Music listening interventions for children receiving mechanical ventilation: A mechanistic trial

对接受机械通气的儿童进行音乐聆听干预：一项机械试验

基本信息

批准号：
10525363
负责人：
Jessica Jarvis
金额：
$ 13.19万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-05 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10525363
关键词：
Acute Adrenal Glands Adult Affect Analgesics Area Artificial Heart Autonomic nervous system Biological Biological Markers Brain Caregivers Child Childhood Clinical Trials Credentialing Critical Care Critical Illness Critically ill children Cross-Over Trials Data Delirium Dopamine Electrocardiogram Elements Family Focus Groups Freezing Frequencies Funding Future Goals Graph Group Interviews Health Heart Rate Hour Hydrocortisone Hypothalamic structure Impaired cognition Impairment Inflammation Intensive Care Interleukin-6 Intervention Interview Intubation Knowledge Linear Regressions Measurement Measures Mechanical ventilation Mediating Mentored Patient-Oriented Research Career Development Award Mentorship Methods Modeling Monitor Music Narcotics Nonpharmacologic Therapy Outcome Pain Participant Pathway interactions Patients Pediatric Intensive Care Units Pediatrics Periodicity Personal Satisfaction Pharmaceutical Preparations Pharmacy facility Physical Medicine Physical Rehabilitation Physics Physiological Physiology Pilot Projects Pituitary Gland Post-Traumatic Stress Disorders Randomized Research Research Personnel Respiration Respiratory Failure Rewards Risk Safety Saliva Sampling Science Sedation procedure Series Stress Stressful Event Structure Swab Syndrome Testing Time Titrations Training United States National Institutes of Health Universities Variant aged base beta-Endorphin career career development clinical implementation cohort design dosage efficacy testing experience functional disability heart rate variability hypothalamic-pituitary-adrenal axis implementation barriers improved individual response medical schools multidisciplinary neurochemistry pain symptom pediatric patients preference prevent professor programs prospective research and development respiratory sedative skills sound standard of care stress symptom survivorship therapy development treatment as usual vibration

项目摘要

PROJECT SUMMARY/ABSTRACT Pediatric critical illness exposes children to painful and stressful experiences. High levels of stress and pain increase the risk for adverse acute health outcomes (e.g., delirium) and long-term functional impairment, known as Post-Intensive Care Syndrome in Pediatrics (PICS-p). Respiratory support with intubation and mechanical ventilation (MV) exacerbates a child's stress and pain, for which the standard of care includes narcotics and sedation medication. However, these medications increase the risk of delirium, posttraumatic stress disorder, and impaired cognition. My long-term career goal is to develop mechanistically-based, nonpharmacologic interventions to remediate PICS-p and improve survivorship for children and their families following pediatric critical illness. I am an Assistant Professor in the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh School of Medicine. The training proposed for this K23 award period is crucial for me to successfully launch this program of research as an independent researcher. Listening to music to increase comfort (“music listening”) decreases stress and pain symptoms and related outcomes (e.g., medication use, heart rate) during MV in adults and there is emerging data on feasibility and preliminary efficacy for music listening during MV in pediatrics. However, the mechanisms through which music listening impacts stress and pain is unclear, which limits identifying the `active ingredient' of music listening interventions, resulting in significant variability in intervention components and delivery. These data would result in an optimized music listening intervention for testing in future trials. We hypothesize live music from certified music therapists of child preferred songs may be most efficacious in decreasing stress and pain among children receiving MV compared to recorded music or usual care, due to rhythmic entrainment (active ingredient) and modulated through the autonomic nervous system (primary mechanism). This proposed research uses a mechanistic design, a randomized crossover trial with three conditions to compare their effects on biomarkers of stress and pain across three conditions in children with respiratory failure: Live music listening provided by a music therapist, recorded music listening, and usual care. To fill crucial gaps in my expertise, I propose five training objectives: (1) gain skills in the identification and use of biomarkers in pediatric critical care clinical trials; (2) obtain training in stress and pain physiology; (3) develop expertise in PICS-p outcomes; (4) develop skills in conducting interventional clinical trials; and (5) cultivate practical skills in team science, study implementation, and management. I have assembled a multidisciplinary mentorship team of NIH-funded investigators with expertise in each of my training areas. Completion of the proposed training and research will result in a competitive R21 application to test an optimized music listening intervention to decrease stress and pain among pediatric patients receiving MV.

项目摘要/摘要小儿重症疾病使儿童接触到痛苦和压力的经历。高水平的压力和疼痛增加不良急性健康结果的风险（例如del妄）和长期功能障碍，已知作为儿科后密集型护理综合征（PICS-P）。呼吸支持和机械通风（MV）加剧了儿童的压力和疼痛，为此，护理标准包括麻醉品和镇静药物。但是，这些药物增加了del妄，创伤后应激障碍的风险，和认知受损。我的长期职业目标是开发基于机械的非药物为补救图片P的干预措施并改善儿童及其家人的生存重症病。我是物理医学与康复系的助理教授匹兹堡大学医学院。对于我来说，针对这个K23颁奖期提议的培训对我来说至关重要成功启动了作为独立研究人员的研究计划。听音乐以增加舒适感（“音乐听力”）会减轻压力和疼痛症状和相关成人MV期间的结果（例如用药，心率，心率），并且有有关可行性和在儿科MV期间听音乐的初步效率。但是，音乐的机制聆听会影响压力和痛苦尚不清楚，这限制了音乐听力的“活跃成分” 干预措施，导致干预组件和交付的显着差异。这些数据将导致在优化的音乐听力干预措施中，以在以后的试验中进行测试。我们假设认证的现场音乐儿童喜欢的歌曲的音乐治疗师在减轻儿童压力和痛苦方面可能最有效由于有节奏的夹带（有效成分）和通过自主神经系统（主要机制）调节。这项提出的研究使用了机械设计，一项随机跨界试验，具有三个条件，以比较其对生物标志物的影响呼吸衰竭儿童的三个条件下的压力和疼痛：现场音乐聆听音乐治疗师，录制音乐听力和通常的护理。为了填补我的专业知识的关键空白，我提出了五个培训目标：（1）获得识别和使用技能小儿重症监护临床试验中的生物标志物；（2）获得压力和疼痛生理学的培训；（3）发展图片-P结果方面的专业知识；（4）发展进行介入临床试验的技能；（5）培养团队科学，研究实施和管理方面的实践技能。我已经组装了一个多学科 NIH资助的调查人员的指导团队在我的每个培训领域都有专业知识。完成拟议的培训和研究将导致竞争性的R21应用程序来测试优化的音乐聆听干预以减轻接受MV的小儿患者的压力和疼痛。