Project Summary Delirium commonly plagues patients in the hospital. Patients in the intensive care unit (ICU) have the highest risks for delirium, estimated to be between 70% to 80%. The effects of delirium are profound, with higher 12- month mortality rates following discharge, significant increases in ICU length of stay, duration of mechanical ventilation, risk of long-term cognitive impairments, and reduced quality of life after discharge. Delirium also leads to challenges for ICU staff including agitation and combative behavior. There are severe financial costs from delirium as well, with higher healthcare costs per patient and an additional burden on the American healthcare system of up to $152 billion each year. These statistics illustrate that an innovative and effective intervention strategy to prevent delirium in the ICU is highly significant and immediately clinically impactful. Non-pharmacological multicomponent interventions (which may include patient mobilization, cognitive stimulation, sleep optimization, and more) have been shown to reduce the odds of incident delirium in hospitalized non-critically ill patients by approximately half. However, such multicomponent interventions place an additional burden on the already constrained resources of nursing staff. Technology-based interventions may be effective intervention delivery mechanisms, but these technology interventions must be multicomponent and not overburden staff. Crucially, an intervention must be multicomponent, can be tailored to specific patient characteristics, targets the physical, cognitive, emotional, and social needs of the patient, and does not overburden nursing staff. RalphVR is applying to this Phase I SBIR to achieve three Specific Aims. Aim 1: Employ focus groups comprised of staff involved in the treatment of delirium in the ICU (N=12) and former ICU patients (N=12) for expert, stakeholder, and patient feedback and insight to inform development. Aim 2: Develop a framework for three innovations and develop three mind body intervention (MBI) components, then combine these software systems into a single VR application (the Virtual PARTNER prototype). Aim 3: Run a feasibility study targeting patients in the ICU (N=22). Three long-term objectives must be met to bring Virtual PARTNER to market: 1) determine the safety and feasibility of Virtual PARTNER to be delivered to patients in the ICU, 2) determine Virtual PARTNERS’s efficacy to promote target outcomes through successful delivery of MBIs, and 3) determine the efficacy of Virtual PARTNER as an intervention to reduce the occurrence of, and treat, delirium. Successfully completing the long-term goals and aims will result in a clinically validated intervention to treat delirium in the ICU. The proposal addresses a gap in current clinical practice and responds to the National Center for Complementary and Integrative Health (NCCIH) program priority area of health promotion, disease prevention, health restoration, and resilience. The proposed VR platform for patients in the ICU directly addresses multiple NCCIH research priority areas, most notably development and testing of innovative technologies for multisensory delivery of an MBI.

Project Narrative This project will contribute to knowledge on delivery of mind and body interventions (MBIs) and specifically to the delivery of MBIs through digital technology including virtual and mixed reality. Furthermore, application of this knowledge will provide a treatment for delirium in the intensive care unit (ICU) which will contribute to enhanced health and decreased mortality both during and after admission to an ICU, as well as improve quality of life during an ICU stay.