Effects of patient-directed music intervention on anxiety and sedative exposure in critically Ill patients receiving mechanical ventilatory support: A randomized clinical trial
Linda L. Chlan,Craig R. Weinert,Annie Heiderscheit,Mary Fran Tracy,Debra J. Skaar,Jill L. Guttormson,Kay Savik +6 more
TLDR
Listening to self-initiated patient-directed music with preferred selections tailored by a music therapist whenever desired can reduce anxiety and sedative exposure during ventilatory support in critically ill patients, which resulted in greater reduction in anxiety compared with usual care, but not compared with NCH.Abstract:
Importance Alternatives to sedative medications, such as music, may alleviate the anxiety associated with ventilatory support. Objective To test whether listening to self-initiated patient-directed music (PDM) can reduce anxiety and sedative exposure during ventilatory support in critically ill patients. Design, Setting, and Patients Randomized clinical trial that enrolled 373 patients from 12 intensive care units (ICUs) at 5 hospitals in the Minneapolis-St Paul, Minnesota, area receiving acute mechanical ventilatory support for respiratory failure between September 2006 and March 2011. Of the patients included in the study, 86% were white, 52% were female, and the mean (SD) age was 59 (14) years. The patients had a mean (SD) Acute Physiology, Age and Chronic Health Evaluation III score of 63 (21.6) and a mean (SD) of 5.7 (6.4) study days. Interventions 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). Main Outcomes and Measures Daily assessments of anxiety (on 100-mm visual analog scale) and 2 aggregate measures of sedative exposure (intensity and frequency). Results Patients in the PDM group listened to music for a mean (SD) of 79.8 (126) (median [range], 12 [0-796]) minutes/day. Patients in the NCH group wore the noise-abating headphones for a mean (SD) of 34.0 (89.6) (median [range], 0 [0-916]) minutes/day. The mixed-models analysis showed that at any time point, patients in the PDM group had an anxiety score that was 19.5 points lower (95% CI, −32.2 to −6.8) than patients in the usual care group (P = .003). By the fifth study day, anxiety was reduced by 36.5% in PDM patients. The treatment × time interaction showed that PDM significantly reduced both measures of sedative exposure. Compared with usual care, the PDM group had reduced sedation intensity by −0.18 (95% CI, −0.36 to −0.004) points/day (P = .05) and had reduced frequency by −0.21 (95% CI, −0.37 to −0.05) points/day (P = .01). The PDM group had reduced sedation frequency by −0.18 (95% CI, −0.36 to −0.004) points/day vs the NCH group (P = .04). By the fifth study day, the PDM patients received 2 fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity. Conclusions and Relevance Among ICU patients receiving acute ventilatory support for respiratory failure, PDM resulted in greater reduction in anxiety compared with usual care, but not compared with NCH. Concurrently, PDM resulted in greater reduction in sedation frequency compared with usual care or NCH, and greater reduction in sedation intensity compared with usual care, but not compared with NCH. Trial Registration clinicaltrials.gov Identifier: NCT00440700read more
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Peripheral Muscle Strength and Correlates of Muscle Weakness in Patients Receiving Mechanical Ventilation
TL;DR: Patients receiving prolonged mechanical ventilation had marked decrements in grip strength, measured by hand dynamometry, a marker for peripheral muscle strength, which can be used to develop interventions to prevent intensive care unit-acquired weakness.
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Survey of Sedation and Analgesia Practice Among Canadian Pediatric Critical Care Physicians.
Gonzalo Garcia Guerra,Ari R. Joffe,Dominic Cave,Jonathan P. Duff,Shannon Duncan,Cathy Sheppard,Gerda Tawfik,Lisa Hartling,Hsing Jou,Sunita Vohra +9 more
TL;DR: There is great variation in practice in the management of pain and anxiety in Canadian PICUs, and standardized strategies for sedation, delirium and withdrawal, and sleep promotion are lacking.
Reporting quality of music intervention research in healthcare: A systematic review
Sheri L. Robb,Deanna Hanson-Abromeit,Lindsey May,Eugenia Hernandez-Ruiz,Megan Allison,Alyssa Beloat,Sarah Daugherty,Rebecca Kurtz,Alyssa Ott,Oladele Oladimeji Oyedele,Shelbi Polasik,Allison Rager,Jamie Rifkin,Emily Wolf +13 more
TL;DR: In this article, the Checklist for Reporting Music-based Interventions was used to evaluate the reporting quality of music intervention research, in chronic and acute medical settings, using MEDLINE, PubMed, CINAHL, HealthSTAR, and PsycINFO.
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Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience
Michele C. Balas,Brenda T. Pun,Chris Pasero,Heidi J. Engel,Christiane Perme,Cheryl L. Esbrook,Tamra Kelly,Ken D. Hargett,Patricia Posa,Juliana Barr,John W. Devlin,Alexandra Morse,Mary Ann Barnes-Daly,Kathleen Puntillo,J. Matthew Aldrich,William D. Schweickert,Lori Harmon,Diane G. Byrum,Shannon S. Carson,E. Wesley Ely,Joanna L. Stollings +20 more
TL;DR: Some of the most challenging implementation issues that Collaborative teams experienced are discussed, and some practical advice from leading experts on ways to overcome these barriers are provided.
References
More filters
Journal ArticleDOI
Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients.
Pratik P. Pandharipande,Ayumi Shintani,Josh F. Peterson,Brenda T. Pun,Grant R. Wilkinson,Robert S. Dittus,Gordon R. Bernard,E. Wesley Ely +7 more
TL;DR: Lorazepam administration is an important and potentially modifiable risk factor for transitioning into delirium even after adjusting for relevant covariates and increasing age and Acute Physiology and Chronic Health Evaluation II scores were also independent predictors of transitioning to delirity.
Journal ArticleDOI
A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial
TL;DR: No sedation of critically ill patients receiving mechanical ventilation is associated with an increase in days without ventilation, and a multicentre study is needed to establish whether this effect can be reproduced in other facilities.
Journal ArticleDOI
Effectiveness of a music therapy intervention on relaxation and anxiety for patients receiving ventilatory assistance
TL;DR: A single music therapy session was found to be effective for decreasing anxiety and promoting relaxation, as indicated by decreases in heart rate and respiratory rate over the intervention period with this sample of patients receiving ventilatory assistance.
Journal ArticleDOI
Canadian survey of the use of sedatives, analgesics, and neuromuscular blocking agents in critically ill patients
Sangeeta Mehta,Lisa Burry,Sandra Fischer,J Carlos Martinez-Motta,David Hallett,Dennis Bowman,Cindy Wong,Maureen O. Meade,Thomas E. Stewart,Deborah J. Cook +9 more
TL;DR: There is significant variation in critical care sedation, analgesia, and neuromuscular blockade practice, and younger physicians (<40 yrs) are more likely to practice daily interruption.
ReportDOI
A mixed model approach for intent-to-treat analysis in longitudinal clinical trials with missing values
Hrishikesh Chakraborty,Hong Gu +1 more
TL;DR: A detailed investigation based on simulation studies suggests that the mixed model approach without any ad hoc imputation is more powerful than other options for ITT analyses of longitudinal controlled clinical trial data with missing values.
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