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

项目摘要 美国100万成年人因急性呼吸衰竭接受机械通气治疗 每年都有重症监护病房(ICU)，其中高达80%的人在ICU逗留期间出现精神错乱。存在 精神错乱使老年人容易立即出现住院并发症，包括较长的ICU时间和 住院时间增加、住院死亡风险增加和护理费用增加。此外，ICU的精神错乱是 与长期出院后并发症有关，如认知障碍和 痴呆症。 最近探索治疗ICU精神错乱的药理学策略的研究还没有证明 疗效；2018年重症监护医学会也承认了疼痛、激动/镇静的局限性， 精神错乱、静止不动和睡眠障碍指南。听音乐是一种非药物干预， 已经证明可以减少危重患者的过度镇静、焦虑和压力，这些因素可能会导致 重症监护室精神错乱。我们进行了一项随机试点临床试验，结果表明，慢节奏放松音乐 可改善机械通气危重患者的神志不清/昏迷天数。我们队现在是 计划进行一项大型随机临床试验，名为“通过音乐减少妄想症”(DDM) 对老年人进行为期7天的慢节奏音乐干预的疗效评估 ICU中接受机械通气的老年人中无精神障碍/昏迷天数的结果。 这项试验的目的如下： 1.测试音乐干预对改善机械通气患者神志不清/昏迷天数的效果 患者的注意力控制相比较。 2.测试音乐干预对改善机械性精神障碍患者妄想程度、疼痛和焦虑的效果。 与注意力控制相比，使用呼吸机的患者。 3.测试音乐干预对改善长期神经心理结果的效果 与注意力控制相比。 实现上述目标将提供有效和可扩展的干预措施，以减少 神志不清，改善大脑健康。

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.