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Journal ArticleDOI

Is there a role for music in the ICU

16 Jan 2015-Critical Care (BioMed Central)-Vol. 19, Iss: 1, pp 17-17

TL;DR: 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.

AbstractResults Patients in the PDM group listened to music for a mean of 79.8 (median (range) 12 (0 to 796)) minutes/day. Patients in the NCH group wore the noise-abating headphones for a mean of 34.0 (median (range), 0 (0 to 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% confidence interval, �32.2 to �6.8) than patients in the usual care group (P = 0.003). 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% confidence interval, �0.36 to �0.004) points/day (P = 0.05) and had reduced frequency by �0.21 (95% confidence interval, �0.37 to �0.05) points/day (P =0 .01). The PDM group had reduced sedation frequency by �0.18 (95% confidence interval, �0.36 to �0.004) points/day versus the NCH group (P = 0.04). By the fifth study day, the PDM patients received two fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity. Conclusions 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.

Topics: Sedation (52%), Confidence interval (50%)

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01 Jan 2016
TL;DR: Today’s intensive care units monitor patients through the use of various medical devices, which generate a high ratio of false positive alarms due to a low alarm specificity.
Abstract: Today’s intensive care units monitor patients through the use of various medical devices, which generate a high ratio of false positive alarms due to a low alarm specificity. The false alarms have r ...

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Journal ArticleDOI
TL;DR: The effects of chronic comorbidities on the management of critically ill adults are explored, and the adjustments of current ICU management modalities and pharmacology to optimize care are discussed.
Abstract: Survival of adults with congenital heart disease (CHD) has improved significantly over the last 2 decades, leading to an increase in hospital and intensive care unit (ICU) admissions of these patients. Whereas most of the ICU admissions in the past were related to perioperative management, the incidence of medical emergencies from long-term sequelae of palliative or corrective surgical treatment of these patients is rising. Intensivists now are confronted with patients who not only have complex anatomy after congenital cardiac surgery, but also complex pathophysiology due to decades of living with abnormal cardiac anatomy and diseases of advanced age. Comorbidities affect all organ systems, including cognitive function, pulmonary and cardiovascular systems, liver, and kidneys. Critical care management requires an in-depth understanding of underlying anatomy and pathophysiology in order to apply contemporary concepts of adult ICU care to this population and optimize patient outcomes. In this review, the main CHD lesions and their common surgical management approaches are described, and the sequelae of CHD physiology are discussed. In addition, the effects of chronic comorbidities on the management of critically ill adults are explored, and the adjustments of current ICU management modalities and pharmacology to optimize care are discussed.

4 citations


Journal ArticleDOI
01 May 2019
TL;DR: A comprehensive strategy based on soundscape design approach is proposed that facilitates a systematic way of tackling the auditory quality of critical care settings in favor of better patient sleep experience.
Abstract: In this paper, the sleep phenomenon is considered in relation to critical care soundscapes with the intention to inform hospital management, medical device producers and policy makers regarding the complexity of the issue and possible modes of design interventions. We propose a comprehensive strategy based on soundscape design approach that facilitates a systematic way of tackling the auditory quality of critical care settings in favor of better patient sleep experience. Future research directions are presented to tackle the knowledge deficits in designing for critical care soundscapes that cater for patient sleep. The need for scientifically-informed design interventions for improving patient sleep experience in critical care is highlighted. The value of the soundscape design approach for resolving other sound-induced problems in critical care and how the approach allows for patient-centred innovation that is beyond the immediate sound issue are further discussed.

4 citations


16 Jun 2017
Abstract: Objectif. — Evaluer l’apport de la musique sur la douleur au cours des soins douloureux chez des patients vigiles en soins critiques. Type d’etude. — Prospective, observationnelle, randomisee en simple aveugle, monocentrique. Methode. — 140 soins douloureux ont ete etudies et repartis en deux groupes (n= 70 avec musique, n=70 sans musique). Les patients etaient tous equipes d’un casque de la marque Bose© et avaient, ou non, une seance de musique de la duree du soin realise. Notre critere de jugement principal etait la douleur, evaluee par le biais de l’EN avant et apres le soin. Nos criteres de jugement secondaires etaient l’anxiete, estimee par une echelle d’hetero-evaluation de COVI avant et apres le soin, la presence d’une interruption de soin liee a la douleur et l’evaluation par une echelle numerique semi quantitative du ressenti des patients et des soignants sur la faisabilite du soin. Resultats. — Concernant le critere de jugement principal, il n’existait pas de difference significative sur la diminution de la douleur entre le groupe musique et sans musique (p > 0,005). En revanche, une diminution de 35% de la douleur a ete observee au sein du groupe musique (p 0,05). En revanche le ressenti de la facilite d’execution du soin par les soignants etait surestime en comparaison a celui des patients dans les deux groupes (p Conclusion. — La musique n’a pas permis d’ameliorer la douleur de facon significative mais elle a diminue de moitie l’anxiete des patients.

4 citations


Additional excerpts

  • ...L’apport sur l’anxiété, de couper les patients des sons extérieurs, en utilisant des casques anti bruit, avait déjà été démontré.(27,32) Quant au ressenti des soignants, il était lui aussi identique, quelque soit le groupe....

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Journal ArticleDOI
TL;DR: The use of music in design applications is experienced as a positive influence that can facilitate wellbeing for community members, persons with disabilities, medical patients, and healthcare professionals in the workplace.
Abstract: In this paper, we discuss some uncommon settings and roles for music, demonstrating how music can aid in the design and implementation of socially responsible healthcare products that are encouraging, inclusive, and sensitive to critical contexts. We review three music-inspired design cases (CareTunes: Musical Alarms for Critical Care, Music and Senior Exercise, and We Are All Musicians and the Adaptive Use Musical Instrument) in which the authors took part. The literature review and the analysis of the case studies provide us with the following insights: music enhances sensory experiences, facilitates physical engagement with the world, music can guide medical professionals in critical contexts, and music creates social cohesion. All of these projects demonstrate the importance of involving participants (users or performers) in the process to address their life experiences. Thus, the use of music in design applications is experienced as a positive influence that can facilitate wellbeing for community members, persons with disabilities, medical patients, and healthcare professionals in the workplace.

2 citations


Cites background from "Is there a role for music in the IC..."

  • ...In addition, music has been shown to aid in the (self)-regulation of emotions in (critical) healthcare settings [14, 15]....

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References
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Journal ArticleDOI
TL;DR: These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.
Abstract: Objective:To revise the “Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult” published in Critical Care Medicine in 2002.Methods:The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task f

2,668 citations


Journal ArticleDOI
TL;DR: Among critically ill cancer patients, multiple distressing symptoms were common in the ICU, often at significant levels of severity, and Symptom assessment may suggest more effective strategies for symptom control and may direct decisions about appropriate use of ICU therapies.
Abstract: Objective To characterize the symptom experience of a cohort of intensive care unit (ICU) patients at high risk for hospital death. Design Prospective analysis of patients with a present or past diagnosis of cancer who were consecutively admitted to a medical ICU during an 8-month period. Setting Academic, university-affiliated, tertiary-care, urban medical center. Patients One hundred cancer patients treated in a medical ICU. Intervention Assessment of symptoms. Measurements Patients’ self-reports of symptoms using the Edmonton Symptom Assessment Scale (ESAS), and ratings of pain or discomfort associated with ICU diagnostic/therapeutic procedures and of stress associated with conditions in the ICU. Main Results Hospital mortality for the group was 56%. Fifty patients had the capacity to respond to the ESAS, among whom 100% provided symptom reports. Between 55% and 75% of ESAS responders reported experiencing pain, discomfort, anxiety, sleep disturbance, or unsatisfied hunger or thirst that they rated as moderate or severe, whereas depression and dyspnea at these levels were reported by approximately 40% and 33% of responders, respectively. Significant pain, discomfort, or both were associated with common ICU procedures, but most procedure-related symptoms were controlled adequately for a majority of patients. Inability to communicate, sleep disruption, and limitations on visiting were particularly stressful among ICU conditions studied. Conclusions Among critically ill cancer patients, multiple distressing symptoms were common in the ICU, often at significant levels of severity. Symptom assessment may suggest more effective strategies for symptom control and may direct decisions about appropriate use of ICU therapies.

402 citations


"Is there a role for music in the IC..." refers background in this paper

  • ...As ICU and hospital mortality improve, other patient-centered outcomes such as alleviating pain, discomfort, and anxiety become important to address [1] – not only from a patient care perspective but also due to their role in improving long-term effects, such as post-traumatic stress disorder [2]....

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Journal ArticleDOI
15 Mar 2000-JAMA
TL;DR: Considering the widespread use of sedation for critically ill patients, more large, high-quality, randomized controlled trials of the effectiveness of different agents for short-term and long-term sedation are warranted.
Abstract: ContextSedation has become an integral part of critical care practice in minimizing patient discomfort; however, sedatives have adverse effects and the potential to prolong mechanical ventilation, which may increase health care costs.ObjectiveTo determine which form of sedation is associated with optimal sedation, the shortest time to extubation, and length of intensive care unit (ICU) stay.Data SourcesA key word search of MEDLINE, EMBASE, and the Cochrane Collaboration databases and hand searches of 6 anesthesiology journals from 1980 to June 1998. Experts and industry representatives were contacted, personal files were searched, and reference lists of relevant primary and review articles were reviewed.Study SelectionStudies included were randomized controlled trials enrolling adult patients receiving mechanical ventilation and requiring short-term or long-term sedation. At least 2 sedative agents had to be compared and the quality of sedation, time to extubation, or length of ICU stay analyzed.Data ExtractionData on population, intervention, outcome, and methodological quality were extracted in duplicate by 2 of 3 investigators using 8 validity criteria.Data SynthesisOf 49 identified randomized controlled trials, 32 met our selection criteria; 20 studied short-term sedation and 14, long-term sedation. Of these, 20 compared propofol with midazolam. Most trials were not double-blind and did not report or standardize important cointerventions. Propofol provides at least as effective sedation as midazolam and results in a faster time to extubation, with an increased risk of hypotension and higher cost. Insufficient data exist to determine effect on length of stay in the ICU. Isoflurane demonstrated some advantages over midazolam, and ketamine had a more favorable hemodynamic profile than fentanyl in patients with head injuries.ConclusionConsidering the widespread use of sedation for critically ill patients, more large, high-quality, randomized controlled trials of the effectiveness of different agents for short-term and long-term sedation are warranted.

344 citations


Additional excerpts

  • ...bradycardia, hypotension, weakness, and delirium [3]....

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Journal ArticleDOI
TL;DR: The hypothesis that the impact of care within the ICU has an impact on subsequent psychological morbidity and therefore must be assessed in future studies looking at the way patients are sedated in theICU and how physical restraint is used is raised.
Abstract: Objective This prospective observational study was designed to explore the relationships between post-traumatic stress disorder (PTSD), patients' memories of the intensive care unit (ICU) and sedation practices.

337 citations


"Is there a role for music in the IC..." refers background in this paper

  • ...As ICU and hospital mortality improve, other patient-centered outcomes such as alleviating pain, discomfort, and anxiety become important to address [1] – not only from a patient care perspective but also due to their role in improving long-term effects, such as post-traumatic stress disorder [2]....

    [...]


Journal ArticleDOI
TL;DR: Music therapy is an effective nursing intervention in decreasing anxiety in ventilator-dependent patients and its use should be incorporated into the care of mechanically ventilated patients.
Abstract: Objective: The purpose of this study was to assess the effectiveness of music therapy in decreasing anxiety in ventilator-dependent patients. Design: A crossover repeated measures design with random assignment was used. Setting: The intensive care unit of a university hospital in Hong Kong was used as the setting for this study. Patients: Twenty patients who were ventilator-dependent were recruited for the study. They were all Chinese with a mean age of 58.25 years (range, 19-84 y). Most (75%) were men. Outcome Measures: Physiologic measures of anxiety assessed in this study were mean blood pressure and respiratory rate. An additional measure was the Chinese version of the Spielberger State-Trait Anxiety Inventory. Intervention: Patients were randomized to receive either 30 minutes of uninterrupted rest and then 30 minutes of music therapy or the music therapy first and then the uninterrupted rest period. Patients listened to relaxing music by using audiocassette players and headphones. Subjects selected the music of their choice from a selection including both Chinese and Western music. Subjects had physiologic measures taken immediately before the intervention (or rest period) and at 5-minute intervals throughout the intervention. The Chinese version of Spielberger's State-Trait Anxiety Inventory was completed before the intervention and immediately after the intervention. Results: Findings indicated that music therapy was more effective in decreasing state anxiety than was an uninterrupted rest period (P <.01). As measured by analysis of variance with repeated measures, blood pressure and respiratory rate showed no significant differences in the 2 conditions over time. However, significant differences were observed at the end of the intervention (after 30 minutes) between the 2 conditions, with music therapy being superior to the rest period. Conclusion: Music therapy is an effective nursing intervention in decreasing anxiety in ventilator-dependent patients and its use should be incorporated into the care of mechanically ventilated patients. For the Chinese patients, culture and language were the predominant factors in their choice of music. (Heart Lung® 2001;30:376-87.)

198 citations


"Is there a role for music in the IC..." refers background in this paper

  • ...respiratory rate [5] or in overall anxiety [6]....

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