Virtual reality-based therapeutic intervention to prevent delirium in the intensive care unit: a systematic review of participant experiences, acceptability, and implementation implications

Delirium is common in intensive care units (ICUs) and is associated with adverse outcomes. Virtual reality (VR) is a non-pharmacological modality that may mitigate contributory factors such as sensory deprivation, anxiety, and immobility. This study aims to synthesise acceptability, feasibility, safety/tolerability, and implementation‑relevant outcomes of VR for ICU delirium prevention. Systematic review of 11 databases (PubMed, Web of Science, EMBASE, PsycINFO, AMED, CINAHL, Cochrane Library, CNKI, Wanfang, Weipu, CBM) from January 2012 to June 2026. Eligible studies evaluated VR-based interventions for delirium prevention in ICUs and reported outcomes on acceptability (e.g., satisfaction, feedback, immersion, comfort), feasibility (e.g. recruitment, completion), and safety/tolerability. Of 877 articles, seven met the criteria, including 190 patients and 21 healthcare professionals. Most interventions delivered nature-based audiovisual VR content via head-mounted displays, typically calm landscapes accompanied by ambient sounds. Patients consistently reported favourable acceptability, describing VR as enjoyable, immersive, and relaxing, while clinicians highlighted realism, engagement, and compatibility with existing ICU workflows. For feasibility, recruitment rates ranged from 12.6% to 67.6%, with a mean completion rate of 71%, despite substantial heterogeneity in intervention frequency and session duration (5–20 min per session). Safety profiles were favourable, with only mild, transient adverse effects such as dizziness or nausea, none leading to discontinuation. VR-based therapeutic interventions in ICU settings may be safe, feasible, and acceptable as adjuncts to multicomponent delirium-prevention strategies, but current estimates are preliminary and subject to substantial uncertainty. Fully powered clinical trials are needed to determine effectiveness and safety. Healthcare professionals might begin with calming, low-exertion, nature-based VR experiences; implement real-time and ongoing monitoring for cybersickness; and embed VR sessions within existing ICU delirium-prevention protocols. Structured staff training and standardised equipment-cleaning procedures will support safe, sustainable adoption while ensuring that technology enhances, rather than replaces, the therapeutic human interaction central to patient-centred ICU care. Clinical trial number CRD420251086766 (ii) What this paper adds