Effect of virtual reality intervention on anxiety in mechanically ventilated patients following neurosurgical procedures: A randomized controlled trial

Anxiety is a state marked by apprehension, agitation, increased activity, fearful withdrawal, and autonomic activity . Persistent anxiety might make it harder to focus, relax, and rest. Thus, anxiety aggravated by fear causes increased sympathetic activation, increased work of breathing, increased oxygen demand, and myocardial stimulation. Patients experience significant levels of anxiety in the ICU while on mechanical ventilation . Furthermore, excess use of sedations like benzodiazepines for anxiety control is a risk factor for chronic depression and anxiety disorders in patients who have been discharged from the ICU . Patients on mechanical ventilation feel anxious for many reasons, like acute anxiety brought on by dyspnea, discomfort from endotracheal tubes, a sense of helplessness, and fears related to their underlying diseases. Pharmacotherapies like benzodiazepines and opioids are the mainstay of managing anxiety and endotracheal tube intolerance. All pharmacotherapy has unfavorable side effects, alters assessment of consciousness (GCS), delays extubation and increases the risk of developing delirium. Research on ventilator weaning was primarily focused on physiological variables and the use of different modes of ventilation. The impact of mental well-being on ventilator weaning is less investigated. While some alternatives, such as music control, have been explored for anxiety control in ICU patients, there remain few other options for non-pharmacological methods.

The use of virtual reality in the ICU reduces anxiety and sedative requirements in non-ventilator patients. We want to explore the feasibility of VR for anxiolysis in patients on mechanical ventilation using a prospective trial. There is no data on the use of VR to reduce anxiety and facilitate extubation in the neurosurgical ICU.

We aim to compare the anxiety levels of postoperative neurosurgical patients on a mechanical ventilator receiving VRI versus routine ICU care and its effect on time to  extubation .