Effectiveness of virtual reality interventions for delirium prevention in intensive care units: A systematic review...

This systematic review aimed to evaluate the effectiveness of virtual reality (VR) interventions for delirium prevention in adult intensive care units (ICU) patients.

This review followed the PRISMA guidelines. A comprehensive search was conducted across 11 English and Chinese electronic databases, including PubMed, Web of Science, EMBASE, PsycINFO, AMED, CINAHL Complete, Cochrane Library, CNKI, Wanfang, Weipu, and CBM from 2012 December to September 2025. Eligible studies included randomised controlled trials (RCTs) that assessed VR-based interventions for ICU delirium prevention, compared with standard care or control conditions. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool.

Eight RCTs published between 2021 and 2025 met the inclusion criteria, involving 764 participants (mean age: 63 years; sample sizes ranging from 50 to 150). VR interventions primarily delivered visual and auditory stimuli, including natural scenes (n = 4 studies), interactive games (n = 3 studies), and family-related media (n = 2 studies), typically administered once or twice daily for 15-20 min. Findings indicate that VR may serve as a promising non-pharmacological intervention, with pooled results showing a significant reduction in delirium incidence (n = 5 articles, OR = 0.56, 95 % CI = 0.33 to 0.93, I² = 16 %; low certainty). VR interventions also demonstrated potential benefits for psychological outcomes, including significant reductions in anxiety (n = 5 studies, SMD = -2.08, 95 % CI = -3.31 to -0.86, low certainty) and depression (n = 4 studies, SMD = -1.16, 95 % CI = -2.12 to -0.21, I² = 93 %; low certainty), and improvements in sleep quality (n = 3 studies, MD = 2.71, 95 % CI = 0.23 to 5.19, low certainty), and mechanical ventilation duration (n = 3 studies, MD = -3.86, 95 % CI = -6.68 to -1.05, low certainty). Evidence for other outcomes, including ICU length of stay, pain, and cognitive function, was limited or inconclusive.

With low certainty, VR interventions effectively reduce ICU delirium incidence and may improve psychological outcomes (anxiety and depression) and sleep. Further high-quality trials are needed to confirm these benefits and guide clinical use.

VR holds promise as an innovative adjunctive approach for delirium prevention in ICU care and may enhance patient comfort and recovery, pending confirmation from future large-scale trials.