A musical intervention for respiratory comfort during noninvasive ventilation in the ICU

Music-Based Interventions for Symptom Management in Critically Ill, Mechanically Ventilated Adults: A Scoping Review of the Literature

Background: Patients in intensive care units experience high symptom burden during mechanical ventilation (MV). Pharmacologic symptom management is associated with side effects and increased morbidity. Music-based interventions (MBIs) have been associated with reductions in both anxiety in MV adults and pain for critically ill adults, yet their use for the management of other burdensome symptoms has not been evaluated. The purpose of this scoping review is to map the state of evidence for the use of prerecorded music listening MBIs for symptom management in MV adults. Methods: A systematic search of the literature was conducted across four electronic databases (PubMed, EMBASE, CINAHL, and Web of Science) for experimental designed studies that measured the efficacy of MBIs for the management of physical and psychological symptoms including anxiety, sedation/agitation, dyspnea, distress, delirium, sleep, stress, fear, loneliness, or depression in critically ill, MV adults between January 1, 1998, and April 18, 2023. Results: A total of 643 abstracts and 29 clinical trials were included. Overall, the risk of bias, assessed using the Evidence Project tool, was moderate. MBIs were mostly delivered with headphones using music selected either by investigators or from a limited selection. MBIs were associated with reduced pain, agitation, dyspnea, distress and anxiety, and improved tolerance of MV and sedative weaning. Outcomes of delirium were mixed. No studies explored sleep disturbances, fear, or loneliness. Conclusions: Use of MBIs improved symptom experience for critically ill adults during MV. Future studies employing unrestricted patient-preferred music selections and exploring outcomes of sleep quality, psychological distress, and delirium are needed in this highly symptomatic patient population.

Musicotherapy mobile applications: what level of evidence and potential role in psychiatric care? A systematic review

Context

In our times of smartphone ubiquity, mobile applications are an inescapable daily life tool, including in health care. Music therapy has already proven its worth, notably in mental health. Hence, we were interested in the mobile app format for this type of therapy, its level of evidence, how to use it in daily psychiatric care and the leads for future research and innovation.

Method

This study carries out a systematic review of scientific literature of this topic on two search engines, PubMed and PubPsych, using these key-words: [(web-application) OR (web-app) OR (smartphone) OR (apps) OR (app)) AND ((music) OR (music therapy) OR (melody)].

Outcome

Out of a total of 282 studies found by keyword, 31 are included in this review. Several outcomes emerge. These studies relate to existing applications like Music Care, Calm or Unwind, on application prototypes or a potential use of music streaming applications on health care. They involve many different populations and clinical situations, including in hospital environments, for patients with chronic illnesses, different age ranges or for the general population. These musical interventions show a significant effect mainly for anxious symptoms, but also for depression, sleep disorders, pain and other psychiatric or psycho-somatic syndromes. These applications have no significant adverse effects.

Conclusion

This review shows that music therapy apps have several potentials for improving mental health care. It could assist psychiatric usual care and could potentially lower medication intake. Nevertheless, the studies on the topic are limited and recent but they open prospects for future research.

The effect of listening to music during continuous positive airway pressure on agitation levels and compliance of intensive care patients with COVID-19: A randomized controlled trial

BACKGROUND

Agitation and incompliance with the treatment may be observed in patients undergoing continuous positive airway pressure (CPAP), which may cause inadequate oxygenation, sedation, termination of CPAP or intubation of the patient.

AIM

This study was conducted to determine the effect of listening to music during CPAP on the agitation levels of intensive care patients who underwent CPAP as a result of COVID-19 and their compliance with the treatment.

STUDY DESIGN

This study was a prospective, randomized, controlled clinical trial. Seventy-six intensive care patients with COVID-19 were included in this study and assigned to the music and control groups via the block randomization method. The study was completed with 70 patients. The patients and outcome assessors were not blinded in this study. The Richmond Agitation and Sedation Scale (RASS) level, respiratory rate, oxygen saturation (SpO2 ) and mask air leakage amount were the outcome measures.

RESULTS

The mean RASS score of the patients in the intervention group was 2.14 ± 0.69 before CPAP, 1.63 ± 064 at the 1st minute, 0.89 ± 0.58 at the 15th minute and 0.74 ± 0.61 at the 30th minute. The mean RASS score of the patients in the control group was 2.06 ± 0.53 before CPAP, 1.80 ± 0.58 at the 1st minute, 1.43 ± 0.60 at the 15th minute and 1.46 ± 0.61 at the 30th minute of CPAP. There was a statistically significant difference between the groups at the 15th and 30th minutes (t = -3.81, p < .001; t = -4.89, p < .001 respectively). The mean respiratory rate, SpO2 and mask air leakage amount were compared between the groups. There was a statistically significant difference in favour of the intervention group at the 15th minute (t = -2.47, p < .001; t = 2.57, p < .001; t = 2.93, p < .001 respectively) and 30th minute (t = -3.17, p < .001; t = 3.46, p < .001; t = -3.93, p < .001 respectively).

CONCLUSIONS

The study results show that listening to music during CPAP reduces the agitation levels of patients and helps them comply with the treatment.

RELEVANCE TO CLINICAL PRACTICE

Music may be a beneficial application for patients who are agitated and unable to comply with CPAP therapy. This is an easy and applicable method, which can protect patients from the adverse effects of failed CPAP.

Dyspnoea in acutely ill mechanically ventilated adult patients: an ERS/ESICM statement

This statement outlines a review of the literature and current practice concerning the prevalence, clinical significance, diagnosis and management of dyspnoea in critically ill, mechanically ventilated adult patients. It covers the definition, pathophysiology, epidemiology, short- and middle-term impact, detection and quantification, and prevention and treatment of dyspnoea. It represents a collaboration of the European Respiratory Society and the European Society of Intensive Care Medicine. Dyspnoea ranks among the most distressing experiences that human beings can endure. Approximately 40% of patients undergoing invasive mechanical ventilation in the intensive care unit (ICU) report dyspnoea, with an average intensity of 45 mm on a visual analogue scale from 0 to 100 mm. Although it shares many similarities with pain, dyspnoea can be far worse than pain in that it summons a primal fear response. As such, it merits universal and specific consideration. Dyspnoea must be identified, prevented and relieved in every patient. In the ICU, mechanically ventilated patients are at high risk of experiencing breathing difficulties because of their physiological status and, in some instances, because of mechanical ventilation itself. At the same time, mechanically ventilated patients have barriers to signalling their distress. Addressing this major clinical challenge mandates teaching and training, and involves ICU caregivers and patients. This is even more important because, as opposed to pain which has become a universal healthcare concern, very little attention has been paid to the identification and management of respiratory suffering in mechanically ventilated ICU patients.

Dyspnoea in acutely ill mechanically ventilated adult patients: an ERS/ESICM statement

This statement outlines a review of the literature and current practice concerning the prevalence, clinical significance, diagnosis and management of dyspnoea in critically ill, mechanically ventilated adult patients. It covers the definition, pathophysiology, epidemiology, short- and middle-term impact, detection and quantification, and prevention and treatment of dyspnoea. It represents a collaboration of the European Respiratory Society (ERS) and the European Society of Intensive Care Medicine (ESICM). Dyspnoea ranks among the most distressing experiences that human beings can endure. Approximately 40% of patients undergoing invasive mechanical ventilation in the intensive care unit (ICU) report dyspnoea, with an average intensity of 45 mm on a visual analogue scale from 0 to 100 mm. Although it shares many similarities with pain, dyspnoea can be far worse than pain in that it summons a primal fear response. As such, it merits universal and specific consideration. Dyspnoea must be identified, prevented and relieved in every patient. In the ICU, mechanically ventilated patients are at high risk of experiencing breathing difficulties because of their physiological status and, in some instances, because of mechanical ventilation itself. At the same time, mechanically ventilated patients have barriers to signalling their distress. Addressing this major clinical challenge mandates teaching and training, and involves ICU caregivers and patients. This is even more important because, as opposed to pain which has become a universal healthcare concern, very little attention has been paid to the identification and management of respiratory suffering in mechanically ventilated ICU patients.

Sensory interventions to relieve dyspnoea in critically ill mechanically ventilated patients

BACKGROUND

In critically ill patients receiving mechanical ventilation, dyspnoea is frequent, severe and associated with an increased risk of neuropsychological sequelae. We evaluated the efficacy of sensory interventions targeting the brain rather than the respiratory system to relieve dyspnoea in mechanically ventilated patients.

METHODS

Patients receiving mechanical ventilation for ≥48 h and reporting dyspnoea (unidimensional dyspnoea visual analogue scale (Dyspnoea-VAS)) first underwent increased pressure support and then, in random order, auditory stimulation (relaxing music versus pink noise) and air flux stimulation (facial versus lower limb). Treatment responses were assessed using Dyspnoea-VAS, the Multidimensional Dyspnea Profile and measures of the neural drive to breathe (airway occlusion pressure (P 0.1) and electromyography of inspiratory muscles).

RESULTS

We included 46 patients (tracheotomy or intubation n=37; noninvasive ventilation n=9). Increasing pressure support decreased Dyspnoea-VAS by median 40 mm (p<0.001). Exposure to music decreased Dyspnoea-VAS compared with exposure to pink noise by median 40 mm (p<0.001). Exposure to facial air flux decreased Dyspnoea-VAS compared with limb air flux by median 30 mm (p<0.001). Increasing pressure support, but not music exposure and facial air flux, reduced P 0.1 by median 3.3 cmH2O (p<0.001).

CONCLUSIONS

In mechanically ventilated patients, sensory interventions can modulate the processing of respiratory signals by the brain irrespective of the intensity of the neural drive to breathe. It should therefore be possible to alleviate dyspnoea without resorting to pharmacological interventions or having to infringe the constraints of mechanical ventilation lung protection strategies by increasing ventilatory support.

Impact of a sensory stimulation program conducted by family members on the consciousness and pain levels of ICU patients: A mixed method study

Background

The results of several studies show the different effects of a balanced sensory stimulation program (SSP) on patients with brain injury admitted to the intensive care unit (ICU), but these effects have been less studied based on mixed and comprehensive methods.

Method

This mixed-method study involved 66 patients with brain injury admitted to the ICU who were allocated into intervention (n = 33) and control (n = 33) groups using random stratified sampling. Patients in the intervention group received a sensory stimulation program from family members for 1 h daily during ICU hospitalization, while the control group received only routine care. Patients' level of consciousness and pain intensity were measured immediately before and after the intervention using Glasgow Coma Scale (GCS) and Behavioral Pain Scale (BPS), respectively. In-depth unstructured interviews were conducted with the patients in the intervention group 3 months after discharge from the ICU. These interviews were analyzed following Graneheim and Lundman (2004) conventional content analysis method.

Results

A significant difference was found between the study groups in terms of the mean difference of GCS (P =0.001) and BPS score (P = 0.001) before and after intervention. Patients in the intervention group had a higher mean GCS and a lower mean BPS than did patients in the control group. The main themes extracted from the qualitative analysis confirmed the results obtained from the quantitative phase of the study.

Conclusion

The combination of the quantitative and qualitative findings suggested that amidst the many hardships and sufferings brain injury patients go through in the ICU, a sensory stimulation program offered by family members may have many benefits such as increased level of consciousness and reduced pain for these patients. Therefore, it is necessary to formulate a framework for this program and provide the needed facilities in order to benefit more from the capacity of such programs for ICU patients.

Use of Musical Intervention in the Pediatric Intensive Care Unit of a Developing Country: A Pilot Pre–Post Study

Music is frequently used in different clinical settings, and it is implemented as a complementary, low-cost and useful intervention to reduce pain, anxiety and to improve relaxation. This pilot pre–post study aimed to examine the feasibility and preliminary effectiveness of a specific musical intervention in patients ≤16 years admitted to the Pediatric Intensive Care Unit (PICU) of an Iraqi hospital. The COMFORT Behavior Scale (CBS) was used by nurses to assess the level of sedation. Fifty-nine children were enrolled during the study period (March 2020–August 2021). CBS was lowered by 2.2 (95% CI: 1.9 to 2.6) points after 30 min, and by 3.3 (95% CI: 2.9 to 3.6) points after 60 min from music initiation. Thirty minutes after music initiation, heart rate decreased by 6.3 (95% CI: 4.5 to 8.1) beats per minute, whereas at 60 min, heart rate decreased by 9.1 (95% CI: 7.2 to 10.9) beats per minute. No clinically significant variations were detected in the other vital signs (blood pressure, respiratory rate and oxygen saturation). These findings support the feasibility of musical intervention in a developing country. CBS and heart rate variation may be worth following up in larger and conclusive studies.