A virtual reality-based multicomponent intervention program for preventing postoperative delirium in the intensive care unit for cardiac surgery patients: from evidence-based design to a pilot trial

Background Postoperative delirium (POD) after cardiac surgery in the intensive care unit (ICU) has a high incidence and poor outcomes. Virtual reality (VR) is a non-pharmacological intervention of growing interest, but its effects in cardiac surgery patients remain underexplored. Aim To evaluate the feasibility of a perioperative VR-based intervention program and to explore its preliminary clinical effects on POD, anxiety, depression, cognition, sleep, and mobility in cardiac surgery patients. Study design A randomized controlled trial was conducted from February to March 2025 in a tertiary hospital in China. Forty participants undergoing elective cardiac surgery were assigned to usual care (control group) or usual care plus daily VR sessions from preoperative preparation until ICU discharge (intervention group) ( n = 20 each). Outcomes included delirium incidence, severity, duration, onset time, and changes in stress, cognition, sleep, and mobility with time perioperatively. Results In this pilot trial, the intervention group had a lower incidence of delirium than the control group (5% vs. 35%, p = 0.048). However, the study was not powered to detect differences in delirium incidence, and the limited number of events (n = 8) makes this estimate unstable. Therefore, this finding should be interpreted as a hypothesis-generating signal only, not as evidence of clinical efficacy. The intervention group also had lower delirium severity, higher Barthel Index scores, and shorter ICU length of stay (all p < 0.05). In addition, patients in the intervention group had lower stress levels at multiple perioperative time points, better sleep on the first and last ICU nights, and higher cognitive scores at ICU discharge than those in the control group. Repeated-measures analyses suggested favorable changes over time in anxiety, depression, and sleep in the intervention group. Conclusion Perioperative VR-based multicomponent intervention was feasible and well accepted in this pilot study, and may indicate potential benefit in reducing POD and improving selected psychological and functional outcomes in cardiac surgery patients. These findings are preliminary and require confirmation in larger, adequately powered multicenter trials.