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

项目摘要 美国有100万成年人因急性呼吸衰竭接受机械通气， 重症监护病房（ICU）每年和高达80%的发展谵妄在他们的ICU停留。存在 谵妄易使老年人发生院内并发症，包括ICU时间较长， 住院时间、住院死亡风险增加和护理费用增加。此外，ICU谵妄是 与长期出院后并发症相关，如认知障碍的发展， 痴呆 最近的研究探索管理ICU谵妄的药理学策略，并没有证明 有效性;重症监护医学学会2018年疼痛、躁动/镇静中也承认了这一局限性， 谵妄，不动和睡眠中断指南。听音乐是一种非药物干预， 已被证明可以减少重症患者的过度镇静、焦虑和压力，这些因素可能会导致 重症监护室谵妄我们进行了一项随机的临床试验，结果表明，慢节奏的放松音乐 可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 建议进行一项大型随机临床试验，名为“通过音乐减少谵妄（DDM）， 重症老年人，以评估为期7天的慢节奏音乐干预对原发性高血压的疗效。 入住ICU的机械通气老年人中无谵妄/昏迷天数的结局。 试验的目的如下： 1.音乐干预对改善机械通气患者无谵妄/昏迷天数的疗效 与注意力控制相比。 2.测试音乐干预在改善机械性谵妄严重程度、疼痛和焦虑方面的疗效 与注意力控制的患者相比。 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 精神错乱和改善大脑健康。

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.