Abstract
INTRODUCTION: The intensive care unit (ICU) provides critical care for severely ill patients, often leading to prolonged stays and psychological issues like delirium, affecting 35%-80% of patients. Delirium impacts cognition and increases mortality. Virtual Reality (VR) shows potential for alleviating symptoms but lacks conclusive evidence for reducing delirium, necessitating further research. The main goal of this systematic review is to evaluate whether VR stimulation can reduce the incidence of delirium among critically ill patients. METHODS: This systematic review follows PRISMA guidelines. Studies on VR for delirium prevention in adult ICU patients up to January 2024 were searched in online databases. Inclusion criteria focused on English-language studies specifically addressing VR's role in delirium prevention. The review excluded non-relevant studies and assessed quality using the ROBINS-I tool for bias in non-randomized studies. Data were synthesized qualitatively, summarizing key findings and evaluating patient perceptions of VR use in ICU settings. The study is registered on PROSPERO (CRD42024505083). RESULTS: The findings indicate that VR may help reduce delirium incidence by providing cognitive stimulation and alleviating sensory overload, with some studies reporting zero rates of delirium. Patients experienced relaxing effects on vital signs, improved pain management, and found VR sessions enjoyable and tolerable, while providers noted ease of use. Importantly, no significant adverse events were reported, and VR interventions can be adapted for infection control in ICU settings. Nature based VR environments were particularly effective in promoting relaxation compared to urban settings, highlighting VR's potential as a safe and beneficial tool for critically ill patients, although these observations are based on a small number of heterogeneous studies with varying designs, populations, and intervention protocols. CONCLUSION: The findings support VR as a practical and safe digital therapy in ICUs, though further evaluation of its role in delirium prevention is needed.