In press. Feasibility of bedside vestibular assessment using vHIT and SHIMP in critically ill ICU patients: An exploratory study

Objectives: To explore the technical feasibility and potential clinical value of implementing the Video Head Impulse Test (vHIT) and Suppression Head Impulse Paradigm (SHIMP) protocols in non-intubated critically ill patients. Design: A cross-sectional study was conducted in Medellin, Colombia between January and June 2024, using the vHIT and the Suppression Head Impulse Paradigm (SHIMP) to assess vestibular function. Setting: Patients aged 18 and older non-intubated, diagnosed with sepsis, respiratory insufficiency, acute kidney disease, heart failure, or cerebrovascular disease were included. Intervention: The tests were performed bedside with vHIT and Shimp (EyeSeeCam system). Variables of interest: VOR gain for each canal and gain asymmetry. Results: Sixteen patients were included, five of had septic shock with single organ involvement, four had multi-organ involvement, one had cerebrovascular disease, three had heart failure, and three had acute kidney injury. Reduced vHIT gains were noted primarily in patients with renal involvement and sepsis (0.6–0.62). Patients with multi-organ septic shock had lower vHIT gains compared to those with fewer organ involvements (0.35–0.62 vs 0.45–0.58). No reductions in vHIT gains were observed in patients with cerebrovascular disease or heart failure. The SHIMP protocol identified reduced gains in patients with multi-organ septic shock (0.30–0.59). Conclusion: Specific comorbidities may differentially impact vestibular function in ICU patients. These preliminary findings highlight the feasibility of bedside vestibular testing and suggest that integrating vHIT and SHIMP into routine assessments could enhance diagnostic accuracy and inform individualized care strategies in critically ill patients.