VR. (STUDY DAY 2): Participants reported significantly less worst pain when distracted with adjunctive computer generated VR than during standard wound care without distraction (Mean = 54.23, SD = 26.13 vs 63.85, SD = 31.50, t(11) = 1.91, p < .05, SD = 17.38). In addition, on Study Day 2, "time spent thinking about pain during wound care" was significantly less during the VR condition, and positive affect was significantly greater during VR, compared to the No VR condition. CONCLUSION: The current study is innovative in that it is the first to show the feasibility of using a custom portable water-friendly immersive VR hardware during burn debridement in adults. However, contrary to predictions, interactive VR did not reduce pain more effectively than nature stimuli viewed in the same VR goggles.

Evidence and Trends in Burn Wound Debridement: An Evidence Map.

Treatment of the burn wound is crucial in care of severely burned patients. Surgical strategies differ in technique and timing of wound excision and are considered to have an impact on morbidity and mortality of burn patients. Most techniques and strategies have been established during the last century and are still standard of care. Nonetheless, several newer techniques have been presented and evaluated recently. To summarize the evidence and trends for eschar removal by burn wound debridement currently available, an evidence map as variant of the systematic review, was prepared. For this purpose, a systematic literature search was performed in the PubMed databases until December 2016. While overall evidence in this domain is low, recent publications focus on optimal timing of wound excision, enzymatic debridement, and hydrosurgery. Several studies report the benefit of an early wound excision in terms of shorter hospital stay, lower wound infection rate, and reduction of postburn metabolic changes. Enzymatic debridement has been shown to be an effective tool for early eschar removal and in addition reduces the need for autografting of the debrided burn wound with a relatively high level of evidence (LoE 2-). Wound debridement by means of hydrosurgery is more precise compared to conventional wound excision and preserves viable dermis, but a positive effect on wound healing or scar formation could not been shown (LoE 2). Furthermore, rarely reported techniques comprise larvae therapy, debridement by laser, and other technical adjuncts, but the level of evidence is limited (LoE 4-/5).

Il est crucial de traiter les plaies des grands brûlés. Les stratégies chirurgicales et le moment d'exciser les plaies dépendent de diverses techniques, qui sont considérées comme ayant des répercussions sur la morbidité et la mortalité des patients brûlés. La plupart des techniques et des stratégies ont été mises au point au cours du dernier siècle et représentent encore la norme des soins. Plusieurs nouvelles techniques ont toutefois été présentées et évaluées récemment. Pour résumer les données probantes et les tendances en matière d'élimination des escarres par débridement, les chercheurs ont préparé une variante de l'analyse systématique, sous forme de cartographie des données probantes. Ils ont ainsi effectué une analyse bibliographique dans les bases de données de PubMed jusqu'en décembre 2016. Les données probantes globales sont faibles dans ce domaine, mais de récentes publications portent sur le moment optimal de procéder à l'excision des plaies, au débridement enzymatique et à l'hydrochirurgie. Plusieurs études soulignent les avantages d'une excision rapide des plaies pour raccourcir le séjour hospitalier, abaisser le taux d'infection et réduire les changements métaboliques après la brûlure. Il a été démontré que le débridement enzymatique est un outil efficace pour éliminer rapidement les escarres et limiter le recours aux autogreffes de la plaie débridée, et la qualité de preuves qui y est reliée est relativement élevée (QdP 2-). Le débridement des plaies par hydrochirurgie est plus précis que l'excision classique et permet de préserver le derme viable, mais n'a pas d'effet positif démontré sur la guérison ou la cicatrisation des plaies (QdP 2). Certaines techniques sont peu déclarées, telles que la larvothérapie, le débridement au laser et des techniques auxiliaires, mais la qualité des preuves s'y rapportant est limitée (QdP 4-/5).