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What is the role of music in the intensive care unit?



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Corresponding author: Samuel Copeland Contact
DOI: 10.12746/swrccc2016.0416.218
What is the role of music in the intensive care unit?
Phumpattra Chariyawong MD, Samuel Copeland MD, Zachary Mulkey MD
Music has been integral to human
development and advancement with the power to
convey powerful emotions. It is not surprising that
music is played all across the globe and that it has
been found advantageous in the field of medicine.
Music has been shown to help surgeons perform
operations faster and to help in neurologic recovery
following traumatic brain insults.1,2 Music therapy is
also unique in that it is very safe and the cost of
implementation is low. Most hospitals have an easy
listening TV channel that couples peaceful music
and imagery.
The intensive care unit is a unique patient
care experience. It is an extremely busy and loud
place with frequent alarms and flashing lights
where sleep often eludes patients. Unfortunately,
these disturbances in sleep are dramatic and can
lead to multiple co-morbidities, including ICU
delirium which is associated with a 3.2 fold increase
in six month mortality.3,4 We wondered if there is
evidence to support a beneficial effect of music in
the intensive care setting. Specifically, we
wondered whether music therapy could decrease
sedation requirements, improve patients’ anxiety
ratings, and improve hemodynamic parameters.
Most of the literature discusses patients who are
undergoing mechanical ventilation. These patients
are susceptible to multiple stressful factors which
can cause anxiety and in turn increase oxygen
The first question was whether music
therapy improves a patient’s sleep quality in the
ICU over standard care without the addition of
music. Su developed a randomized controlled trial
in which patients were randomized to non-
commercial music for 45 minutes at nocturnal sleep
time or usual care with no music. The music
consisted of sedating piano pieces composed by
the authors of the study. Polysomnography was
recorded for the first two hours of sleep. Results
showed that stage N2 sleep was shorter by 5.2
minutes and stage N3 sleep was longer by 6.5
minutes in the first two hours. Patients in the music
group had significantly lower heart rates and
reported improved sleep quality over the control
The second question was whether music is
actually beneficial or is it simply the reduction in
background ICU noise that offers benefits. In the
largest music focused clinical trial to date, Chlan
found that there are multiple benefits to music
therapy. Experimental patients in the MICU were
recruited and divided into three groups of either
patient-driven music (PDM), noise-cancelling
headphones (NCH), or control. Patients in the
experimental group had an anxiety score that was
19.5 points lower than the control group. In
addition, patients in the experimental group also
used fewer sedatives, both in intensity and
frequency, than control patients. Both findings were
statistically significant. Their conclusion was that in
patients receiving ventilator support for respiratory
failure, PDM and NCH resulted in greater reduction
in anxiety compared with usual care. Interestingly,
when PDM is compared to NCH, there was no
statistically significant difference in the reduction in
anxiety or sedation intensity in PDM compared with
NCH.7 This study demonstrates that some type of
therapy is preferable to none, but it does not
answer the question of whether music therapy is
driving the lower anxiety scores.
Another study by Chlan evaluated the
effectiveness of music therapy on relaxation and
anxiety in mechanically ventilated patients. Patients
experienced significantly less anxiety assessed by
pretest-posttest state anxiety scores. Physiologic
parameters were also measured. The heart rates
and respiratory rates decreased significantly over
time in patients in the study group compared to the
control group, suggesting relaxation and less
stress-arousal.8 Positive effects of music on anxiety
levels based on patient perception have been
supported by several studies. Wong conducted a
study of music therapy on anxiety in twenty
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Chariyawong P, et al. Role of Music in ICU
ventilator-dependent Chinese patients. The results
suggested that music therapy was more effective in
decreasing state anxiety than an uninterrupted rest
period. Physiologic measures of blood pressure
and respiratory rate were significantly lower by the
end of the 30 minutes of music.9 Almerud evaluated
qualitative and quantitative measures after
mechanically ventilated patients listened to
classical music for 30 minutes. Systolic and
diastolic blood pressures significantly fell during the
music therapy session and rose after the end of the
session.10 One randomized controlled trial of twenty
subjects did not support the conclusion that music
influences physiologic parameters. This study
indicated that listening to music leads to higher
sedation scores but no significant decrease in
blood pressure and heart rate.11 However, this
study collected data from sedated mechanically
ventilated patients whose blood pressures and
heart rates might be lower than patients’ baseline
secondary to sedative drugs. Music may not have
additional effects when added to pharmacological
sedation. In aggregate these studies indicate that
music therapy might improve anxiety using both
psychological and physiological criteria.
Not only patients in medical intensive care
units, but patients in cardiovascular intensive care
units seem to benefit from music therapy. Two
studies have reported good outcome of music
therapy on cardiovascular disease patients. White
used a three group repeated measures
experimental design in forty-five patients with acute
myocardial infarction. Patients were divided into
three groups: 1. music in quiet, restful environment
(experimental group), 2. quiet, restful environment
without music (attention group), and 3. treatment as
usual (control group). State anxiety was reduced
significantly immediately during the intervention and
for one hour after the intervention in the
experimental group only. Heart rate, respiratory
rate and myocardial oxygen demand were
significantly decreased immediately during the
intervention and for one hour after in the
experimental group compared to the control group
but did not differ significantly differ from the
attention group.12 Barnason studied effects of
music on anxiety in coronary artery bypass graft
patients. Spielberger’s state-trait anxiety inventory,
patient’s verbal ratings of both mood and anxiety by
numeric rating scale, and physiologic parameters
were measured. This study found significant
improvement in mood but not in anxiety scores in
these subjects. Heart rate and systolic and diastolic
blood pressures were significantly decreased by
the intervention, indicating generalized physiologic
relaxation.13 These two studies indicate that music
is not harmful to patients and may help improve
mood, anxiety, and physiologic responses to stress.
However, Elliot did not find any relation between
music therapy and anxiety reduction in a
randomized controlled trial. Both psychologic and
physiologic variables were measured but there was
no significant reduction in anxiety in patients
exposed to music. The author claimed that these
results may be explained by a type II error.14
Most of the studies have focused on non-
invasive measures, such as subjective state anxiety
and physiologic parameters, such as blood
pressure, respiratory rate, and heart rate. The
human body also responds to stress with hormone
release. Cortisol, corticotrophin, epinephrine, and
norepinephrine levels increase when patients are
under stress. Chlan studied the influence of music
on these biomarkers using a 2-group experimental
design with repeated measures study of 10
patients. The levels of cortisol, corticotrophin,
epinephrine and norepinephrine were measured
four times during 60 minutes. However, there were
no significant changes in these four biomarkers in
patients who listened to music and in patients who
rested quietly.15 Chlan also measured 24 hour
urinary free cortisol levels as a stress biomarker in
70 patients; music intervention did not significantly
reduce urinary free cortisol levels.16
Our review of the literature indicates that
there were important differences among trials
studying whether music therapy has physiologic
benefits. Chan took note of these differing results
and proposed that there may be demographic
differences that would make patients more or less
likely to respond to music therapy. In his
randomized trial, he studied Chinese patients
The Southwest Respiratory and Critical Care Chronicles 2016;4(16) 41
Chariyawong P, et al. Role of Music in ICU
admitted to an ICU and was able to categorize
patients into two distinct clusters. He found that
older, less educated females had a greater
response to music therapy played over a 30 minute
period with reductions in pulse, blood pressure, and
respiratory rate. Those who were less likely to
respond were younger, male, and more educated,
with only a significant reduction in systolic blood
pressure noted with music therapy.17 This study
suggests that certain population subgroups may be
more influenced by music therapy. The types of
music that were offered in the study were limited to
Chinese classical music, religious Tibetan music,
Western classical, or Jazz. It is universally
understood that there are different preferences in
music. While one person may enjoy classical
music, another person may find the rhythms of
heavy metal to be soothing; this leads us to the
questions of whether patients’ personal preferences
affect their responses. The general
recommendation for music used to relax patients is
soothing music with a sustained melodic quality
and a general absence of strong rhythms,
percussions, and lyrics.
To answer whether a specific type of music
should be used, Chi performed a literature review.
Her analysis concluded that overall results
indicated music selected on the basis of research
yielded better results that music selected simply on
basis of individual preference. The argument was
that music that was selected by an individual could
cause stimulation rather than relaxation.
Specifically, she found that music specially
designed to enhance relaxation was effective in
treating tension and negative moods. This concept
was at least partly refuted by noting that repetitive
exposures to music increased the listener’s comfort
level. This finding led them to ask whether patient
preference should play a role in music selection.
Their review suggested that personal preference,
familiarity, cultural background, and past
experiences should not be ignored. They suggest
that while patient preference should be considered,
the first consideration must always be grounded in
research. Their conclusion was that music chosen
by research generally produces more relaxation,
reduces pain or anxiety, and prevents stress
induced changes in psychological responses.
Patients should be given options for listening, but
each option should be research driven so that it has
the highest chance of achieving the desired
Overall, the evidence suggests that music
therapy should routinely be prescribed for patients
in the intensive care unit. Nurses have a key role in
music implementation. We suggest that music
therapy should be triggered by a nursing
assessment of either elevated CAM ICU scores,
hemodynamic parameters which suggest acute
agitation, or patient reported anxiety.
Demographics should be considered when
implementing music therapy, but demographics
should not prevent offering therapy. The type of
music should be geared towards relaxation, and
patients should be offered music often. Multiple
relaxing selections should be offered so that
patients can choose which one they feel is most
suitable for relaxation and better physiologic
Key wordsICU, music therapy, agitation, anxiety
The Southwest Respiratory and Critical Care Chronicles 2016;4(16) 42
Chariyawong P, et al. Role of Music in ICU
Table 1. Summary of Reviewed Studies
Su 6
Chlan 7
Chlan 8
Wong 9
Type of Trial
2 group, pretest-posttest
experimental design
Crossover repeated measures
design with random
Number of patients
Main Outcome
polysomnography, VSH sleep
Anxiety and sedative use
Anxiety, heart rate and
respiratory rate
Mean blood pressure,
respiratory rate, Spielberger
State Trait Anxiety Inventory
Music group had shorter
stage N2 sleep and longer
stage N3 sleep, lower heart
rates, and reported better
sleep quality
Experimental groups
experienced decreased
anxiety scores and sedative
exposure compared to the
control group.
Music therapy group
significantly less anxiety and
decrease heart rate and
respiratory rate compared to
control group
Music therapy was more
effective in decreasing
anxiety and decreased blood
pressure and respiratory rate
at the end of the intervention
Soothing music can be used
in the ICU to improve
patients sleep
Patient directed music
resulted in greater reduction
in anxiety compared with
usual care but not noise
cancelling headphones
A single music therapy
session found to be effective
for decreasing anxiety and
promoting relaxation
Music therapy is an effective
intervention in decreasing
anxiety in ventilator
dependent patients
Almerud 10
Dijkstra 11
White 12
Barnason 13
Type of Trial
Quantitative and qualitative
RCT with repeated measures
3 group repeated measures
experimental design
Prospective, repeated
measures, quasi-
experimental, random
Number of patients
Main Outcome
Systolic, diastolic blood
pressure and heart rate
Systolic, diastolic, mean
arterial blood pressure, heart
rate, respiratory rate
Anxiety level, heart rate,
respiratory rate and
myocardial oxygen demand
Anxiety, mood, blood
pressure and heart rate
Significant fall in systolic and
diastolic blood pressure
during music therapy session
and a corresponding rise after
cessation of treatment
Higher sedation scores in
experimental group, no
significant differences in
physiologic parameters
Significant reduction in heart
rate, respiratory rate,
myocardial oxygen demand
in experimental compared to
control group but not in
attention group. Anxiety
reduced in experimental
group only,
Significant mood
improvement but no
significant differences of
anxiety ratings, significant
effects over time on heart
rate, systolic and diastolic
blood pressure
Intensive care nursing staff
can beneficially apply music
therapy as a non-
pharmacological intervention
Music associated with higher
level of sedation in sedated,
mechanically ventilated ICU
Patients recovering from
acute myocardial infarction
may benefit from music
therapy in quiet, restful
The overall response by all
intervention groups
demonstrated relaxation
response. Reduced anxiety
and improved mood within
all three groups.
Elliott 14
Chlan 15
Chlan 16
Chan 17
Type of Trial
2 group experimental design
with repeated measures
Repeated measures design
Number of patients
Main Outcome
Psychologic and physiologic
Urinary free cortisol
Levels of cortisol,
corticotrophin, epinephrine
and norepinephrine
Demographic characteristics,
physiologic parameters
No significant reduction in
anxiety was achieved for
patients using music or
muscle relaxation
No significant differences
among groups in urinary free
cortisol over the course of
ventilator support
Levels of 4 biomarkers did
not differ significantly
between patients who listened
to music and patients who
rested quietly
Cluster analysis yielded 2
clusters. Cluster 1 was
younger educated males and
had less effect from music
therapy. Cluster 2 was older
uneducated females and had
more effect from music
These results differ from
those of similar studies but
may be related to the high
probability of a type II error.
Music did not significantly
reduce cortisol
Additional research is needed
with larger sample size
Music is more likely to be
effective in patients who have
similar characteristics to
cluster 2.
The Southwest Respiratory and Critical Care Chronicles 2016;4(16) 43
Chariyawong P, et al. Role of Music in ICU
1. Siu KC, Suh IH, Mukherjee M, Oleynikov D, Stergiou
N. The effect of music on robot-assisted laparoscopic
surgical performance. Surg Innov 2010; 17, 306-311.
2. Thaut MH, Gardiner JC, Holmberg D, et al. Neurologic
music therapy improves executive function and
emotional adjustment in traumatic brain injury
rehabilitation. Ann N Y Acad Sci 2009; 1169, 406-416.
3. Trompeo AC, Vidi Y, Locane MD, et al. Sleep
disturbances in the critically ill patients: role of
delirium and sedative agents. Minerva Anestesiol 2011;
77, 604-612.
4. Jackson P, Khan A. Delirium in critically ill patients.
Crit Care Clin 2015; 31, 589-603.
5. Davis T, Jones P. Music therapy: decreasing anxiety in
the ventilated patient: a review of the literature. Dimens
Crit Care Nurs 2012; 31, 159-166.
6. Su CP, Lai HL, Chang ET, Yiin LM, Perng SJ, Chen
PW. A randomized controlled trial of the effects of
listening to non-commercial music on quality of
nocturnal sleep and relaxation indices in patients in
medical intensive care unit. J Adv Nurs 2013; 69, 1377-
7. Chlan LL, Weinert CR, Heiderscheit A, et al. Effects of
patient-directed music intervention on anxiety and
sedative exposure in critically ill patients receiving
mechanical ventilatory support: a randomized clinical
trial. JAMA 2013; 309, 2335-2344.
8. Chlan L. Effectiveness of a music therapy intervention
on relaxation and anxiety for patients receiving
ventilatory assistance. Heart Lung 1998 May-Jun;
9. Wong HL, Lopez-Nahas V, Molassiotis A. Effects of
music therapy on anxiety in ventilator-dependent
patients. Heart Lung 2001 Sep-Oct; 30(5):376-87.
10. Almerud S, Petersson K. Music therapy--a
complementary treatment for mechanically ventilated
intensive care patients. Intensive Crit Care Nurs 2003
Feb; 19(1):21-30.
11. Dijkstra BM, Gamel C, van der Bijl JJ, Bots ML,
Kesecioglu J. The effects of music on physiological
responses and sedation scores in sedated, mechanically
ventilated patients. J Clin Nurs 2010 Apr; 19(7-
12. White JM. Effects of relaxing music on cardiac
autonomic balance and anxiety after acute myocardial
infarction. Am J Crit Care 1999 Jul;8(4):220-30.
13. Barnason S, Zimmerman L, Nieveen J. The effects of
music interventions on anxiety in the patient after
coronary artery bypass grafting. Heart Lung 1995 Mar-
Apr; 24(2):124-32.
14. Elliott D. The effects of music and muscle relaxation on
patient anxiety in a coronary care unit. Heart Lung 1994
Jan-Feb; 23(1):27-35.
15. Chlan LL, Engeland WC, Savik K. Does music
influence stress in mechanically ventilated patients?
Intensive Crit Care Nurs 2013 Jun; 29(3):121-7.
16. Chlan LL, Engeland WC, Anthony A, Guttormson J.
Influence of music on the stress response in patients
receiving mechanical ventilatory support: a pilot study.
Am J Crit Care 2007 Mar; 16(2):141-5.
17.Chan MF, Chung YF, Chung SW, Lee OK.
Investigating the physiological responses of patients
listening to music in the intensive care unit. J Clin Nurs
2009; 18, 1250-1257.
18.Chi GC, Young A. Selection of music for inducing
relaxation and alleviating pain: literature review. Holist
Nurs Pract 2011; 25, 127-135.
1. Submitted-11/18/2015
2. Accepted-9/23/2016
3. Reviewer-Steven Urban MD
4. Author affiliations- Phumpattra Chariyawong is a resident
in Internal Medicine at Texas Tech University Health Sciences
Center in Lubbock, TX. Samuel Copeland is a fellow in
Pulmonary and Critical Care Medicine at TTUHSC in
Lubbock, TX. Zachary Mulkey is a faculty member in
Internal Medicine at TTUHSC in Lubbock, TX.
5. Corresponding author- Samuel Copeland at
6. Conflicts-none
The Southwest Respiratory and Critical Care Chronicles 2016;4(16) 44
The opioid epidemic has left its toll on the United States with millions suffering from an opioid use disorder and tens of thousands dying from overdoses each year. With intentions to combat the crisis, health providers have been prescribing less opioids, which resulted in an unintentional increase in the abuse of other opioid-like substances. Three emerging drugs of abuse have been noted in the literature as having increased abuse potential in light of recent trends. Kratom, an herbal supplement, gabapentin, a prescription nerve pain and anticonvulsant medication, and loperamide, an over-the-counter antidiarrheal medication. These have all displayed opioid-like properties at high doses and used to alleviate opioid withdrawal. Healthcare clinicians and patients might not be aware of the potential risks involved with misusing or abusing these opioid substitutes. This article discusses the increased usage of kratom, gabapentin, and loperamide, the abuse potential, adverse effects and withdrawal symptoms of each drug, and nursing implications that impact inpatient safety and management.
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Delirium in the intensive care unit (ICU) is a common diagnosis, with an incidence ranging between 45% and 87%. Delirium represents a significant burden both to the patient and to the health care system, with a 3.2-fold increase in 6-month mortality and annual US health care costs up to $16 billion. In this review, the diagnosis, epidemiology, and risk factors for delirium in the ICU are discussed. The pathophysiology of delirium and evolving prevention and treatment modalities are outlined. Copyright © 2015 Elsevier Inc. All rights reserved.
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Impairment of sleep quality and quantity has been described in critically ill patients. Delirium, an organ dysfunction that affects outcome of the critically ill patients, is characterized by an acute onset of impaired cognitive function, visual hallucinations, delusions, and illusions. These symptoms resemble the hypnagogic hallucinations and wakeful dreams seen in patients with neurological degenerative disorders and suffering of disorders of rapid eye movement (REM) sleep. We assessed the characteristics of sleep disruption in a cohort of surgical critically ill patients examining the hypothesis that severe impairments of rapid eyes movement (REM) sleep are associated to delirium. Surgical patients admitted to the intensive care units of the San G. Battista Hospital (University of Turin) were enrolled. Once weaning was initiated, sleep was recorded for one night utilizing standard polysomnography. Clinical status, laboratory data on admission, co-morbidities and duration of mechanical ventilation were recorded. Patients were a priori classified as having a "severe REM reduction" or "REM reduction" if REM was higher or lower than 6% of the total sleep time (TST), respectively. Occurrence of delirium during intensive care unit (ICU) stay was identified by CAM-ICU twice a day. Multivariate forward stepwise logistic regression analysis was performed with sleep ("severe REM reduction" vs. "REM reduction") as the a priori dependent factor. REM sleep amounted to 44 (16-72) minutes [11 (8-55) % of the TST] in 14 patients ("REM reduction") and to 2.5 (0-36) minutes [1 (0-6) % of the TST] in the remaining 15 patients ("severe REM reduction") (P = 0.0004). SAPS II on admission was higher in " severely REM deprived" then in "REM deprived" patients. Delirium was present in 11 patients (73.3%) of the patients with "severe REM reduction" and lasted for a median of 3 (0-11) days before sleep assessment, while only one patient having "REM reduction" developed delirium that lasted for 1 day. The factors independently associated with a higher risk of developing "severe REM reduction" were delirium and daily dosage of lorazepam. The present study shows that while all critically ill patients present a profound fragmentation of sleep with a high frequency of arousals and awakenings and a reduction of REM sleep, a percentage of patients present an extremely severe reduction of REM sleep. Delirium and daily dosage of lorazepam are the factors independently associated to extremely severe REM sleep reduction.
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Music is often played in the operating room to increase the surgeon's concentration and to mask noise. It could have a beneficial effect on surgical performance. Ten participants with limited experience with the da Vinci robotic surgical system were recruited to perform two surgical tasks: suture tying and mesh alignment when classical, jazz, hip-hop, and Jamaican music were presented. Kinematics of the instrument tips of the surgical robot and surface electromyography of the subjects were recorded. Results revealed that a significant music effect was found for both tasks with decreased time to task completion (P = .005) and total travel distance (P = .021) as well as reduced muscle activations ( P = .016) and increased median muscle frequency (P = .034). Subjects improved their performance significantly when they listened to either hip-hop or Jamaican music. In conclusion, music with high rhythmicity has a beneficial effect on robotic surgical performance. Musical environment may benefit surgical training and make acquisition of surgical skills more efficient.
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 Identifier: NCT00440700
Objectives: Mechanically ventilated patients experience profound stress. Interventions are needed to ameliorate stress that does not cause adverse effects. The purpose of this study was to explore the influence of music on stress in a sample of patients over the duration of ventilatory support. Research methodology/design: Randomised controlled trial; randomised patients (56.8+16.9 years, 61% male, APACHE III 57.2+18.3) receiving ventilatory support to: (1) patient-directed music (PDM) where patients self-initiated music listening whenever desired from a preferred collection, (2) headphones only to block ICU noise, or (3) usual ICU care. Twenty-four hour urinary cortisol samples were collected from a sub-set of subjects with intact renal function and not receiving medications known to influence cortisol levels (n=65). Setting: 12 ICUs in the Midwestern United States. Main outcome measures: Urinary free cortisol (UFC), an integrative biomarker of stress. Results: Controlling for illness severity, gender, and baseline UFC (29-45 mg/day), mixed models analysis revealed no significant differences among groups in UFC over the course of ventilatory support. Conclusion: While music did not significantly reduce cortisol, less profound spikes in UFC levels were observed but that, given the limitations of the research, this observation could have occurred merely by chance.
The purpose was to examine the effects of non-commercial music on quality of sleep and relaxation indices, including heart rate, mean arterial pressure, and respiratory rate in patients in intensive care units. There is currently insufficient scientific knowledge for the effects of music on quality of sleep in critically ill patients. A randomized controlled trial. Between January–December 2010, 28 patients aged 39–78 years were randomly assigned to music and control groups. Participants in the music groups listened to non-commercial music for 45 minutes at nocturnal sleep time. In the control group, participants slept with no music. Participants were assessed using vital signs monitors, standardized questionnaire, and polysomnography. Polysomnography sleep was recorded for the first 2 hours of the nocturnal sleep. General estimating equation was applied to analyse data. Participants in the music group had shorter stage N2 sleep and longer stage N3 sleep in the first 2 hours of the nocturnal sleep and improved self-reported sleep quality, compared with those in the control group. The music group patients also had significantly lower heart rates than those in the control group. The intensive care units patients experienced fragmented sleep with a high frequency of awakenings and severe reduction in random eye movement sleep during the first 2 hours of the nocturnal sleep. The findings provided evidence for nurses to use soothing music as a research-based nursing intervention for intensive care unit patients' sleep improvement.
Objective: To examine the influence during the early postoperative period of selected nursing interventions on mood and anxiety of patients undergoing heart surgery. Design: Prospective, repeated measures, quasiexperimental, random assignment. Setting: The cardiovascular intensive care and progressive care units of a midwestern community hospital were used as the setting for this study. Patients: Ninety-six patients who underwent elective, heart bypass surgery; the mean age of the subjects was 67 years, with an age range of 37 to 84 years. Most subjects were men (n = 65, 68%). Outcome measures: Physiologic measures of anxiety and mood include blood pressure and heart rate. Additional measures included the use of Spielberger's state-trait anxiety inventory (STAI) and patient verbal ratings of both mood and anxiety with use of a numeric rating scale (NRS). Intervention: Patients were randomly assigned to one of three groups: (1) music therapy, (2) music-video therapy, or (3) scheduled rest group. Subjects in the groups received their assigned 30-minute intervention at two episodes on postoperative days 2 and 3. Subjects had physiologic measures of blood pressure and heart rate measured immediately before the intervention and at 10-minute intervals throughout the intervention. Mood and anxiety were evaluated by having subjects use a NRS (i.e., 0 to 10) to give rating of mood and anxiety immediately before and after each session. Anxiety was further measured with the STAI. A baseline measure of STAI was taken before surgery; patients also completed the "state" anxiety tool before the intervention session on postoperative day 2 and on completion of the session on postoperative day 3. Results: With use of an analysis of covariance (ANCOVA), subjects' mood ratings showed significant improvement in mood among subjects in the "music intervention" group after the second intervention when controlling for the preintervention rating of mood, F(2, 87) = 4.33, p = 0.016. However, no significant differences were reported for anxiety ratings as measured by the NRS and state anxiety instruments. With use of repeated measures analysis of variance (ANOVA), there were no significant interactions between the intervention groups and time for any of the physiologic variables. However, there were significant main effects over time for heart rate and systolic and diastolic blood pressure, which indicated a generalized physiologic relaxation response. Conclusions: Although none of the three interventions was overwhelmingly superior, the overall response by all intervention groups demonstrated a generalized relaxation response. It is also important to note that there was reduced anxiety and improved mood within all three groups.
The use of music as an intervention involves choices. What kind of music should be used? Who should choose the music? Thirty-one articles were reviewed. To maximize effects, the primary music selection should be based on research and then a variety of selections be presented to individuals for choice on the basis of personal preferences.
A pilot study designed as future randomised controlled trial was carried out to determine the effects of music on physiological responses and sedation scores in sedated, mechanically ventilated patients. Mechanically ventilated ICU patients, even when receiving intravenous sedatives, may experience stress and anxiety. One possible intervention to reduce stress and anxiety is listening to music. A randomised controlled trial design with repeated measures was used. Data were collected over a six-month period in 2006. Twenty subjects were randomly assigned to either the experimental or control group. Subjects in the experimental group listened to music three times for 30 minutes over two days; subjects in the control group undertook three 30 minute rest periods. Physiological effects of music on systolic, diastolic and mean arterial blood pressure and heart and respiratory rate were assessed. Sedation scores were also measured. Physiological parameters did not show a significant difference between the groups. Patients in the experimental group showed significantly higher Ramsay (sedation) scores than patients in the control group after the first session. The higher scores indicate that patients were less responsive to external stimuli. Our results suggest that listening to music leads to higher sedation scores in sedated, mechanically ventilated ICU patients. No significant decreases in physiological parameters were observed. Listening to music showed no negative changes in the condition of these patients. Future research should focus on the use of other measures, such as stress hormones, to assess stress in sedated, mechanically ventilated ICU patients. For the sedated, mechanically ventilated ICU patient, the benefit of music may lie in the associated (deeper) level of sedation that is achieved, which in turn may make the patient less susceptible to stress and anxiety.
This study examined the immediate effects of neurologic music therapy (NMT) on cognitive functioning and emotional adjustment with brain-injured persons. Four treatment sessions were held, during which participants were given a pre-test, participated in 30 min of NMT that focused on one aspect of rehabilitation (attention, memory, executive function, or emotional adjustment), which was followed by post-testing. Control participants engaged in a pre-test, 30 min of rest, and then a post-test. Treatment participants showed improvement in executive function and overall emotional adjustment, and lessening of depression, sensation seeking, and anxiety. Control participants improved in emotional adjustment and lessening of hostility, but showed decreases in measures of memory, positive affect, and sensation seeking.