Music Can Reduce Anxiety in ICU Patients

During the past decade, several studies have shown that if patients can press a button to control the amount of pain medication they receive, they experience better pain control than if they do not have this option.

These findings gave Linda Chlan, Ph.D., a professor of symptom management research at Ohio State University College of Nursing, and her colleagues an idea. If intensive care unit (ICU) patients could press a button to play relaxing music whenever they felt anxious, would it reduce their anxiety and need for sedating medications?

Chlan and her colleagues report promising results from their study in the June 12 JAMA.

The study included some 400 critically ill patients being mechanically ventilated for acute respiratory failure in 12 ICUs in five hospitals. The subjects were randomized to one of three groups. Subjects in the first group received care as usual. Subjects in the second group were encouraged to use noise-reducing headphones whenever they wanted to block out ICU noise or have some quiet time. And subjects in the third group were encouraged to listen to relaxing music via headphones whenever they felt anxious or they simply felt like it. The subjects participated in the study for up to 30 days as long as they were receiving ventilator support. The average length of participation was six days.

Both at the start of the study and throughout it, the subjects were evaluated for anxiety with the VAS-A (Visual Analog Scale-Anxiety). “The VAS-A is a single-item scale used in this study to assess reduced response burden in nonvocal critically ill patients,” Chlan told Psychiatric News. “This instrument was chosen as the mechanically ventilated could easily [rate] their current level of anxiety when the instrument was presented vertically and conceptualized as a thermometer, from ‘none’ [at the bottom of the thermometer] to the ‘most anxious ever’ at the top of the thermometer.”

Also at the start of and throughout the study, subjects were evaluated for their use of eight sedatives or pain medications commonly used in the ICU—midazolam, lorazepam, propofol, dexmedetomidine, morphine, fentanyl, hydromorphone, and haloperidol. Even though the pain medications are not pharmacologically classified as sedatives, they can induce sedation, Chlan explained—hence their being included in the sedative-medication evaluation.

The subjects with access to music were monitored for how often they used it, and those with access to noise-abating headphones were monitored for how often they used them. Subjects in the music group listened to music for an average of 80 minutes a day. Subjects in the headphone group used headphones for an average of 34 minutes a day.

An abstract of “Effects of Patient-Directed Music Intervention on Anxiety and Sedative Exposure in Critically Ill Patients Receiving Mechanical Ventilatory Support” is posted at http://jama.jamanetwork.com/article.aspx?articleid=1687827 .