Systematic review: The impact of virtual reality interventions on stress and anxiety in intensive care units

Introduction: Virtual reality (VR) is an emerging non-pharmacological tool for reducing stress and anxiety among ICU patients. However, current evidence is limited by small sample sizes, variability in intervention design, and the absence of standardised protocols. This systematic review evaluates the effectiveness of VR interventions in reducing stress and anxiety. Methods: We searched PubMed, Scopus, Google Scholar, Cochrane Library, and Medline databases for relevant full-text original English studies published between 2018 and 2024, examining VR interventions to mitigate stress and anxiety in adult (≥18 years) ICU patients. Study quality was evaluated using the Cochrane Risk of Bias and Effective Public Health Practice Project Quality Assessment tools. The main outcome was stress and anxiety. We synthesised the data via systematic review methods and pooled Visual Analog Scale for Anxiety (VAS-A) scores using random-effects meta-analyses. Results: Of 791 studies screened, seven studies (286 participants; 174 post-attrition) were included; four studies had quantitative data suitable for meta-analysis. VR sessions ranged between 5 and 20 min, with diverse content and delivery. VAS-A score decreased by 9.22 points (95 %CI: −14.84 to −3.61;). Most participants found the VR goggles comfortable (89.3 %; 95 %CI: 80.5–94.3 %;), enjoyed the content (77.2 %; 95 %CI: 59.6–88.5 %), and felt immersed (71.4 %; 95 %CI: 43.4–89.1 %). Acceptability was high, and adverse effects were minimal. Conclusion: VR is feasible, well-accepted, and a safe non-pharmacological alternative to reduce stress and anxiety in ICU patients. However, larger trials with standardised protocols are needed to confirm effectiveness and inform clinical implementation.