Exploratory ICU Trial Evaluates Vibroacoustic Music Therapy for Postoperative Delirium

Therapist-guided vibroacoustic music therapy did not significantly shorten delirium duration among non-ventilated adult intensive care unit patients recovering from surgery, according to findings from the VIMUD-ICU single-center exploratory randomized controlled trial published in Intensive Care Medicine. Registered under DRKS00031985, the trial evaluated whether combining vibroacoustic sound stimulation with responsive therapist interactions could reduce the time intensive care unit patients spent with postoperative delirium. The investigation reached a neutral result for its primary endpoint, which measured delirium duration from trial enrollment until a patient maintained a 48-hour period with no positive delirium score during their intensive care unit stay.

Postoperative delirium is documented in the study as a frequent clinical complication in intensive care units, linked with prolonged hospital stays, extended intensive care duration, increased mortality, and heightened risk for long-term cognitive impairment under post-intensive care syndrome. With pharmacological options for preventing and treating delirium remaining limited, clinical guidelines emphasize multimodal non-pharmacological strategies. Within this clinical setting, music therapy is defined specifically as an intervention distinguished from simple music listening by the presence of a trained therapist who structures the session responsively using musical and relational elements.

Developed in collaboration with the university’s Department of Music Therapy, the tested intervention delivered vibroacoustic music therapy through the SoundPad, a thin wooden board equipped with integrated speakers manufactured by Resono in Germany. The device provided tactile vibroacoustic stimulation while a trained therapist guided verbal and non-verbal interactions. Each full treatment session incorporated two distinct musical selections: an initial piece composed specifically for the intervention protocol, followed by a personalized piece familiar to the individual patient, administered in three consecutive daily sessions lasting 20 to 30 minutes each.

Between September 2023 and December 2024, clinical investigators screened 3,481 intensive care unit patients, identifying postoperative delirium using an Intensive Care Delirium Screening Checklist score of four or greater. A total of 111 adult patients were enrolled and randomized, with 56 assigned to the vibroacoustic music therapy group and 55 allocated to standard care alone. The trial terminated early relative to its intended target of 122 participants because music therapy institutional support concluded in December 2024. Baseline patient characteristics showed no significant differences between the two study arms, and among the intervention cohort, 49 patients (87.5 percent) completed all three planned sessions, while three patients received two sessions, two received one session, and two received no sessions.

Despite the neutral primary outcome, researchers identified statistically significant differences across secondary endpoints during the delirium episode. Patients assigned to vibroacoustic music therapy experienced significantly longer cumulative periods without a positive delirium score, recording a median of 84.5 hours (interquartile range, 47.75 to 151 hours) compared to 55 hours (interquartile range, 18 to 102.5 hours) in the control group (p = 0.018). Furthermore, participants in the intervention arm had significantly more days free from alpha-2 agonist medication, recording a median of 6 days (interquartile range, 3 to 10.25 days) versus 3 days (interquartile range, 1 to 9 days) among control participants (p = 0.028).

Patient arousal levels, evaluated via the Richmond Agitation-Sedation Scale, also demonstrated differences between the study cohorts. The absolute pre-session to post-session change in scale scores was significantly greater in the vibroacoustic intervention group, showing a median change of 0 (interquartile range, -1 to 0) compared to 0 (interquartile range, 0 to 0) in the standard care group (p = 0.006). Maximum daily agitation and sedation scores were also significantly lower in the intervention group across study days 5 through 7 (p < 0.05), with day 5 comparisons between 43 intervention and 29 control patients yielding p = 0.026, day 6 comparisons between 39 intervention and 27 control patients yielding p = 0.013, and day 7 comparisons between 35 intervention and 22 control patients yielding p = 0.014. Conversely, overall intensive care unit length of stay, total delirium duration across the entire intensive care stay, days without neuroleptics, and days without physical restraint procedures exhibited no statistically significant differences between groups.

The trial authors noted that because delirium is defined by clinical fluctuation, delirium-free intervals may capture changes in symptom burden that are not reflected in overall episode duration alone. Grounded in a bio-psycho-social framework, the vibroacoustic sequence was designed to engage delirious patients through auditory input, haptic vibrations, relational attunement, and autobiographical musical selections. Investigators suggested that for patients experiencing acute delirium with compromised attention, this low-stimulus approach might diminish arousal by mitigating sensory overload and providing external orientation, while shared therapist listening and familiar music could foster interpersonal security and temporarily stabilize cognitive and emotional functions.

The researchers underscored several methodological limitations, noting that the investigation was conducted at a single center without blinding. Although clinicians followed a standardized delirium management protocol, prescribing choices regarding alpha-2 agonists could have been influenced by clinical staff awareness of group assignments. Additionally, the control group did not receive time-matched or attention-matched contact from a therapist, preventing investigators from isolating the specific contributions of auditory, vibroacoustic, or interpersonal therapeutic components. Consequently, the investigators designated the positive secondary findings as hypothesis-generating observations that warrant further evaluation in multimodal critical care research.

Subject of Research: Vibroacoustic music therapy for postoperative delirium in intensive care

Article Title: Vibroacoustic music therapy for postoperative delirium in the ICU: the VIMUD-ICU single-center exploratory randomized controlled trial

Article References: Burzlaff, P., Simon, P., von der Nahmer, P. M., Metzner, S., & Deetjen, P. (2026). Vibroacoustic music therapy for postoperative delirium in the ICU: the VIMUD-ICU single-center exploratory randomized controlled trial. Intensive Care Medicine. https://doi.org/10.1007/s00134-026-08645-6

Image Credits: AI Generated

DOI: 10.1007/s00134-026-08645-6

Keywords: postoperative delirium, intensive care unit, vibroacoustic music therapy, music therapy, critical care, delirium management, Richmond Agitation-Sedation Scale, randomized controlled trial, Vibroacoustic, music, therapy, postoperative