ICU-specific virtual reality for mental health after critical illness: an international three-arm randomized clinical trial

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

doi:10.1186/s13054-026-06186-4

ICU-specific virtual reality for mental health after critical illness: an international three-arm randomized clinical trial

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^*

^*Corresponding author for this work

Franciscus Gasthuis & Vlietland
Université libre de Bruxelles
Albert Schweitzer Ziekenhuis
Maasstad Hospital
Ikazia Hospital
Groene Hart Ziekenhuis
IJsselland Hospital
Haaglanden Medisch Centrum
Gelderland Valley Hospital
Van-Weel-Bethesda Ziekenhuis
Universitätsklinikum Düsseldorf
Heinrich Heine University Düsseldorf

Research output: Contribution to journal › Article › Academic › peer-review

1 Citation (Scopus)

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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.

Original language	English
Article number	444
Journal	Critical Care
Volume	30
Issue number	1
DOIs	https://doi.org/10.1186/s13054-026-06186-4
Publication status	Published - 24 Aug 2026

Bibliographical note

Publisher Copyright:
© The Author(s) 2026.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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ICU-specific virtual reality for mental health after critical illnessFinal published version, 2.73 MBLicence: CC BY-NC-ND

Cite this

Drop, D. L. Q., Vlake, J. H., van Bommel, J., Wils, E. J., Hilling, D. E., Korevaar, T. I. M., Taccone, F. S., Devroey, M., So, R. K. L., den Uil, C. A., Schut, A. F. C., Raben, A. M. T. J., Elderman, J. H., Achterberg, S., Festen, B., Dijkstra, A., van Mol, M. M. C., Jung, C., Gommers, D., & van Genderen, M. E. (2026). ICU-specific virtual reality for mental health after critical illness: an international three-arm randomized clinical trial. Critical Care, 30(1), Article 444. https://doi.org/10.1186/s13054-026-06186-4

@article{92832058da514912bc3d4d5b24e46a1b,

title = "ICU-specific virtual reality for mental health after critical illness: an international three-arm randomized 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{\textendash}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{\textendash}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 {\textendash}3.38 to 4.02; p = 0.87) nor late ICU-VR and control ({\textendash}0.82; 95\% CI {\textendash}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.",

author = "Drop, \{Denzel L.Q.\} and Vlake, \{Johan H.\} and \{van Bommel\}, Jasper and Wils, \{Evert Jan\} and Hilling, \{Denise E.\} and Korevaar, \{Tim I.M.\} and Taccone, \{Fabio S.\} and Marianne Devroey and So, \{Ralph K.L.\} and \{den Uil\}, \{Corstiaan A.\} and Schut, \{Anna F.C.\} and Raben, \{Adrienne M.T.J.\} and Elderman, \{Jan H.\} and Sefanja Achterberg and Barbara Festen and Annemieke Dijkstra and \{van Mol\}, \{Margo M.C.\} and Christian Jung and Diederik Gommers and \{van Genderen\}, \{Michel E.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2026.",

year = "2026",

month = aug,

day = "24",

doi = "10.1186/s13054-026-06186-4",

language = "English",

volume = "30",

journal = "Critical Care",

issn = "1364-8535",

publisher = "BioMed Central Ltd.",

number = "1",

}

Drop, DLQ, Vlake, JH, van Bommel, J , Wils, EJ , Hilling, DE , Korevaar, TIM, Taccone, FS, Devroey, M, So, RKL, den Uil, CA, Schut, AFC, Raben, AMTJ, Elderman, JH, Achterberg, S, Festen, B, Dijkstra, A, van Mol, MMC, Jung, C, Gommers, D & van Genderen, ME 2026, 'ICU-specific virtual reality for mental health after critical illness: an international three-arm randomized clinical trial', Critical Care, vol. 30, no. 1, 444. https://doi.org/10.1186/s13054-026-06186-4

TY - JOUR

T1 - ICU-specific virtual reality for mental health after critical illness

T2 - an international three-arm randomized clinical trial

AU - Drop, Denzel L.Q.

AU - Vlake, Johan H.

AU - van Bommel, Jasper

AU - Wils, Evert Jan

AU - Hilling, Denise E.

AU - Korevaar, Tim I.M.

AU - Taccone, Fabio S.

AU - Devroey, Marianne

AU - So, Ralph K.L.

AU - den Uil, Corstiaan A.

AU - Schut, Anna F.C.

AU - Raben, Adrienne M.T.J.

AU - Elderman, Jan H.

AU - Achterberg, Sefanja

AU - Festen, Barbara

AU - Dijkstra, Annemieke

AU - van Mol, Margo M.C.

AU - Jung, Christian

AU - Gommers, Diederik

AU - van Genderen, Michel E.

PY - 2026/8/24

Y1 - 2026/8/24

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/105048129828

U2 - 10.1186/s13054-026-06186-4

DO - 10.1186/s13054-026-06186-4

M3 - Article

C2 - 42638131

AN - SCOPUS:105048129828

SN - 1364-8535

VL - 30

JO - Critical Care

JF - Critical Care

IS - 1

M1 - 444

ER -

ICU-specific virtual reality for mental health after critical illness: an international three-arm randomized clinical trial

Abstract

Bibliographical note

UN SDGs

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