Virtual reality immersion therapy in awake ICU patients: potential uses and feasibility study

• Virtual reality (VR) headsets and software - Meta Quest 3S will be used as the device for immersion due to its portability, ease of use and available software. The headset along with the software will be trialled by all members of the research team. Their application is simple and no formal training is required. The following procedures will take place for eligible participants who provides signed informed consent: 1. Answer daily the Edmonton Symptom Assessment Scale (ESAS) to assess symptom severity (well validated tool for in-patient symptoms assessment). This will be completed by either a member of the research group or a part of the healthcare team caring for the patient before and after the VR immersion session. 2. Patients will have a choice of VR scenarios available from the VR headset – their choice will be recorded as part of the VR questionnaire. Scenarios will be available from multiple apps available on the device such as "Brink traveller" and "Ocean rift" and will range from famous cities, touristic destinations to ocean submersion, among others, 3. Sessions will be offered once daily, conducted by one of the study investigators. The choice of VR scenario can change each day if the participant desires. These sessions and questions will be applied by a member of the research team. Typically, each session will last between 5 to 10 minutes. 4. The duration of therapy will be up to 5 days or until patient is either: a) discharged to the ward, b) developed a contra-indication or complication of the therapy, c) withdrew wish to continue, d) deceased, e) no longer able to provide ongoing consent (e.g. sedated, intubated, Non-Invasive Ventilation (NIV), development of confusion or reduced conscious state). Assessment of acceptability, tolerability and feasibility: we will collect eligible participants’ willingness to use VR therapy and reasons for it. Data on optimal duration and frequency of the VR therapy will be obtained from participants. They will be also asked about barriers and challenges in the practical applications of the Virtual Reality experience. Compliance and side effects incidence of VR therapy will be evaluated. Literature has suggested possible side effects might include cyber sickness, vertigo, fear, anxiety and discomfort. Data on incidence and severity of side effects will be recorded, and how these potential adverse events were managed will be done by the caring physician. Discontinuation of therapy due to side-effects is allowed and will also be recorded. A modified version of Evaluation of Virtual Reality intervention questionnaire will be used for the above..