VR-guided deep breathing during needle procedures in children

Virtual reality-based treatment has been found to be effective at reducing stress and fear in children during procedures involving needles, but its effects on the autonomic nervous system and heart rate variability remain uncertain. This feasibility study compared a virtual reality-mediated deep breathing exercise with treatment as usual in managing the stress and fear of children during a venipuncture. We included 45 children who underwent a needle procedure as part of their routine treatment. The study patients performed 6 min of deep breathing training in a virtual natural environment during the needle procedure. The stress response in the autonomic nervous system was determined by heart rate variability measurements. The median respiratory rate was significantly lower during the intervention in the deep breathing training group (median 14 [Q1-12, Q3-16.5]) than in the control group (20 [18, 20.88]), (p < .001), confirming good compliance with exercise. In a 6-min heart rate variability measurement, mean high frequency in normalised unit (HFnu, 0.15-0.4 Hz) indicates a significantly greater level of activation in the parasympathetic nervous system during exercise (mean 61.57 [SD 16.29]) than in the control (40.46 [16.10]), (p < .001). Virtual reality-mediated guided deep breathing is a feasible nonpharmaceutical treatment option for stress and fear relief when treating child patients undergoing a needle procedure.