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

项目总结/摘要 儿科危重病使儿童遭受痛苦和压力的经历。高度的压力和疼痛 增加不良急性健康结果的风险（例如，谵妄）和长期功能障碍，已知 儿科重症监护后综合征（PICS-p）。气管插管和机械呼吸支持 机械通气（MV）会加剧儿童的压力和疼痛，其护理标准包括麻醉剂和 镇静药然而，这些药物会增加精神错乱、创伤后应激障碍、 和认知受损。我的长期职业目标是开发基于机械的，非药物的 干预措施，以补救PICS-p和提高儿童及其家庭的生存率， 病危我是物理医学和康复系的助理教授， 匹兹堡大学医学院。K23奖励期间的培训对我来说至关重要， 作为一名独立研究员成功地启动了这项研究计划。 听音乐以增加舒适度（“听音乐”），减少压力和疼痛症状， 结果（例如，药物使用，心率），并且有关于可行性和 在儿科MV期间听音乐的初步疗效。然而，音乐的机制 听音乐会影响压力和疼痛还不清楚，这限制了对听音乐的“活性成分”的识别。 在这方面，由于各种干预措施，导致干预措施的组成部分和交付方面存在很大差异。这些数据将导致 在未来的试验中进行测试。我们假设现场音乐来自 音乐治疗师的儿童喜爱的歌曲可能是最有效的减少儿童的压力和痛苦 与录制的音乐或常规护理相比，由于有节奏的夹带（活性成分）， 通过自主神经系统调节（主要机制）。这项研究使用了一个 机械设计，一项随机交叉试验，有三种条件，以比较它们对生物标志物的影响， 呼吸衰竭儿童在三种情况下的压力和疼痛： 音乐治疗师，录制音乐听，和日常护理。 为了填补我在专业知识方面的关键空白，我提出了五个培训目标：（1）获得识别和使用 儿科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方面的培训;（3）开发 PICS-p结果的专业知识;（4）发展进行干预性临床试验的技能;（5）培养 团队科学、研究实施和管理方面的实践技能。我召集了一个多学科的 由NIH资助的研究人员组成的导师团队，他们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力的R21应用程序，以测试优化的音乐听 干预以减少接受MV的儿科患者的压力和疼痛。

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.