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
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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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References
More filters
Journal ArticleDOI
Advantages and disadvantages of combining sedative agents
TL;DR: The current status of research regarding combination sedative therapy is reviewed, with a focus on the use of small doses of agents from different drug classes to treat concomitant behavioral problems.
Journal Article
Sedation in the Intensive Care Unit. The basis of the problem.
TL;DR: The authors focus the importance of an individualized sedative approach which provides pain relief and modulates stress response, allowing patients to be easily arousable and cooperative as necessary.
Journal ArticleDOI
Endocrine Responses to the Stress of Critical Illness
TL;DR: The physiologic and pathophysiologic basis underlying endocrine responses to the stress of critical illness is described and the critical care nurse is challenged by the complexity of this patient and needs to be familiar with the endocrine response for assessment and clinical interventions to be meaningful.
Journal ArticleDOI
Data acquisition for a patient-directed intervention protocol in the dynamic intensive care unit setting
TL;DR: Modifications of commercially available headphones and the application of a data logging device to capture frequency and length of protocol use (music listening or headphones only for noise cancellation) without burdening participants or busy ICU nurses are described.
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