Decreasing Delirium through music (DDM) in critically ill older adults

通过音乐 (DDM) 减少危重老年人的谵妄

• 批准号: 10656367
• 负责人: Linda L Chlan
• 金额: $ 38.78万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10656367
• 关键词: Achievement; Acute respiratory failure; Adherence; Admission activity; Adult; Agitation; Analgesics; Anti-Anxiety Agents; Anxiety; Arousal; Caring; Central Nervous System; Clinical Trials; Cognitive; Coma; Conduct Clinical Trials; Critical Care; Critical Illness; Delirium; Dementia; Development; Dose; Elderly; Generalized Anxiety Disorder; Guidelines; Health; Hospitals; Hydrocortisone; Immobilization; Impaired cognition; Indiana; Inflammatory; Inpatients; Intensive Care Units; Intervention; Investigation; Knowledge; Length; Length of Stay; Measures; Mechanical Ventilators; Mechanical ventilation; Medicine; Mental Depression; Music; Neuropsychology; Noise; Norepinephrine; Outcome; Pain; Pain management; Pathway interactions; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Production; Questionnaires; Randomized; Randomized, Controlled Trials; Relaxation; Risk; Sedation procedure; Severities; Signal Transduction; Sleep disturbances; Societies; Stress; Surveys; Testing; United States; Universities; Visual; acceptability and feasibility; adverse outcome; analog; anxiety reduction; anxiety symptoms; arm; associated symptom; attentional control; brain health; care costs; confusion assessment method; cytokine; design; efficacy evaluation; efficacy testing; experience; feasibility trial; group intervention; high risk; improved; mortality; mortality risk; pain symptom; pharmacologic; prescription opioid; primary outcome; randomized, clinical trials; research study; secondary outcome; sedative; telephone based; tool; treatment arm

PROJECT ABSTRACT One million adults in the United States receive mechanical ventilation for acute respiratory failure in the intensive care units (ICUs) annually and up to 80% of them develop delirium during their ICU stay. Presence of delirium predisposes older adults to immediate in-hospital complications including a longer length of ICU and hospital stay, increased risk of in-patient mortality and elevated costs of care. In addition, ICU delirium is associated with long-term post-discharge complications such as development of cognitive impairment and dementia. Recent research studies exploring pharmacological strategies to manage ICU delirium have not demonstrated efficacy; a limitation also acknowledged in the Society of Critical Care Medicine 2018 Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption guidelines. Music listening is a non-pharmacological intervention that has shown to decrease over-sedation, anxiety and stress in critically ill patients, factors that could predispose to ICU delirium. We conducted a randomized pilot clinical trial, which showed that slow-tempo relaxing music could improve delirium/coma free days in mechanically ventilated critically ill patients. Our team is now proposing to conduct a large randomized clinical trial called “Decreasing Delirium through Music (DDM) in Critically Ill Older Adults to evaluate the efficacy of a seven-day slow-tempo music intervention on the primary outcome of delirium/coma free days among mechanically-ventilated older adults admitted to the ICU. The trial has the following aims: 1. Test the efficacy of music intervention in improving delirium/coma free days among mechanically ventilated patients as compared to attention control. 2. Test the efficacy of music intervention in improving delirium severity, pain and anxiety among mechanically ventilated patients as compared to attention control. 3. Test the efficacy of music intervention in improving the long-term neuropsychological outcomes as compared to attention control. Achievement of the aforementioned aims will provide an efficacious and scalable intervention to reduce delirium and improve brain health.

项目摘要 美国有 100 万成年人因急性呼吸衰竭而接受机械通气 每年都会有重症监护病房 (ICU)，其中高达 80% 的患者在 ICU 住院期间会出现谵妄。的存在 谵妄使老年人容易出现院内并发症，包括延长 ICU 治疗时间和 住院时间、住院死亡风险增加以及护理费用增加。此外，ICU 谵妄是 与长期出院后并发症有关，例如认知障碍的发展和 失智。 最近探索治疗 ICU 谵妄的药理学策略的研究尚未证明 功效; 2018 年重症监护医学学会也承认了这一限制：疼痛、激动/镇静、 谵妄、不动和睡眠中断指南。听音乐是一种非药物干预措施 已被证明可以减少危重患者的过度镇静、焦虑和压力，这些因素可能导致 ICU 谵妄。我们进行了一项随机试点临床试验，结果表明慢节奏的放松音乐 可以改善机械通气危重患者的无谵妄/昏迷天数。我们的团队现在 提议进行一项名为“通过音乐减少谵妄（DDM）”的大型随机临床试验 危重老年人评估为期 7 天的慢节奏音乐干预对初级儿童的疗效 入住 ICU 的机械通气老年人无谵妄/昏迷天数的结果。 该试验的目的如下： 1. 测试音乐干预对改善机械通气患者无谵妄/昏迷天数的功效 患者与注意力控制相比。 2. 测试音乐干预对改善机械性谵妄严重程度、疼痛和焦虑的功效 通气患者与注意力控制患者相比。 3. 测试音乐干预在改善长期神经心理学结果方面的功效 与注意力控制相比。 实现上述目标将提供有效且可扩展的干预措施，以减少 谵妄并改善大脑健康。