1. Publication
- Title: Slow-Tempo Music and Delirium/Coma-Free Days Among Older Adults Undergoing Mechanical Ventilation: A Randomized Clinical Trial (DDM Trial)
- Acronym: DDM
- Year & Journal: JAMA Internal Medicine, epublished October 13, 2025 (print: 2025;185(12):1442-1453)
- Citation: Khan BA, Khan SH, Perkins AJ, et al. JAMA Intern Med. 2025;185(12):1442-1453. doi:10.1001/jamainternmed.2025.5263
2. Context & Rationale
Background: 70-80% of older ICU adults develop delirium, associated with mortality, prolonged stay, and long-term cognitive decline. Pharmacologic delirium prevention/treatment has largely failed, prompting interest in nonpharmacologic strategies like music therapy.
Research Question/Hypothesis: In mechanically ventilated older adults (≥50y), does twice-daily slow-tempo music (60-80 bpm) reduce delirium duration, severity, pain, or anxiety vs a silence control?
3. Design & Methods
- Study Type: Multicenter, two-arm, parallel-group RCT with concealed outcome assessment
- Setting & Centers: Indiana University Health/Eskenazi Hospital (Indianapolis) and Mayo Clinic (Rochester, MN)
- Population: Mechanically ventilated ICU adults ≥50y
- Intervention: Twice-daily slow-tempo music listening (curated playlist)
- Comparator: Silence-track control
- Statistical Power & Follow-Up: Primary: delirium/coma-free days. Secondary: delirium severity, pain, anxiety, MV duration, LOS.
4. Key Results
Outcome | Music | Silence Control | Notes |
Delirium/coma-free days (primary) | Not significantly improved | — | Clear null |
Delirium severity, pain, anxiety | No significant difference | — | Null across all secondary measures |
MV duration, ICU/hospital LOS | No significant difference | — | Null |
5. Internal Validity Assessment
Multicenter, concealed outcome assessment — a meaningful methodological strength for a nonpharmacologic intervention trial. Overall: Strong for this clean, well-powered null result; described by the lead author as "rigorously conducted."
6. External Validity Assessment
US academic center population ≥50y on MV — broadly representative of the target population for nonpharmacologic delirium interventions.
7. Strengths & Limitations
Strengths: Multicenter, concealed assessment, addresses a widely-adopted but poorly-evidenced practice.
Limitations: Standardized (not personalized/therapist-guided) music delivery may have limited any true effect; music preference/tempo response likely varies by individual.
8. Interpretation & Practice Impact
Does not support routine prescribed slow-tempo music listening for delirium prevention/reduction in ventilated older ICU adults. Per the lead author: "despite the intuitive appeal... prescribed slow-tempo playlists did not reduce delirium, pain or anxiety, nor change length of ventilation or stay."
9. Controversies & Subsequent Evidence
An accompanying JAMA Intern Med commentary ("The Potential of Music as a Nonpharmacologic Intervention for the ICU") engages with the null result; the authors themselves suggest future research focus on "personalized, therapist-guided approaches and targeted populations" rather than abandoning music-based interventions entirely.
10. Summary & Executive Takeaway
Summary: This multicenter RCT randomized ventilated older ICU adults to twice-daily slow-tempo music or silence control. Delirium/coma-free days, delirium severity, pain, and anxiety were all not significantly different.
Overall Takeaway: A standardized, prescribed slow-tempo music intervention does not reduce delirium, pain, or anxiety in ventilated older ICU adults — refining practice away from generic music prescriptions toward more personalized, therapist-guided approaches for future study.
11. Bibliography
- Kaiksow FA, Vasilevskis EE. The Potential of Music as a Nonpharmacologic Intervention for the ICU [commentary]. JAMA Intern Med. 2025;185(12):1453-1454.