Can patient-directed music therapy decrease anxiety and reduce sedative use in the intensive care unit?
Patient-directed music therapy in the intensive care unit (ICU) reduces anxiety in awake, ventilated patients while also decreasing the intensity and frequency of sedative use. (LOE = 1b-)
Chlan LL, Weinert CR, Heiderscheit A, et al. Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support. JAMA 2013;309(22):2335-2344.
Randomized controlled trial (nonblinded);
Inpatient (ICU only)
These investigators studied the effects of patient-directed music therapy in reducing anxiety and sedative use in the ICU. Patients using ventilatory support for acute respiratory failure who were alert enough to consent and operate a music player were randomized, using concealed allocation, to 1 of 3 groups: (1) the use of headphones to listen to music (n = 126), (2) the use of noise-cancelling headphones to block out ICU noise (n = 122), and (3) usual care (n = 125). Only 5% of patients who were assessed for eligibility actually underwent randomization, as patients who were unable to consent because of confusion or deep sedation were excluded. A music therapist helped patients in group 1 select their preferred music. These patients were then directed and prompted to listen to music via headphones as often as desired. In group 2, patients were encouraged to wear noise-cancelling headphones whenever they wanted to block out ICU noise. Patients in all 3 groups had similar baseline characteristics, including anxiety scores at study entry and intensity and frequency of sedation 24 hours prior to enrollment. There was a wide range of Acute Physiology, Age and Chronic Health Evaluation III (APACHE III) scores, but the mean fell between 62 and 66 in all 3 groups. A research nurse administered a 100-mm anxiety visual analog scale to patients daily when feasible.
Patients in the music therapy group listened to music for an average of 80 minutes per day; those in the noise-cancelling group wore their headphones for 34 minutes per day. After adjusting for APACHE III scores and sedation frequency and intensity, the use of music therapy lowered anxiety scores by 19 mm compared with usual care (relative decrease of 36%; P = .003). The music group also had decreased sedation intensity (P = .05) and frequency (P = .01) over time when compared with usual care after adjustments were made for imbalances. For example, by day 5, patients in the music group received 3 doses per day of sedative medication, while those in the usual care group received 5 doses. The music therapy group also showed reduction in sedation frequency when compared with the noise-cancelling headphones group, but there were no significant differences detected in anxiety scoring or sedation intensity between these 2 groups. The study did not examine ICU length of stay or other clinical outcomes.
Dr. Kulkarni is an assistant professor of hospital medicine at Northwestern University in Chicago.