Fran Lowry

February 09, 2012

February 7, 2012 (Houston, Texas) — Listening to music can greatly reduce anxiety levels in patients on mechanical ventilation, according to research presented here at the Society of Critical Care Medicine 41st Critical Care Congress.

"Being on a ventilator is one of the most stressful events for critically ill patients in the intensive care unit [ICU], and it causes them...a great deal of fear and anxiety," said Linda Chlan, PhD, from the University of Minnesota School of Nursing, Minneapolis.

"We need interventions that are safe and do not induce adverse effects. We thought that being able to listen to music of one's own choosing might be one such intervention," Dr, Chlan said.

"We know that music is a very complex stimulus and can be a powerful distracter. Our aim was to see if patient-initiated music listening could reduce anxiety over the course of ventilator support," she said.

Dr. Chlan and her colleagues randomized 373 patients on acute mechanical ventilation for respiratory failure to 1 of 3 regimens: preferred music, where they could listen to music of their choice whenever they wished; noise-cancelling head phones; or usual care.

They assessed anxiety levels once a day using a visual analog scale.

Patients in the preferred music group chose a wide variety of music to listen to, ranging from classical, to reggae, to hard rock. "Don't assume that it's a one-size-fits-all approach. The point here was to give patients the music that they liked," she said.

Patients in the preferred music group listened to music for a mean of 79 minutes per day. Patients in the noise-cancelling group wore their headphones for a mean of 34 minutes a day.

Mean days on the protocol was 5.7 ± 6.4 days.

After possible confounders, such as illness severity, sedative exposure, and sedative medication frequency, were controlled for, patients assigned to preferred music showed a 26-point decrease in their anxiety score, compared with patients receiving usual care (P < .001).

"One of the patients who was on mechanical ventilation for a long time told me that being able to listen to his favourite music was the only thing that got him through," Dr. Chlan told Medscape Medical News in an interview after her presentation.

"I hope the findings from this study will be used to benefit mechanically ventilated patients in the self-management of anxiety with preferred, relaxing music," she added.

"I hope that ICU clinicians consider integrating adjunctive interventions like music in their ICU practice. Our study demonstrates that patients can use music whenever they feel anxious and would like to relax."

Commenting on this study for Medscape Medical News, Brian Kavanagh, MD, from the University of Toronto, Ontario, Canada, said: "This study suggests that music therapy has a positive impact on patients in the ICU. Further work will differentiate between the impact of the music and the additional care imparted with the music. In addition, the timing of music therapy and the mechanisms of potential benefit will be important future questions."

Music listening in ventilated patients is an interesting concept "and unlike many things in medicine, it appears to be free," added Todd W. Rice, MD, from Vanderbilt University in Nashville, Tennessee.

"Music certainly has some soothing properties and...appears to reduce anxiety," Dr. Rice told Medscape Medical News. "The big question will be whether or not this results in improved clinical outcomes, such as less time on the ventilator, or long-term outcomes such as less PTSD, anxiety, and depression, which we know are very common in survivors of critical illness."

He added that it is important to understand whether something like listening to music can reduce the sedative and analgesic needs that are associated with time on a ventilator.

The study was supported by a grant from the National Institute of Nursing Research of the National Institutes of Health. Dr. Chlan, Dr. Kavanagh, and Dr. Rice have disclosed relevant financial relationships.

Society of Critical Care Medicine (SCCM) 41st Critical Care Congress. Presented February 5, 2012.

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