Exploring the Effectiveness of Intelligent Audiovisual Interventions in Delirium, Agitation, and Pain Among Middle Aged and Elderly Patients in Emergency Intensive Care Units: A Quasi-Experimental Study
The goal of this nonrandomized, quasi-experimental clinical trial is to evaluate whether an intelligent audiovisual intervention can prevent delirium and reduce delirium severity, agitation, and pain among adults aged 55 years or older admitted to an emergency intensive care unit (EICU). The main questions it aims to answer are:
Does the intelligent audiovisual intervention reduce the incidence and severity of delirium compared with routine care? Does the intervention improve agitation and pain scores compared with routine care?
Researchers will compare participants receiving the intelligent audiovisual intervention plus routine care with participants receiving routine care alone. Participants will be assigned according to the week of EICU admission: those admitted during odd-numbered weeks will receive the intervention, while those admitted during even-numbered weeks will receive routine care.
Participants in the intervention group will:
View a structured audiovisual program containing a prerecorded message from a family member, current date and weather information, and images of the area surrounding the hospital.
Receive the intervention for 2 minutes per session, 3 times daily for 2 consecutive days, beginning within 24 hours after EICU admission.
Participants in both groups will undergo assessments of delirium, agitation, and pain 3 times daily for 2 consecutive days. Delirium incidence and severity will be assessed using the Confusion Assessment Method for the Intensive Care Unit-7 (CAM-ICU-7). Agitation will be evaluated using the Richmond Agitation-Sedation Scale (RASS), and pain will be assessed using either the Numerical Rating Scale (NRS) or the Face, Legs, Activity, Cry, and Consolability (FLACC) scale.
Descripción general del estudio
Estado
Estado
Condiciones
Condiciones
Intervención / Tratamiento
Intervención / Tratamiento
Tipo de estudio
Tipo de estudio
Inscripción (Estimado)
Inscripción
Fase
Fase
- No aplica
Contactos y Ubicaciones
Estudio Contacto
Estudio Contacto
- Nombre: Li Fang-Yu
- Número de teléfono: +886 966-914-515
- Correo electrónico: fylee6@vghtpe.gov.tw
Criterios de participación
Criterio de elegibilidad
Criterio de elegibilidad
Edades elegibles para estudiar
- Adulto
- Adulto Mayor
Acepta Voluntarios Saludables
Descripción
Inclusion Criteria:
- Aged 55 years or older.
- Admitted to the emergency intensive care unit within the previous 24 hours.
- No delirium at baseline, defined as a negative Confusion Assessment Method for the Intensive Care Unit assessment and a CAM-ICU-7 score of 0-2.
- Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥14.
- Sufficiently alert to communicate, with a Glasgow Coma Scale score of E4V4-5M6 or E4VTM6.
- Diagnosed with an infection or an infection-related critical illness, such as sepsis, urinary tract infection, or pneumonia.
Exclusion Criteria:
- Diagnosed visual or hearing impairment that would interfere with receiving the audiovisual intervention.
- History of substance abuse.
- History of psychiatric illness.
- Moribund status, receipt of a palliative care consultation, or an expected survival of 7 days or less.
- Unable to communicate in Mandarin Chinese or Taiwanese Hokkien.
- No family caregiver available to participate in preparation of the audiovisual intervention.
- History of surgery within the previous 7 days.
- Montreal Cognitive Assessment (MoCA) score <23.
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Cuidados de apoyo
- Asignación: No aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Ninguno (etiqueta abierta)
Número de brazos
Armas e Intervenciones
Grupo de participantes/brazoGrupo de participantes/brazo |
Intervención / TratamientoIntervención / Tratamiento |
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Experimental: Intelligent Audiovisual Intervention
Participants will receive routine care plus a structured intelligent audiovisual intervention beginning within 24 hours after admission to the emergency intensive care unit.
The audiovisual program includes a prerecorded message from a family member, current date and weather information, and images of the area surrounding the hospital to provide cognitive orientation cues and emotional support.
The intervention will be delivered for 2 minutes per session, 3 times daily (at 7:00 AM, 5:00 PM, and 9:00 PM) for 2 consecutive days.
Participants will also receive routine family visiting twice daily.
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A structured, personalized audiovisual intervention designed to provide cognitive reorientation and emotional support.
The program incorporates person, time, and place orientation cues, including a prerecorded message from a family member using the participant's name and familiar language; current date, weather, and temperature information presented through automated audiovisual content; and images of the area surrounding the hospital.
Participants will receive the intervention for 2 minutes per session, 3 times daily (at 7:00 AM, 5:00 PM, and 9:00 PM) for 2 consecutive days, beginning within 24 hours after admission to the emergency intensive care unit.
The intervention will be provided in addition to routine care.
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Sin intervención: Routine Care
Participants will receive routine care without the intelligent audiovisual intervention.
Routine care includes standard medical and nursing care and family visiting twice daily, at 11:00 AM and 7:00 PM, for 1 hour per visit.
Participants will undergo the same assessments of delirium, agitation, and pain as those in the experimental arm.
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¿Qué mide el estudio?
Medidas de resultado primarias
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Incidence of Delirium Assessed Using the CAM-ICU-7
Periodo de tiempo: From baseline through the end of Day 2; assessed 3 times daily
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Delirium will be assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU-7).
The outcome will be reported as the percentage of participants with at least one positive CAM-ICU-7 assessment during the 2-day assessment period.
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From baseline through the end of Day 2; assessed 3 times daily
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Change From Baseline in Delirium Severity Assessed Using the CAM-ICU-7
Periodo de tiempo: Baseline through the end of Day 2; assessed 3 times daily
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Delirium severity will be measured using the CAM-ICU-7.
Total scores range from 0 to 7, with higher scores indicating greater delirium severity.
Scores of 0 to 2 indicate no delirium, 3 to 5 indicate mild to moderate delirium, and 6 to 7 indicate severe delirium.
Changes from baseline will be evaluated across the scheduled assessments.
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Baseline through the end of Day 2; assessed 3 times daily
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Medidas de resultado secundarias
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Change From Baseline in Richmond Agitation-Sedation Scale Score
Periodo de tiempo: Baseline through the end of Day 2; assessed 3 times daily
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Agitation and sedation will be assessed using the Richmond Agitation-Sedation Scale (RASS).
Scores range from -5 to +4.
A score of 0 indicates that the participant is alert and calm, positive scores indicate increasing agitation, and negative scores indicate increasing levels of sedation.
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Baseline through the end of Day 2; assessed 3 times daily
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Change From Baseline in Pain Intensity Score
Periodo de tiempo: Baseline through the end of Day 2; assessed 3 times daily
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Pain intensity will be assessed using the 11-point Numerical Rating Scale (NRS) for participants able to self-report or the Face, Legs, Activity, Cry, and Consolability (FLACC) scale for participants unable to communicate reliably.
Both scales range from 0 to 10, with higher scores indicating greater pain intensity.
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Baseline through the end of Day 2; assessed 3 times daily
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Colaboradores e Investigadores
Patrocinador
Patrocinador
Publicaciones y enlaces útiles
Publicaciones Generales
- Khan BA, Perkins AJ, Gao S, Hui SL, Campbell NL, Farber MO, Chlan LL, Boustani MA. The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU. Crit Care Med. 2017 May;45(5):851-857. doi: 10.1097/CCM.0000000000002368.
- Waszynski CM, Milner KA, Staff I, Molony SL. Using simulated family presence to decrease agitation in older hospitalized delirious patients: A randomized controlled trial. Int J Nurs Stud. 2018 Jan;77:154-161. doi: 10.1016/j.ijnurstu.2017.09.018. Epub 2017 Oct 7.
- Ma Y, Zhang Y, Cui N, Guo Z, Jin J. The effects of structured family auditory stimulation on preventing ICU delirium among patients with unplanned admissions: A randomized controlled study. Intensive Crit Care Nurs. 2025 Aug;89:103944. doi: 10.1016/j.iccn.2025.103944. Epub 2025 Feb 5.
- Munro CL, Cairns P, Ji M, Calero K, Anderson WM, Liang Z. Delirium prevention in critically ill adults through an automated reorientation intervention - A pilot randomized controlled trial. Heart Lung. 2017 Jul-Aug;46(4):234-238. doi: 10.1016/j.hrtlng.2017.05.002. Epub 2017 Jun 9.
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Estimado)
Inicio del estudio
Finalización primaria (Estimado)
Finalización primaria
Finalización del estudio (Estimado)
Finalización del estudio
Fechas de registro del estudio
Enviado por primera vez
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Publicado por primera vez
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización publicada
Última actualización enviada que cumplió con los criterios de control de calidad
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
Otros números de identificación del estudio
- 2026-08-007BC
Plan de datos de participantes individuales (IPD)
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Descripción del plan IPD
Información sobre medicamentos y dispositivos, documentos del estudio
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