Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial
Chlan LL, Weinert CR, Heiderscheit A, Tracy MF, Skaar DJ, Guttormson JL, Savik K
JAMA · 196 citations
How it was studied
- Design
- Randomized controlled trial (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- Government
- National Institutes of Health
- Government
- National Institute of Nursing Research
- Government
- NINR NIH HHS
- Grants
- National Institute of Nursing Research (R01 NR009295)
Based on 3 listed funder(s).
Publication
- Published
- 2013-05-20 · JAMA · vol. 309 · issue 22 · p. 2335
- Publisher
- American Medical Association
- Cited
- 315 citations · more than 100% of similar papers · 24.3× the field average
- Impact
- Top 10% most cited in its field
- References
- 33 works
- Access
- Free to read
- Research areas
- Music Therapy and Health · Intensive Care Unit Cognitive Disorders · Family and Patient Care in Intensive Care Units
- Keywords
- Medicine, Critically ill, Sedative, Anxiety, Mechanical ventilation, Intervention (counseling), Intensive care medicine, Critical illness, Anesthesia, Psychiatry
- MeSH
- humans, respiratory insufficiency, critical illness, hypnotics and sedatives, music therapy, respiration, artificial, self care, ear protective devices, anxiety, noise, adult, aged, middle aged, intensive care units, female, male, relaxation therapy, patient preference
7 authors
From US
- Linda L. Chlan · correspondingThe Ohio State University
- Craig WeinertPulmonary and Allergy Associates; University of Minnesota Medical Center
- Annie HeiderscheitUniversity of Minnesota; Office of International Affairs
- Mary Fran TracyUniversity of Minnesota; University of Minnesota Medical Center
- Debra J. SkaarUniversity of Minnesota
- Jill GuttormsonMarquette University
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: NCT00440700.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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