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“That Was Amazing!” - Use of Virtual Reality Distraction as Adjunct for Bronchoscopy
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A6469 - “That Was Amazing!” - Use of Virtual Reality Distraction as Adjunct for Bronchoscopy
Author Block: D. Golovyan1, B. A. Khan2, M. O. Farber3; 1Section of Pulmonary and Critical Care, Indiana University, Indianapolis, IN, United States, 2Indiana University, Indianapolis, IN, United States, 3pulmonary/ccm, indiana university school of medicine, Indianapolis, IN, United States.
Introduction: Complementary nonmedicinal adjuncts for bronchoscopy were not recommended in a 2011 consensus statement by the ACCP based on results of two trials. One showed reduction in pain but not anxiety using distraction therapy with relaxing images, another showed no reduction in anxiety using music therapy.1,2 Despite much more infrequent use in the early 1990s3, intravenous sedation was recommended in the 2011 consensus statement and was used in 95% of procedures in the most recent comprehensive survey of European practitioners.4,5 Technology has evolved dramatically since then, with wide availability of high quality virtual reality (VR) equipment. Since VR is inherently more immersive than techniques used in those studies, it may be that distraction therapy used a decade ago was merely inadequately distracting rather than inherently ineffective. We present a case of periprocedural use of virtual reality goggles during elective outpatient bronchoscopy.
Case Report: A 61-year-old man was referred to pulmonary clinic for evaluation of usual interstitial pneumonia pattern on chest radiography and underwent bronchoscopy with bronchoalveolar lavage for further evaluation. He underwent standard premedication for the procedure with nebulized lidocaine, and was offered the use of a virtual reality headset (Samsung Gear VR Headset with content from AppliedVR) displaying a relaxing beach scene as well as scenic 360 degree helicopter tour of Iceland. He stated that he did not want to remove virtual reality headset removed during the procedure, which was conducted with mild sedation with midazolam and fentanyl. The goggles were removed after the procedure, but the patients initial demand during recovery was for them to be replaced. A sense of presence survey based on previously validated tools used in virtual reality studies was administered following the procedure, which showed that the patient felt a stronger sense of being in the virtual environment than in the hospital.6 He stated “I just can’t describe how relieved I felt when I was there.”
Discussion: Moderate sedation for bronchoscopy has both clinical and practical drawbacks, including respiratory and cardiovascular suppression, need to arrange transportation following the procedure, as well necessitating a full day off from work due to recovery. Prior trials with nonmedical distraction therapy used non-immersive techniques, resulting in distraction possibly being under-dosed. Although our patient received intravenous sedation per practice guidelines, virtual reality provided him with a high degree of distraction. Its evaluation as an adjunct for bronchoscopic procedures deserves scientific evaluation.
References:
Author Block: D. Golovyan1, B. A. Khan2, M. O. Farber3; 1Section of Pulmonary and Critical Care, Indiana University, Indianapolis, IN, United States, 2Indiana University, Indianapolis, IN, United States, 3pulmonary/ccm, indiana university school of medicine, Indianapolis, IN, United States.
Introduction: Complementary nonmedicinal adjuncts for bronchoscopy were not recommended in a 2011 consensus statement by the ACCP based on results of two trials. One showed reduction in pain but not anxiety using distraction therapy with relaxing images, another showed no reduction in anxiety using music therapy.1,2 Despite much more infrequent use in the early 1990s3, intravenous sedation was recommended in the 2011 consensus statement and was used in 95% of procedures in the most recent comprehensive survey of European practitioners.4,5 Technology has evolved dramatically since then, with wide availability of high quality virtual reality (VR) equipment. Since VR is inherently more immersive than techniques used in those studies, it may be that distraction therapy used a decade ago was merely inadequately distracting rather than inherently ineffective. We present a case of periprocedural use of virtual reality goggles during elective outpatient bronchoscopy.
Case Report: A 61-year-old man was referred to pulmonary clinic for evaluation of usual interstitial pneumonia pattern on chest radiography and underwent bronchoscopy with bronchoalveolar lavage for further evaluation. He underwent standard premedication for the procedure with nebulized lidocaine, and was offered the use of a virtual reality headset (Samsung Gear VR Headset with content from AppliedVR) displaying a relaxing beach scene as well as scenic 360 degree helicopter tour of Iceland. He stated that he did not want to remove virtual reality headset removed during the procedure, which was conducted with mild sedation with midazolam and fentanyl. The goggles were removed after the procedure, but the patients initial demand during recovery was for them to be replaced. A sense of presence survey based on previously validated tools used in virtual reality studies was administered following the procedure, which showed that the patient felt a stronger sense of being in the virtual environment than in the hospital.6 He stated “I just can’t describe how relieved I felt when I was there.”
Discussion: Moderate sedation for bronchoscopy has both clinical and practical drawbacks, including respiratory and cardiovascular suppression, need to arrange transportation following the procedure, as well necessitating a full day off from work due to recovery. Prior trials with nonmedical distraction therapy used non-immersive techniques, resulting in distraction possibly being under-dosed. Although our patient received intravenous sedation per practice guidelines, virtual reality provided him with a high degree of distraction. Its evaluation as an adjunct for bronchoscopic procedures deserves scientific evaluation.
References:
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