Delirium in the Intensive Care Unit
Conditions
Keywords
delirium, ICU, prevention, sensory stimulation, VR
Brief summary
The goal of this clinical trial is to evaluate whether virtual reality (VR)-based sensory stimulation can help prevent delirium in adult intensive care unit (ICU) patients, compared with an active control condition delivering the same nature-based audiovisual content via a tablet. The main questions it aims to answer are: 1. Does VR-based sensory stimulation delay the time to the first delirium event during ICU stay? 2. Does VR-based sensory stimulation reduce delirium incidence, duration, and severity? 3. What are the effects of the intervention on ICU length of stay, duration of mechanical ventilation, cognitive function at 3 months after ICU discharge, and health-related quality of life? Researchers will compare immersive VR-based sensory stimulation with a non-immersive tablet-based active control to assess the added value of immersion beyond the effects of sensory content alone. Participants will: 1. Receive either immersive VR-based sensory stimulation or tablet-based sensory stimulation 2. Receive one 20-minute session per day for up to 3 days during ICU stay Undergo twice-daily delirium assessments during ICU stay Complete follow-up assessments of cognitive function and health-related quality of life at 3 months after ICU discharge
Detailed description
Delirium is a common acute neurocognitive disorder in critically ill patients and is associated with poor short- and long-term outcomes, including prolonged ICU stay, extended mechanical ventilation, persistent cognitive impairment, and reduced quality of life after discharge. Environmental factors in the ICU, particularly sensory deprivation and excessive noise and light disturbance, are recognized as modifiable contributors to delirium risk. Conventional sensory stimulation has shown potential to delay delirium onset and reduce delirium severity in ICU patients. However, implementation in routine ICU practice is challenging because intervention delivery may be disrupted by the complex ICU environment and may vary across clinical staff and settings. This study evaluates a virtual reality (VR)-based sensory stimulation intervention designed to provide immersive visual and auditory input while reducing interference from the ICU environment. The intervention uses a head-mounted display and headphones to deliver standardized nature-based content. An active control condition was selected to receive the same content through a tablet, allowing comparison of immersive versus non-immersive delivery while controlling for the sensory content itself. This study is a pilot randomized controlled trial conducted in adult ICU patients. Participants are randomly assigned in a 1:1 ratio to either the VR intervention group or the active control group. Both groups receive one 20-minute session daily for up to 3 days during ICU stay. Delirium is assessed twice daily during ICU stay, and participants are followed at 3 months after ICU discharge for cognitive and quality-of-life outcomes. The study is intended to generate preliminary estimates of intervention effects and to inform the design of a future definitive trial.
Interventions
DEVICEimmersive VR group
Participants received immersive VR-based sensory stimulation delivered through a head-mounted display with over-ear headphones. The intervention consisted of nature-based audiovisual content delivered at the bedside by trained ICU nurses for 20 minutes once daily for up to 3 days.
BEHAVIORALActive control group
Participants received the same nature-based audiovisual content through a tablet in a non-immersive format for 20 minutes once daily for up to 3 days during ICU stay.
Sponsors
Chinese University of Hong Kong
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Masking description
Outcome assessors conducting delirium assessments were blinded to group allocation. Participants and intervention providers were not blinded because of the nature of the intervention.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older * Admitted to the ICU * Undergoing or expected to require mechanical ventilation * Expected ICU stay of at least 48 hours * Awake or lightly sedated, defined as a Richmond Agitation-Sedation Scale - (RASS) score between -1 and +1 * Able to understand and follow instructions * Provided informed consent \[or surrogate consent, if applicable\]
Exclusion criteria
* Pre-existing cognitive impairment or dementia * Acute psychiatric illness at admission * Delirium at enrollment as assessed by CAM-ICU * Terminal-stage cancer * APACHE II score \> 20 * Severe uncorrectable hearing or visual impairment * Traumatic brain injury or intracranial drainage tubes that make use of the VR headset impractical
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to First Delirium Event During ICU Stay | Every day, from ICU admission to ICU discharge, assessed up to 28 days | Time from study enrollment to the first episode of delirium detected by the Confusion Assessment Method for the ICU (CAM-ICU). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Delirium Incidence | Every day, from ICU admission to ICU discharge, assessed up to 28 days | Proportion of participants who developed delirium during ICU stay as assessed by CAM-ICU. |
| Delirium Duration | Every day, from ICU admission to ICU discharge, assessed up to 28 days | Total number of days during which delirium was present during ICU stay. |
| ICU Length of Stay | From date of ICU admission until the date of ICU discharge, assessed up to 28 days | Total number of days from ICU admission to ICU discharge. |
| Duration of Mechanical Ventilation | From date of randomization until the date of first successful liberation from mechanical ventilation or date of in-hospital death, whichever came first, assessed up to 28 days | Total duration of mechanical ventilation during ICU stay. |
| Cognitive Function at 3 Months | 3 months after ICU discharge | Cognitive function assessed by the telephone-based Montreal Cognitive Assessment (t-MoCA). |
| Health-Related Quality of Life at 3 Months | 3 months after ICU discharge | Health-related quality of life assessed by the EuroQol Five Dimensions Questionnaire (EQ-5D). |
Countries
China
Outcome results
None listed