Intensive care units (ICUs) are environments specialized in the care of critically ill patients. Despite significant advances, ICUs are often seen as a dehumanized environment. Among the various stressors in ICUs, anxiety, pain, psychomotor agitation and mental confusion, need for mechanical restraint, lack of privacy, noise, restricted visiting time with family members and excessive lighting stand out. The tripod composed of pain, anxiety and delirium (often associated with the presence of psychomotor agitation, mental confusion and altered level of consciousness) has a high incidence and morbidity. A set of prevention, intensity reduction and treatment measures has been proposed for these conditions, with a growing number of scientific evidence supporting their routine use.

Elderly patients tend to be particularly susceptible to the stressors described above. This aspect represents an additional source of concern for ICUs, since the elderly today represent the majority of patients admitted to ICUs. Hospitalization in ICUs after surgical procedures is often an unknown moment for the individual and, consequently, associated with the development of numerous unpleasant sensations, directly interfering with the patient's recovery.

Music as a therapy tool in medical practice has been used since 1890. After a little more than two decades, in 1914 it was applied in a surgical procedure by physician Evan Kane as a way of "calming patients and diverting attention from fear". associated with combined therapy with local anesthesia. In this context, being a low-cost tool, with minimal adverse effects and high acceptability, the use of music has proven to be a great ally in the arsenal of non-pharmacological therapies for the prevention of delirium, anxiety and pain.

We intend, through a randomized multicenter clinical trial, to investigate whether the use of music as therapy is capable of reducing the incidence of anxiety, pain and delirium in elderly patients undergoing surgical procedures and hospitalized during the postoperative period in intensive care units.

Inclusion Criteria:

• Elective surgery admitted to the ICU in the immediate period after the surgical procedure; · Age equal to or greater than 65 years

Exclusion Criteria:

• · Moderate to severe dementia, defined by 2 to 3 points in the clinical dementia rating (CDR)66;

  • Impossibility of verbal communication (eg: aphasia);
  • Lack of understanding of the Portuguese language;
  • Inability to listen to music due to hearing impairment or intolerance to the use of headphones;
  • Mechanical ventilation for more than 12 hours;
  • Richmond Agitation Sedation Scale (RASS) less than or equal to 324;
  • Neurosurgical and craniofacial procedures;
  • Refusal or failure to sign the free and informed consent form (TCLE).