title: Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  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
  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.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00440700.
authors.affiliation: College of Nursing, Ohio State University, 398 Newton Hall, 1585 Neil Ave, Columbus, OH 43210, USA. chlan.1@osu.edu
authors.forename: Linda L
authors.initials: LL
authors.lastname: Chlan
authors.forename: Craig R
authors.initials: CR
authors.lastname: Weinert
authors.forename: Annie
authors.initials: A
authors.lastname: Heiderscheit
authors.forename: Mary Fran
authors.initials: MF
authors.lastname: Tracy
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Skaar
authors.forename: Jill L
authors.initials: JL
authors.lastname: Guttormson
authors.forename: Kay
authors.initials: K
authors.lastname: Savik
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000628:therapy*; D016638:Critical Illness; D004430:Ear Protective Devices; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009147:Music Therapy; D009622:Noise; D057240:Patient Preference; D012064:Relaxation Therapy; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000523:psychology; D012131:Respiratory Insufficiency / Q000628:therapy; D012648:Self Care
chemical_list: D006993:Hypnotics and Sedatives