ICU-specific virtual reality for mental health after critical illness: an international three-arm randomized clinical trial
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: Survivors of critical illness frequently experience symptoms of post-intensive care syndrome (PICS), including post-traumatic stress disorder (PTSD), anxiety, and depression, with downstream impact on health-related quality of life (HRQoL). We evaluated whether an intensive care unit-specific virtual reality (ICU-VR) video improves mental health outcomes and whether timing (early vs. late) matters. METHODS: We conducted an international, three-arm, multicentre randomized clinical trial across eleven hospitals. Adults (≥ 18 years) with ICU stay ≥ 72 h and mechanical ventilation ≥ 24 h were randomized 1:1:1 to (1) standard care, (2) early ICU-VR (within 7-15 days post-ICU), or (3) late ICU-VR (≈ 3 months, during aftercare). The primary endpoint was PTSD symptom severity at six months (T3) measured by the Impact of Event Scale-Revised (range 0-88). Secondary endpoints included anxiety/depression severity and prevalence, and HRQoL. RESULTS: We randomized 344 participants (median age 61 years; 62% male); follow-up among survivors at six months (T3) was 80%. At six months, PTSD symptom severity did not differ between early ICU-VR and control (β = 0.32; 95% CI -3.38 to 4.02; p = 0.87) nor late ICU-VR and control (-0.82; 95% CI -4.62 to 2.97; p = 0.67). No between-group differences were observed for anxiety, depression, or HRQoL (all adjusted p > 0.05). Patients rated ICU-VR highly for improving understanding of the ICU experience and overall satisfaction (median 8/10). CONCLUSIONS: In this multicentre randomized clinical trial, a single ICU-VR video did not improve PTSD, anxiety, depression, or HRQoL at six months versus standard care. Findings should not be generalized to multi-session, therapist-guided, or personalized VR interventions. Future trials should target high-risk patients, make multi-session mandatory, and personalize ICU-VR. TRIAL REGISTRATION: This study was prospectively registered Netherlands: Trial Register/International Clinical Trials Registry Platform, NL9812, October 21, 2021.
Source: Critical Care
Authors: Denzel L. Q. Drop, Johan H. Vlake, Jasper van Bommel, Evert-Jan Wils, Denise E. Hilling, Tim I. M. Korevaar, Fabio S. Taccone, Marianne Devroey, Ralph K. L. So, Corstiaan A. den Uil, Anna F. C. Schut, Adrienne M. T. J. Raben, Jan H. Elderman, Sefanja Achterberg, Barbara Festen, Annemieke Dijkstra, Margo M. C. van Mol, Christian Jung, Diederik Gommers, Michel E. van Genderen
Institutions: Erasmus MC, Sint Franciscus Gasthuis, Erasmus University Rotterdam, Erasmus MC Cancer Institute, Université Libre de Bruxelles, Albert Schweitzer Ziekenhuis, Maasstad Ziekenhuis, Ikazia Ziekenhuis, Groene Hart Ziekenhuis, IJsselland Ziekenhuis, Medisch Centrum Haaglanden, Stichting Haaglanden Medisch Centrum, Ziekenhuis Gelderse Vallei, Ziekenhuis Bethesda, Düsseldorf University Hospital, Heinrich Heine University Düsseldorf
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,190
OpenAlex ID: W7170402876