To our knowledge, this is the first case study describing the feasibility of coupling VR with NIV to improve the patient experience in ICU. The patient described showed a considerable increase in satisfaction score concerning NIV treatment when coupled with VR. Interestingly, the relaxing effect of VR helped him sleep better after the session [15, 16]. The patient enjoyed the VR experiences.
In the field of psychology, VR is becoming an accepted treatment modality for many psychological disorders, related or not to the stressful ICU environment [15, 16, 18]. Previous studies have shown the beneficial effect of VR to improve the well-being of patients. The study of Ong and colleagues  showed that VR meditative intervention improved patients’ ICU experience with reduced levels of anxiety and depression. In the same way, Lee and collegues  showed that a 30-minute virtual reality meditation may improve the quality of sleep of ICU patients. In post-ICU setting, Vlake and collegues  used VR to treat post-intensive care syndrome: they reported that VR was able to reduce post-traumatic stress disorder, depression scores and improve mental health status. The ICU is a noisy and busy place, with constant surveillance that leaves no room for privacy. Frightening memories and low satisfaction negatively impact psychological sequelae after critical care . By diverting the patient's attention by immersing her/him in a more pleasant virtual universe, it becomes possible to solicit positive feelings through a non-pharmacological approach despite the stressful context of hospitalization in intensive care.
Although the current report does not provide absolute evidence, it shows the feasibility of using an innovative technology such as VR to improve psychological well-being during NIV treatment in ICU. In a simple way, we used a qualitative analysis of the patient's experience instead of more complex scales, but time-consuming, that would have been less appropriate in the ICU setting . Of note, we have opted for a personalized choice of VR theme and decor based on the patient's preferences. Therefore, a standard choice without adjustment to the patient's personality would likely have yielded less convincing results . The psychologist's interaction with the patient may have had an effect on the patient's motivation and this therapeutic relationship may have improved satisfaction. Nevertheless, VR was emotionally evocative: the movie about the Rocky Mountains evoked a pleasant feeling of nostalgia in this patient. It was only the discussion prior to the VR session that allowed for a satisfying choice for the patient (for example, a film about the sea could have been experienced negatively by a person with a phobia of water, or with traumatic memories related to her/his life experience) .
In conclusion, the combination of VR distraction therapy with NIV is feasible and has the potential to improve psychological well-being in intensive care.