Jennifer Townsend MMT, MT-BC Manager of Creative Arts Therapies Houston Methodist

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As the number of COVID 19 cases continues to rise, so does the need for analagosedation and mechanical ventilation for management of critical cases. While necessary for increasing chances of survival these intense and often long-term treatments come with an increased risk for ICU delirium. One study reports that COVID 19 patients may be at even higher risk for ICU delirium due to visitation restrictions, decreased nonpharmacological, increased anxiety and depression that comes from the uncertainty around a global pandemic, and interruptions to religious and spiritual practice (Brunk, 2020). In fact, a recent study showed that 65% of the 58 patients studied had positive findings on the Confusion Assessment Method- ICU and 9% had agitation (Polack, et al., 2020). Common treatments for preventing ICU delirium include reorienting patients often, canceling out noise, and encouraging sedation vacations (Devlin et al., 2018) Music Therapy is a multicomponent, nonpharmacologic intervention that can provide preventative treatment for patient at risk for ICU delirium. Music Therapy has been shown to increase orientation and cognitive stimulation, improve wakefulness, reduce immobility, decrease anxiety and increase social interaction (Korhan, 2011; Chlan & Heiderscheit, 2009; Chlan, Wienert, Heidershceit, et al., 2013). Studies on disorders of consciousness have shown promising results that music therapy assessment and interventions may better detect awareness (Magee, 2018). Studies on disorders of consciousness, like the one above, have shown that the use of music medicine, prescribed music provided to the patient in the absence of a therapeutic relationship, has also shown successful in decreasing delirium for critically ill patients (Sikandar, 2020). Stubbs (2005) demonstrates that patients can hear and remember music listening experiences even under sedation. Furthermore, music listening can activate areas of the brain involved in memory, cognitive function and emotion which can lead to maintained cognitive function. Additionally, patients in a coma that received recorded familiar stories told by family members recovered faster with better overall recovery (Northwestern University, 2015). Based on the brief overview above, our team has developed a protocol using patient name, familiar stories told by family voices, and familiar music to provide positive stimulation in patients who are medically sedated and mechanically ventilated. This protocol aims to explore the use of familiar story, voice and song to mitigate ICU delirium, decrease agitation during the sedation weaning process and improve the psychoemotional stat of patients post long term sedation.

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