Wednesday, May 11, 2011

Music May Ease Stress of Mechanical Ventilation

The sound of music played for patients on mechanical ventilation may help soothe their anxiety and distress, a Cochrane review showed.

In three studies, the state anxiety of patients on vents was reduced by 1.06 standard deviations (P=0.04) when researchers played prerecorded music, according to Joke Bradt, PhD, a music therapist at Drexel University in Philadelphia, and colleagues.

Listening to music also reduced patients' heart rates by an average of nearly 5 bpm across five studies and respiratory rates by more than 3 bpm across six studies (P≤0.001 for both), suggesting a relaxation effect.

There were no significant effects from hearing music on patients' blood pressures or oxygen saturation, and no information was available about quality of life, patient satisfaction, post-discharge outcomes, mortality, or cost-effectiveness related to the music interventions.
"Because of these results, and because music listening is an easy intervention to implement, it is recommended that music listening be offered as a stress-management intervention to these critically ill patients," Bradt and her colleagues wrote.
Because mechanical ventilation often causes major distress and anxiety in patients, analgesia and sedation are considered important treatment options. But both options may lead to prolonged hospitalization resulting from associated complications, such as weakened immune function and venous thrombosis and pressure damage from immobility.
Music interventions have been used to ease anxiety and distress in patients with various conditions, but studies looking specifically at patients on mechanical ventilation have been small.
To evaluate the evidence for music interventions in this patient population, the researchers searched for randomized and quasi-randomized controlled trials that compared standard care with standard care plus a music intervention. They identified eight trials involving 213 participants.
Only one of the eight studies used a trained music therapist and involved the selection of live music to match the respiratory rate of the patients. The rest used prerecorded music delivered through headphones.
The intervention in all of the studies was delivered in a single session.
As measured using the Spielberger State and Trait Anxiety Inventory-State Anxiety Short Form, mean state anxiety was lower with a music intervention than in the control group. However, results were not consistent across the three studies included in the anxiety analysis, and the quality of the evidence was rated as very low by the researchers.
In addition, Bradt and her colleagues noted that the results should be interpreted with caution because of the small sample size.
The findings concerning heart rate and respiratory rate were more consistent, but were still based on evidence rated as very low to low.
The researchers noted that the mean reduction in heart rate may not be clinically significant when the resting heart rate is within the normal range, but added that the reduction may be important when the rate is tachycardiac.
They called for more research on the effects of music interventions delivered by trained music therapists, rather than by other healthcare professionals, pointing to evidence that music therapists seem to be more effective for numerous outcomes.
"This difference might be attributed to the fact that music therapists individualize their interventions to meet patients' specific needs; more actively engage the patients in the music making; and employ a systematic therapeutic process, including assessment, treatment, and evaluation," Bradt and her colleagues wrote.

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