ICU delirium is a devastating complication of illness, acute trauma, and surgery often resulting in prolongedmechanical ventilation, longer lengths of stay, and long-term disability. Delirium is associated with over 12 timesincreased odds of developing Alzheimer's disease (AD) and AD-related dementias (ADRD). In addition, deliriumaccelerates cognitive decline in AD/ADRD patients. Likewise, patients with underlying dementia are 2.5-4.7 timesmore likely to develop delirium. AD/ADRD patients who develop delirium have a marked increase in adverseoutcomes including rate of cognitive decline, institutionalization, and death following an episode of deliriumcompared to those without pre-existing AD/ADRD. The ABCDEF (A2F) Bundle has the best success atdecreasing ICU delirium among pharmacologic and nonpharmacologic interventions. The A2F Bundle is a groupof evidence-based assessments and interventions (i.e., Assess, prevent, and manage pain, Both spontaneousawakening and breathing trials, Choice of analgesia and sedation, Delirium: assess, prevent, and manage, Earlymobility and exercise, and Family engagement and empowerment) designed to improve ICU patient careregardless of illness pathology. Family engagement, an A2F bundle component independently associated withreduced ICU delirium prevalence, was implemented in 63% of ICUs pre-pandemic and dropped to under 20%during the pandemic. As the pandemic resolves, there is a gradual return to normal visitation policies, but, overall,families remain under engaged. Interventions that expand family engagement have the potential to significantlyimprove short- and long-term patient (e.g., AD/ADRD, disability) and family outcomes. VoiceLove LLC isdeveloping a novel HIPAA-compliant mobile application that enables expanded family engagement by mitigatingmultifactorial barriers known to influence A2F bundle implementation. The VoiceLove app is a safe and time-efficient tool allowing direct communication between patients and their family members, and between careproviders and absent family members, allowing more time for direct patient care. A pilot study with ICU patientsat New York-Presbyterian Hospital demonstrated thousands of direct family messages exchanged without anyadditional nursing burden. In this Fast-Track STTR, we will refine the VoiceLove prototype and evaluate the newapplication among mechanically ventilated adult patients admitted to a medical, surgical, or coronary ICU. PhaseI will optimize the VoiceLove app for ICU patients, families, and providers. Phase II will include a randomizedcontrol trial (RCT) comparing VoiceLove implementation to usual care control to investigate the effect onoptimizing patient-family-provider communication, engagement, and ICU delirium prevalence. Mitigating ICUdelirium is of paramount importance to reducing the risk of long-term complications, including an increased riskof developing AD/ADRD as well as accelerating decline in patients with AD/ADRD. This Fast-Track STTRrepresents a major step forward in bringing a novel technology to the bedside to expand family engagement andempowerment, decrease the prevalence of ICU delirium, and thus reduce long-term AD/ADRD risk.
Public Health Relevance Statement: ICU delirium is a devastating complication of illness, acute trauma, and surgery that significantly increases the
risk of developing Alzheimer's disease (AD) and AD-related dementias (ADRD) and accelerates cognitive decline
in patients with AD/ADRD. The ABCDEF (A2F) Bundle has the best success at decreasing ICU delirium among
pharmacologic and nonpharmacologic interventions, but the Family Engagement component is challenging to
implement. VoiceLove LLC is developing a novel HIPAA-compliant mobile application that enables expanded
Family Engagement by mitigating barriers known to influence A2F bundle implementation with the potential to
significantly improve short- and long-term patient (e.g., ICU delirium, AD/ADRD, disability) and family outcomes.
Project Terms: <21+ years old> 