Image: PD
1. Conscious, intubated patients in the intensive care unit frequently experience significant anxiety, which can affect their clinical condition and often requires significant sedative use.
2. In the present study, patient-directed music therapy reduces both anxiety and sedative administration in conscious, intubated patients.
Evidence Rating Level: 1 (Excellent)
Study Rundown: In the present study, the authors examine the use of integrative music therapy for reducing anxiety and sedative requirements in mechanically ventilated patients in the intensive care unit (ICU). Anxiety is a significant issue in the ICU setting, as patients are critically ill, in an unfamiliar setting, and in the case of this study, experiencing the discomfort of conscious intubation. Moreover, anxiety directly affects a patient’s condition in the ICU, adversely affecting patients’ emotional states and, through systemic sympathetic activity, their respiratory and cardiovascular stability. For these reasons, intubated patients often receive high and/or frequent doses of sedatives, which carry their own adverse effects including lower respiratory drive, potential dependence, and constipation. Here, the authors demonstrate that patient-directed music therapy (PDM) may be an effective adjunct to ameliorate patient anxiety and perhaps even reduce sedative requirements.
This study design carries key limitations: due to the nature of the intervention, neither the patients nor ICU care teams could be blinded, introducing a possible source of bias. Second, the primary outcome of patient-reported anxiety relies on a subjective measure that, while validated in prior studies, does not account for objective symptoms of anxiety that can affect patients’ conditions. Lastly, these findings can only be applied to patients who are consciously intubated in the ICU, despite the fact that the majority of patients in the ICU are more deeply sedated or even comatose. That said, this study highlights the potential of music therapy in the ICU setting and may serve as a stimulus for broader future studies to further characterize the use of non-pharmacologic therapies.
Click to read the study, published today in JAMA
Click to read an accompanying editorial in JAMA
Relevant Reading: Anxiety and Agitation in Mechanically Ventilated Patients
In-Depth [randomized clinical trial]: The authors analyzed data from 241 patients admitted to five ICUs receiving mechanical ventilation. Though critically ill, all patients were conscious and able to participate in the intervention. Patients were randomized to receive either PDM, self-directed noise-cancelling headphones without music (NCH), or routine ICU care. Patients used PDM for a mean of 79.8 minutes per day (median 12, range 0-796 minutes), compared with a mean of 34.0 minutes per day (median 0, range 0-916 minutes) in the NCH group. After controlling for severity of illness and changes in sedative dosing, patients receiving PDM reported a 36.5 percent decrease in anxiety by the fifth study day (p=0.003) relative to those receiving routine care. Similarly, sedative administration frequency and intensity between these groups showed significant downward trends and were reduced by 38 percent (p=0.01) and 36 percent (p=0.05), respectively, on the fifth study day. Of note, patients using NCH showed no significant change in anxiety levels or sedative administration.
By Jeff Dewey and Rif Rahman
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