Preventive Effect Of Early Activity Combined With Music Therapy On Post-ICU Cognitive Impairment In Patients With Mechanical Ventilation

Background:There are special environment and numerous stressors in intensive care units.45%～80%of mechanically ventilated patients have post-ICU cognitive impairment after discharge.In-bed Cycling(IBC)has been shown to be effective in reducing the incidence of ICU acquired weakness,but has no significant effect on post ICU cognitive impairment.Previous studies have shown that music therapy can directly stimulate the nervous system and activate different areas of the brain through resonance and pitch regulation,or indirectly affect cognitive function by regulating sympathetic nervous system activity and promoting cortisol secretion to improve sleep.In this study,for the first time,IBC exercise therapy combined with music therapy was applied to patients with mechanical ventilation to explore the effect of its intervention on cognitive impairment in ICU.Objective:To compare the differences of cognitive function,delirium,blood glucose,blood oxygen index,procalcitonin level,medication,anxiety and depression between the intervention group and the control group after IBC exercise combined with music intervention.Methods:This was a quasi-experimental study.Convenience sampling method was adopted from April 2022 to February 2023,patients meeting the inclusion and exclusion criteria were collected in the surgical ICU ward of a Grade-A hospital in Beijing for intervention.Patients in the control group were treated with ICU routine nursing methods,while patients in the intervention group were treated with IBC exercise and music therapy twice a day on the basis of routine nursing.The occurrence of delirium,treatment and medication,physiological indicators and other relevant data were recorded when patients were transferred out of ICU.The Chinese version of China State anxiety inventory(C-SAI)and Chinese version of China self-rating depression scale(C-SDS)were used to evaluate the anxiety and depression of patients.Post-ICU Cognitive impairment was assessed at discharge using the Montreal Cognitive Assessment Scale(MoCA).To evaluate the intervention effect of IBC exercise combined with music therapy on patients with mechanical ventilation.Results:A total of 60 subjects participated in the study and completed the whole studyprocess(30 cases in the intervention group and 30 cases in the control group).Cognitive function,delirium,physiological indexes,medication and negative emotions were compared between the intervention group and the control group:(1)Cognitive function:at discharge,the total score of MoCA in the intervention group was 21.40±3.62 points,and the total score of MoCA in the control group was 23.73±2.02 points.At the same time,the executive function score of patients in the intervention group was 4(3,4)points,and that of patients in the control group was 3(2,4)points.The difference of the scores of MoCA and executive function between the two groups was statistically significant(P<0.05).(2)Physiological indexes:when patients were transferred out of ICU,the oxygenation index of patients in the intervention group was 302.10±9.22mmHg,and that of patients in the control group was 285.67±13.66mmHg.The PCT level of patients in the intervention group was 0.25±0.06ng/ml,and that of patients in the control group was 0.44±0.09ng/ml.The difference of oxygenation index and PCT level between the two groups was statistically significant(P<0.05).(3)Drug use:During ICU stay,the amount of exogenous insulin in the intervention group was 16.00(12.00,48.00)u,and that in the control group was 48.00(24,50,97.00)u,and the difference between the two groups was statistically significant(P<0.05).(4)Negative emotion:when transferred out of ICU,the anxiety score of patients in the intervention group was 53.10±5.82 points,and that of patients in the control group was 61.73±8.34 points.The depression score of the intervention group was 52.57±4.34 points,and that of the control group was 62.23±7.49 points.The anxiety score and depression score of the intervention group was significantly lower than that of the control group(P<0.05).Conclusion:IBC exercise combined with music therapy can improve the overall cognitive function,executive function,oxygenation,inflammatory response,stress hyperglycemia,anxiety and depression in patients with mechanical ventilation.This study provides methods for the prevention of post ICU cognitive impairment,and the intervention method is safe and feasible,it is worthy of clinical promotion.