Effect of a music intervention on anxiety in adult critically ill patients: a multicenter randomized clinical trial

Abstract

Background: Previous studies show positive effect of music on reducing anxiety, pain, and medication requirement. Anxiety has become a more pertinent issue in the intensive care unit (ICU) since wakefulness is preferred according to recent guidelines. Nevertheless, evidence on the effect of music in ICU patients is scarce. Therefore, we studied the effect of music intervention on anxiety in ICU patients.Methods: A multicentre randomized clinical trial was conducted between August 2020 and December 2021 in ICU’s at an academic medical center and two regional hospitals. Adult critically ill patients were eligible when hemodynamically stable and communicable (Richmond agitation-sedation scale (RASS) of at least -2). Patients in the intervention arm were offered music twice daily during three days for at least 30 minutes per session. Patients in the control group received standard care. The primary outcome was anxiety level assessed with the visual analogue scale for anxiety [VAS-A; range 0-10] twice daily (morning and evening). Secondary outcomes included; 6-item state-trait anxiety inventory (STAI-6), sleep quality, delirium, heart rate, mean arterial pressure pain, RASS, medication, ICU length of stay, patients’ memory and experience of ICU stay. Results: 94 patients were included in the primary analysis. Music did not significantly reduce anxiety (VAS-A in the intervention group; 2.5(IQR 1.0-4.5), 1.8(0.0-3.6), and 2.5(0.0-3.6) on day 1,2, and 3 versus 3.0(0.6-4.0), 1.5(0.0-4.0), and 2.0(0.0-4.0) in the control group; p>0.92). Overall median daily VAS-A scores ranged from 1.5 to 3.0. Fewer patients required opioids (21 vs. 29, p=0.03) and sleep quality was lower in the music group on study day one (5.0(4.0-6.0) vs. 4.5(3.0-5.0), p=0.03). Other outcomes were similar between groups. Conclusions: Anxiety levels in this ICU population were low, and music did not decrease anxiety. This study indicates that efficacy of music is context and intervention-dependent, given previous evidence showing decreased anxiety. Trial Registration number: Netherlands Trial Register: NL8595, Registered, 1 April 2020ClinicalTrials.gov ID: NCT04796389, Registered retrospectively, 3 April 2021

Different nursing interventions on sleep quality among critically ill patients: A systematic review and network meta-analysis

“…Nevertheless, research has underscored the prevalence of sleep disruptions and inadequate rest among patients in intensive care units. [1–3] These disruptions manifest as suboptimal sleep quality, difficulties in falling asleep, fragmented sleep patterns, frequent nocturnal awakenings, and diminished periods of deep, slow-wave sleep. [4,5]…”

“…Nevertheless, research has underscored the prevalence of sleep disruptions and inadequate rest among patients in intensive care units. [1][2][3] These disruptions manifest as suboptimal sleep quality, difficulties in falling asleep, fragmented sleep patterns, frequent nocturnal awakenings, and diminished periods of deep, slowwave sleep. [4,5] Disturbed sleep has been associated with compromised immune function, prolonged stays in critical care units, an elevated risk of delirium among critically ill patients, and increased mortality rates within this population.…”