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

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.

Inclusion Criteria:

1. Aged 55 years or older.
2. Admitted to the emergency intensive care unit within the previous 24 hours.
3. 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.
4. Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥14.
5. Sufficiently alert to communicate, with a Glasgow Coma Scale score of E4V4-5M6 or E4VTM6.
6. Diagnosed with an infection or an infection-related critical illness, such as sepsis, urinary tract infection, or pneumonia.

Exclusion Criteria:

1. Diagnosed visual or hearing impairment that would interfere with receiving the audiovisual intervention.
2. History of substance abuse.
3. History of psychiatric illness.
4. Moribund status, receipt of a palliative care consultation, or an expected survival of 7 days or less.
5. Unable to communicate in Mandarin Chinese or Taiwanese Hokkien.
6. No family caregiver available to participate in preparation of the audiovisual intervention.
7. History of surgery within the previous 7 days.
8. Montreal Cognitive Assessment (MoCA) score <23.