Healthcare News & Insights

Critically ill patients get help through music therapy

When patients are critically ill and receiving mechanical ventilation, it’s vital to keep their spirits up. Reason: A number of studies have proven that patients in the intensive care unit suffer from post-traumatic stress disorder (PTSD), cognitive impairment and depression — none of which help in their recovery.

110859617And this isn’t just during their stay, it occurs after discharge, too.

The good news is, the majority of these patients survive. The challenge nowadays is how to keep these patients positive and moving forward in their recovery.

Getting them to focus on things that make them feel good can help speed up their recovery and keep them from being readmitted.

Music therapy

One way to do this: music therapy.

Recently, a randomized clinical trial that used music therapy to reduce anxiety and sedation in patients receiving mechanical ventilation for acute respiratory failure was reported in the Journal of the American Medical Association.

The study examined 373 patients:

  • 126 patients had a music therapist help them select the music they liked and were allowed to listen to it whenever they wanted
  • 122 patients used noise-abating headphones when they wanted, and
  • 125 received the usual care.

After the fifth day of the study, the music therapy group reported decreased anxiety (about a 36% decrease). They also had a reduced sedation intensity and frequency (three doses per day vs. five doses per day in the usual care group).

So it would appear from this study that something as simple as letting patients listen to their favorite music can improve their spirits.

Issues at hand

However, while the study showed promising results, there are a few issues surrounding the study to take into consideration:

  1. It can’t be proved that anxiety was what was measured in the study. According to the JAMA report, anxiety is characterized by apprehension, agitation, increased motor activity, arousal and fearful withdrawal. The study, however, didn’t define anxiety based on the existence of these symptoms. Instead, the patients in the study used a 100-mm visual analog scale (VAS) from “not anxious at all” to “most anxious ever” to self-report their anxiety level in response to the question “How are you feeling today?” at the beginning of the study and daily during mechanical ventilation. Therefore, the VAS score collected probably reflected patients’ general well-being, as well as anxiety.
  2. The study only looked at short-term outcomes. The VAS score was measured once a day during patients’ ICU stay and, on average, patients only listened to music around 12 minutes per day. An earlier study revealed a significant decrease in anxiety immediate after a 30-minute music session.
  3. The patients in the music portion of the study were conscious AND receiving mechanical ventilation. However, most of the patients were too deeply sedated to use an audio device. The question here is whether providing music to the more deeply sedated patients would have benefited them by reducing sedation, delirium and post-ICU depression.
  4. Sedative administration wasn’t directed by protocol or standardized across ICUs. This is an issue since one of the more important findings of the study is the potential decrease in sedation among patients in the music group. Due to the number of adverse effects related to sedation, a decline in the use of sedation would be a significant advancement.
  5. The study doesn’t describe the ICU environment in term of patient- centered and holistic care. Information such as visitation hours, involvement of family members in music choices and the role of the nurses would be beneficial to know, as it might have an affect on the outcomes of the study.

While there are issues with the reporting of the research, the one thing this study offers is a jumping off point for another larger trial on music therapy in critically ill patients receiving mechanical ventilation.

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