"Critically ill mechanically ventilated patients receive intravenous sedative and analgesic medications to reduce anxiety and promote comfort and ventilator synchrony," according to background information in the article. These potent medications are often administered at high doses for prolonged periods and are associated with various adverse effects. "Mechanically ventilated patients have little control over pharmacological interventions to relieve anxiety; dosing and frequency of sedative and analgesic medications are controlled by intensive care unit (ICU) clinicians. Interventions are needed that reduce anxiety, actively involve patients, and minimize the use of sedative medications." The authors note that "listening to preferred, relaxing music has reduced anxiety in mechanically ventilated patients in limited trials. It is not known if music can reduce anxiety throughout the course of ventilatory support, or reduce exposure to sedative medications."
Linda L. Chlan, Ph.D., R.N., of Ohio State University, Columbus, and colleagues conducted a study to evaluate if a patient-directed music (PDM) intervention could reduce anxiety and sedative exposure in ICU patients receiving mechanical ventilation. The clinical trial included 373 patients from 12 ICUs at 5 hospitals in the Minneapolis-St. Paul area receiving acute mechanical ventilatory support for respiratory failure between September 2006 and March 2011. Of the patients included in the study, 86 percent were white, 52 percent were female, and the average age was 59 years. Patients were randomized to self-initiated PDM (n=126) with preferred selections tailored by a music therapist whenever desired while receiving ventilatory support; self-initiated use of noise-canceling headphones (NCH; n = 122); or usual care (n = 125). The main outcomes examined were daily assessments of anxiety (on a 100-mm visual analog scale) and 2 aggregate measures of sedative exposure (intensity and frequency).
The PDM patients listened to music for an average of 80 minutes/day; the NCH patients wore the noise-abating units for an average of 34.0 minutes/day. Analysis showed that patients in the PDM group had an anxiety score that was 19.5 points lower than patients in the usual care group.
For an average patient on the fifth study day (the average time patients were enrolled), a usual care patient received 5 doses of any 1 of the 8 study-defined sedative medications. An equivalent PDM patient received 3 doses of sedative medications on the fifth day, a relative reduction of 38 percent. By the end of the fifth day, a PDM patient had a relative reduction of 36 percent in their sedation intensity score and 36.5 percent in their anxiety score.
PDM did not result in greater reduction in anxiety or sedation intensity compared with NCH.
"Music provides patients with a comforting and familiar stimulus and the PDM intervention empowers patients in their own anxiety management; it is an inexpensive, easily implemented nonpharmacological intervention that can reduce anxiety, reduce sedative medication exposure, and potentially associated adverse effects. The PDM patients received less frequent and less intense sedative regimens while reporting decreased anxiety levels," the authors write.
(doi:10.1001/jama.2013.5670; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Music Therapy for Reducing Anxiety in Critically Ill Patients
In an accompanying editorial, Elie Azoulay, M.D., Ph.D., of the Universite Paris-Diderot, Sorbonne Paris-Cite, and colleagues comment on the findings of this study.
"Reducing anxiety and amount of sedation in mechanically ventilated patients is of the utmost importance, particularly because the result may be a decrease in the post-ICU burden, which weighs heavily on many patients, as well as numerous complications related to sedation. The trial by Chlan et al provides preliminary data that create new possibilities for improving the well-being of ICU patients. Further studies are needed to better understand how music therapy might improve the ICU experience for critically ill patients."