Is there a role for music in the ICU
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.
Abstract: Results 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.
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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.
9 citations
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.
7 citations
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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 ...
5 citations
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.
4 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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16 Jun 2017
TL;DR: In this paper, the authors evaluated the effect of musique on the douleur of a soin in a caseque de the marque Bose© and found that the musique n’a permis d’ameliorer la soin de facon significative mais elle a diminue de moitie l’anxiete des patients.
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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References
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TL;DR: Although patients were minimally arousable or nonarousable in 32% and motionless in 21% of the sedation assessments, surprisingly, an oversedation rating occurred in <3%, which suggests that collaborative research is needed to define adequate sedation.
Abstract: Objective:Describe the pharmacoepidemiology of sedative medications and nurse-rated patients' behavior and sedation adequacy.Design:Cohort study, 2001–2003.Patients:Patients ventilated for >36 hrs in a medical or surgical intensive care unit at a university-affiliated hospital. Proxies for 312 eligi
152 citations
"Is there a role for music in the IC..." refers background in this paper
...Sedation exposure was measured both in terms of intensity (weight-adjusted dose given during a 4-hour block) and frequency (the number of 4-hour blocks during which any sedation was administered) [9]....
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TL;DR: It was found that intensive care nursing staff can beneficially apply music therapy as a non-pharmacological intervention and patients remembered very little of their time in ICU.
127 citations
"Is there a role for music in the IC..." refers background in this paper
...The long-term effects remain more uncertain, as one study noted that the decrease in blood pressure observed during a music listening session was accompanied by a corresponding rise after cessation of treatment [7]....
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TL;DR: Data indicated that music listening decreased heart rate, respiratory rate, and Profile of Mood States scores, indicating relaxation and mood improvement.
Abstract: Background Although mechanically ventilated patients experience numerous stressors, they have not been included in music therapy stress reduction and relaxation studies. Objective To examine selected psychophysiologic responses of mechanically ventilated patients to music. Methods A two-group experimental design with pretest, posttest, and repeated measures was used. Twenty mechanically ventilated patients were randomized to a music-listening group or a nonmusic (headphones only) group. Physiologic dependent measures--heart rate and rhythm, respiratory rate, systolic and diastolic blood pressure, oxygen saturation, and airway pressure--were collected at timed intervals. Psychologic data were collected before and after intervention using the Profile of Mood States. Results Using repeated measures analysis of variance, results for heart rate and respiratory rate over time and over time between groups were significant. Between-group differences were significant for respiratory rate. Significant differences were found via t test for the music group's Profile of Mood States scores. No adverse cardiovascular responses were noted for either group. Conclusions Data indicated that music listening decreased heart rate, respiratory rate, and Profile of Mood States scores, indicating relaxation and mood improvement.
78 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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TL;DR: The levels of the 4 biomarkers of the stress response did not differ significantly between patients who listened to music and patients who rested quietly, though the levels of corticotropin and cortisol showed interesting trends.
Abstract: • BACKGROUND Music is considered an ideal therapy for reducing stress in patients receiving mechanical ventilation. Previous studies of the effect of music on stress in such patients have focused solely on indirect markers of the stress response rather than on serum biomarkers. • OBJECTIVE To explore the influence of music on serum biomarkers of the stress response in patients receiving ventilatory support. • METHODS A convenience sample of 10 patients receiving mechanical ventilation was recruited from an 11-bed medical intensive care unit. Patients were randomly assigned to listen to music or to rest quietly for 60 minutes. Levels of corticotropin, cortisol, epinephrine, and norepinephrine were measured 4 times during the 60 minutes. • RESULTS The levels of the 4 biomarkers of the stress response did not differ significantly between patients who listened to music and patients who rested quietly, though the levels of corticotropin and cortisol showed interesting trends. • CONCLUSIONS Additional research is needed with a larger sample size to evaluate further the influence of music on biochemical markers of the stress response in patients receiving mechanical ventilatory support. In future studies, confounding factors such as endotracheal suctioning and administration of medications that influence the stress response should be controlled for. (American Journal of Critical Care. 2007;16:141-145)
52 citations
"Is there a role for music in the IC..." refers background in this paper
...A final study found no effect of music on serum biomarkers of the stress response between patients listening to music and those resting quietly [8]....
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TL;DR: A multicenter randomized clinical trial using music therapy to help reduce anxiety and sedation among 373 patients receiving mechanical ventilation for acute respiratory failure demonstrates that an apparently easily implemented intervention used actively by the patient can reduce anxiety.
Abstract: THE VAST MAJORITY OF CRITICALLY ILL PATIENTS WHO receive mechanical ventilation now survive, even those with acute lung injury or acute respiratory distress syndrome. Over the past decade, an increasing number of studies have focused not only on survival, but also on the patients’ experience of critical care. These studies have evaluated 3 periods: the intensive care unit (ICU) stay (confusion, delirium, acute stress, nightmares, hallucinations, and sleep disorders), the first few weeks or months after ICU discharge (symptoms of posttraumatic stress disorder [PTSD], cognitive impairment, and depression), and the period beyond one year after ICU discharge. Many of these studies have shown a significant association between the amount of ICU sedation and decline in factual memory, presence of delusional memory, and additional PTSD-related symptoms. Few studies have assessed patient comfort and symptoms during the ICU stay. Among patients with cancer admitted to the ICU, 55% to 75% reported pain, discomfort, anxiety, sleep disturbances, or unsatisfied hunger or thirst; 40% reported depression. A study with an 8-year follow-up found acute stress at ICU discharge in 44% of patients and PTSD during follow-up in 24%. In another study that evaluated in-ICU symptoms recalled by patients several weeks to months after ICU discharge, anxiety was reported by 52% of patients. In this issue of JAMA, Chlan and colleagues report the results of a multicenter randomized clinical trial using music therapy to help reduce anxiety and sedation among 373 patients receiving mechanical ventilation for acute respiratory failure. In the intervention group (n=126), a music therapist helped the patients select their preferred pieces of music, which the patients could then listen to as they wanted. The patients in the intervention group were compared with patients who self-initiated use of noise-abating headphones (n = 122) or patients who received usual care (n=125). By the fifth study day, the patient-directed music group had relative decreases of about 36% in anxiety (19-point difference on a 100-point scale), sedation intensity, and sedation frequency (eg, by day 5, patients in the music group received 3 doses per day of sedative medication vs 5 doses per day in the usual care group). This trial demonstrates that an apparently easily implemented intervention used actively by the patient can reduce anxiety. However, several issues remain. First, it is not clear whether anxiety really was the primary end point of the study. Anxiety is characterized by apprehension, agitation, increased motor activity, arousal, and fearful withdrawal. However, in the study, anxiety was not defined based on the presence of these symptoms. Instead, at study entry and daily during mechanical ventilation, patients used a 100-mm visual analog scale (VAS, from “not anxious at all” to “most anxious ever”) to self-report their level of anxiety in response to the question “How are you feeling today?” Although VAS anxiety scores correlate with Spielberger State Anxiety Inventory scores, the VAS score collected in the study probably reflected satisfaction or general well-being, as well as anxiety. Second, only short-term outcomes were evaluated. In an earlier study, the same group showed that state anxiety was significantly decreased immediately after a 30-minute music condition. In the present study, the VAS anxiety score was measured once daily during the ICU stay, and the patients listened to music as they self-directed. The timing of listening to music relative to the VAS measurements was not reported, although the median time spent listening to music was only 12 minutes per day (range, 0-796 minutes). Third, the study included patients who were both conscious and receiving mechanical ventilation. However, only 5.3% of patients assessed for trial eligibility were randomized, because most patients were too deeply sedated to use an audio device. Whether providing music to more deeply sedated patients can decrease not only sedation but also delirium and post-ICU burden would deserve investigation. Fourth, sedative administration in terms of drugs used, dosage, frequency, or indication was not directed by protocol and was not standardized across ICUs. This outcome must be robust because the more important finding of the
14 citations
Additional excerpts
...study outcome measure of sedative exposure [10]....
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