ICU-specific virtual reality for mental health after critical illness: an international three-arm randomized clinical trial
In brief
Single ICU-specific VR video fails to lower PTSD symptoms after critical illness
In a multinational trial of 344 ventilated ICU survivors, a one-time ICU-VR video given early or three months later did not change PTSD severity, anxiety, depression, or health-related quality of life at six months compared with standard care. Patients liked the video, but the result suggests a single session is insufficient; future studies should test repeated, personalized VR for high-risk patients.
- Journal
- Critical care (London, England) (Q1)
- Published
- 24 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Denzel L Q Drop, Johan H Vlake, Jasper van Bommel, Evert-Jan Wils, Denise E Hilling, Tim I M Korevaar, et al.
- PMID
- 42638131
- DOI
- 10.1186/s13054-026-06186-4
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (paper of the day, 31 August 2026): ICU‑VR trial shows no mental‑health benefit after critical illness
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.