May 21, 2013
Music Could Lower Anxiety, Reduce Need For Sedatives In Some ICU Patients
redOrbit Staff & Wire Reports - Your Universe Online
Some intensive care patients on mechanical ventilators could have their anxiety levels lowered and the need for sedative medication reduced by listening to some of their favorite songs, according to research presented Monday at the American Thoracic Society international conference.
The study, which has also been published online by the Journal of the American Medical Association, showed that ICU patients receiving acute ventilatory support for respiratory failure saw their anxiety levels decrease by an average of 36.5 percent when they had the option to listen to music. Those patients also saw a 38 percent reduction in the number of sedatives administered and a 36 percent reduction in the intensity of sedation versus those who did not receive the music intervention.
As part of the clinical trial, the researchers first determined the musical preferences of their patients, and then kept a continuous loop of appealing music running on CD players located besides the patients´ beds. When a patient wanted to listen to music, they donned headphones equipped with a special system that recorded and registered the time and date of each use. Beneficial effects were observed an average of five days into the study.
While medical professionals are tasked with carefully managing pain, agitation, and delirium in intensive care, the study authors report that mechanically ventilated patients are often over-sedated. That could result both in physiological problems associated with prolonged immobility and psychological issues, including fear and frustration over the inability to communicate. Post-traumatic stress disorder (PTSD) can even result in some cases.
“We're trying to address the problem of over-sedation from a very different perspective, by empowering patients. Some patients do not want control, but many patients want to know what is going on with their care,” Linda Chlan, a professor of symptom management research at the Ohio State University College of Nursing and the lead author of the study, said in a statement.
“But I'm not talking about using music in place of the medical plan of care,” she added. “These findings do not suggest that clinicians should place headphones on just any ICU patient. For the intervention to have the most impact and to have the desired effect of reducing anxiety, the music has to be familiar and comforting to the patient — which is why tailoring the music collection for the patient to listen to was key to the success of this study.”
Chlan and her colleagues recruited 373 patients in 12 ICUs at five different hospitals in the in the Minneapolis-St. Paul area. They were split into three groups: 126 patients were randomized to receive patient-directed music intervention, 125 received usual care and the other 122 were in an active control group that was allowed to self-initiate the use of noise-canceling headphones. Each of them had provided their consent to participate.
The researchers performed daily anxiety assessments, as well as two measures of exposure to any of eight commonly used sedatives (both intensity and frequency of use). The patients were asked to describe their anxiety levels by pointing at a ranking chart, and continued to participate in the study for as long as they were on ventilators, up to a maximum of 30 days.
“The study showed that patients in the music group listened to music, on average, for almost 80 minutes per day, and patients with noise-canceling headphones used them for an average of 34 minutes per day,” the university explained. “No relationship was found between time spent using the device and anxiety, but researchers did note that more patients listening to music were liberated from the mechanical ventilator than were patients from either other group at the end of the study.”
“A complex statistical analysis of the data showed that significant reductions in anxiety and sedation could be seen in patients in the music intervention within five days when they were compared to patients who received usual care,” they added. “Patients using noise-canceling headphones showed some improvements in anxiety and lower sedation intensity, but the effects were not as strong as those seen in the music group.”