Clinical experience of using the virtual reality method for the prevention of delirium in patients in the intensive care unit

Introduction. The development of delirium in intensive care units (ICUs) increase total hospitalization days, and mortality. In recent years, the use of virtual reality (VR) to prevent delirium has been discussed.

Aim. To evaluate the efficacy and safety of using VR for the prevention of delirium in patients in the intensive care unit.

Materials and methods. A randomized, controlled, single-center study was conducted at the Veresaev City Clinical Hospital in Moscow. Ninety patients admitted to the intensive care unit (ICU) were divided into two groups: Group 1 received standard delirium prevention, while Group 2 additionally received VR stimulation using special helmets as part of early rehabilitation. The primary endpoint was the incidence of delirium. Secondary endpoints included the duration and severity of delirium.

Results. VR was well tolerated, all patients in group 2 completed the full course of VR. Delirium developed in 12 patients (26.7%) in the standard therapy group and in 7 patients (15.6%) in the group with additional use of VR, which indicated a positive trend, but had no statistically significant differences (p = 0.302). Delirium in the control group of patients was more severe than in the group using VR stimulation (p < 0.05). The severity of delirium according to the DRS-R-98 scale was significantly less in the VR group (p < 0.05). The duration of delirium was 42 hours in group 1 and 24 hours in group 2, which indicated a positive trend, but had no statistically significant differences (p = 0.153).

Conclusions. Virtual reality can be considered as an additional tool for non-drug prevention of delirium development in patients in intensive care units.

1. Salluh JI, Soares M, Teles JM, Ceraso D, Raimondi N, Nava VS et al. Delirium epidemiology in critical care (DECCA): an international study. Crit Care. 2010;14(6):R210. https://doi.org/10.1186/cc9333.

2. Liu SB, Wu HY, Duan ML, Yang RL, Ji CH, Liu JJ et al. Delirium in the ICU: how much do we know? A narrative review. Ann Med. 2024;56(1):2405072. https://doi.org/10.1080/07853890.2024.2405072.

3. Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing. 2006;35(4):350–364. https://doi.org/10.1093/ageing/afl005.

4. Carpenter CR, Hammouda N, Linton EA, Doering M, Ohuabunwa UK, Ko KJ et al. Delirium prevention, detection, and treatment in emergency medicine settings: a geriatric emergency care applied research (GEAR) network scoping review and consensus statement. Acad Emerg Med. 2021;28(1):19–35. https://doi.org/10.1111/acem.14166.

5. Tilouche N, Hassen MF, Ali HBS, Jaoued O, Gharbi R, El Atrous SS. Delirium in the Intensive Care Unit: Incidence, Risk Factors, and Impact on Outcome. Indian J Crit Care Med. 2018;22(3):144–149. https://doi.org/10.4103/ijccm.IJCCM_244_17.

6. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859–864. https://doi.org/10.1007/s001340100909.

7. Arumugam S, El-Menyar A, Al-Hassani A, Strandvik G, Asim M, Mekkodithal A et al. Delirium in the Intensive Care Unit. J Emerg Trauma Shock. 2017;10(1):37–46. https://doi.org/10.4103/0974-2700.199520.

8. Stollings JL, Kotfis K, Chanques G, Pun BT, Pandharipande PP, Ely EW. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Med. 2021;47(10):1089–1103. https://doi.org/10.1007/s00134-021-06503-1.

9. Hshieh TT, Yang T, Gartaganis SL, Yue J, Inouye SK. Hospital elder life program: systematic review and meta-analysis of effectiveness. Am J Geriatr Psychiatry. 2018;26(10):1015–1033. https://doi.org/10.1016/j.jagp.2018.06.007.

10. Zhang Z, Pan L, Ni H. Impact of delirium on clinical outcome in critically ill patients: a meta-analysis. Gen Hosp Psychiatry. 2013;35(2):105–111. https://doi.org/10.1016/j.genhosppsych.2012.11.003.

11. Witlox J, Eurelings LSM, de Jonghe JFM, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta analysis. JAMA. 2010;304(4):443–451. https://doi.org/10.1001/jama.2010.1013.

12. Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care. 2005;9(4):R375. https://doi.org/10.1186/cc3729.

13. Chan L, Corso G. Pharmacological and non-pharmacological prevention and management of delirium in critically ill and palliative patients in the inpatient setting: a review. Front Med. 2024;11:1403842. https://doi.org/10.3389/fmed.2024.1403842.

14. Janssen TL, Mosk CA, van Hoof-de Lepper CCHA, Wielders D, Seerden TCJ et al. A multicomponent prehabilitation pathway to reduce the incidence of delirium in elderly patients in need of major abdominal surgery: study protocol for a before-and-after study. BMC Geriatr. 2019;19(1):87. https://doi.org/10.1186/s12877-019-1101-7.

15. Kat MG, Vreeswijk R, de Jonghe JF, van der Ploeg T, van Gool WA, Eikelenboom P et al. Long-term cognitive outcome of delirium in elderly hip surgery patients. A prospective matched controlled study over two and a half years. Dement Geriatr Cogn Disord. 2008;26(1):1–8. https://doi.org/10.1159/000140611.

16. Sosnowski K, Lin F, Chaboyer W, Ranse K, Heffernan A, Mitchell M. The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: A systematic review and metaanalysis. Int J Nurs Stud. 2023;138:104410. https://doi.org/10.1016/j.ijnurstu.2022.104410.

17. DeMellow JM, Kim TY, Romano PS, Drake C, Balas MC. Factors associated with ABCDE bundle adherence in critically ill adults requiring mechanical ventilation: An observational design. Intensive. Crit Care Nurs. 2020;60:102873. https://doi.org/10.1016/j.iccn.2020.102873.

18. Zhang S, Han Y, Xiao Q, Li H, Wu Y. Effectiveness of Bundle Interventions on ICU Delirium: A Meta-Analysis. Crit Care Med. 2021;49(2):335–346. https://doi.org/10.1097/CCM.0000000000004773.

19. Albazee E, Alrajehi A, Alsahli FM, Alqemlas A, Aldhaen A, Alkandari A et al. Virtual Reality Distraction for Reducing Pain and Anxiety During Percutaneous Cardiovascular Interventions: A Systematic Review and Meta-Analysis with Trial Sequential Analysis. Medicina. 2025;61(6):957. https://doi.org/10.3390/medicina61060957.

20. Taylan S, Kılıç KM, Özkan İ. Effects of virtual reality on pain, anxiety, and delirium in pediatric surgery: a systematic review and meta-analysis. Pediatr Surg Int. 2025;41(1):163. https://doi.org/10.1007/s00383-025-06084-w.

21. Kotfis K, Marra A, Ely EW. ICU delirium – a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiol Intensive Ther. 2018;50(2):160–167. https://doi.org/10.5603/AIT.a2018.0011.

22. Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Crit Care Clin. 2013;29(1):51–65. https://doi.org/10.1016/j.ccc.2012.10.007.

23. MacLullich AM, Beaglehole A, Hall RJ, Meagher DJ. Delirium and long-term cognitive impairment. Int Rev Psychiatry. 2009;21(1):30–42. https://doi.org/10.1080/09540260802675031.

24. Soares MR, Mahanna Gabrielli E, Manjarrez EC. The Geriatric Patient: Frailty, Prehabilitation, and Postoperative Delirium. Med Clin North Am. 2024;108(6):1101–1117. https://doi.org/10.1016/j.mcna.2024.06.001.

25. Janssen TL, Steyerberg EW, Langenberg JCM, de Lepper CCHAVH, Wielders D, Seerden TCJ et al. Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery: An uncontrolled before-and-after study. PLoS ONE. 2019;14(6):e0218152. https://doi.org/10.1371/journal.pone.0218152.

26. Burry L, Hutton B, Williamson DR, Mehta S, Adhikari NK, Cheng W et al. Pharmacological interventions for the treatment of delirium in critically ill adults. Cochrane Database Syst Rev. 2019;(9):CD011749. https://doi.org/10.1002/14651858.CD011749.pub2.

27. Sanchez D, Brennan K, Al Sayfe M, Shunker SA, Bogdanoski T, Hedges S et al. Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study. Crit Care. 2020;24(1):609. https://doi.org/10.1186/s13054-020-03318-2.

28. Kim S, Kang J. Effects of Virtual Reality Meditation on Sleep and Delirium in ICU Patients: A Randomized Controlled Trial. Comput Inform Nurs. 2025;43(8):e01307. https://doi.org/10.1097/CIN.0000000000001307.