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

IF 3.8 2区医学 Q1 CRITICAL CARE MEDICINE Journal of Intensive Care Pub Date : 2023-08-17 DOI:10.1186/s40560-023-00684-1

Ellaha Kakar, Thomas Ottens, Susanne Stads, Sanne Wesselius, Diederik A M P J Gommers, Johannes Jeekel, Mathieu van der Jagt

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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 multicenter randomized clinical trial was conducted between August 2020 and December 2021 in ICU's at an academic medical centre and two regional hospitals. Adult critically ill patients were eligible when hemodynamically stable and able to communicate (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 min 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 vs. 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 during 3 days did not decrease anxiety. This study indicates that efficacy of music is context and intervention-dependent, given previous evidence showing decreased anxiety. Trial registration Netherlands Trial Register: NL8595, Registered, 1 April 2020.

Clinicaltrials: gov ID: NCT04796389, Registered retrospectively, 12 March 2021.

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音乐干预对成人危重病人焦虑的影响:一项多中心随机临床试验。

背景:以往的研究表明音乐对减轻焦虑、疼痛和药物需求有积极作用。焦虑已成为重症监护室(ICU)更相关的问题，因为根据最近的指导方针，醒着是首选。然而，关于音乐对ICU患者的影响的证据很少。因此，我们研究了音乐干预对ICU患者焦虑的影响。方法:于2020年8月至2021年12月在一家学术医疗中心和两家地区医院的ICU进行多中心随机临床试验。当血液动力学稳定且能够交流时(Richmond激动镇静量表(RASS)至少为- 2)，成年危重患者才符合条件。干预组的患者在三天内每天提供两次音乐，每次至少30分钟。对照组患者接受标准治疗。主要结局是用焦虑视觉模拟量表评估焦虑水平[VAS-A;[0-10]每天两次(早晚)。次要结局包括;状态-特质焦虑量表(STAI-6)、睡眠质量、谵妄、心率、平均动脉压、疼痛、RASS、用药、ICU住院时间、患者记忆和ICU住院体验。结果:94例患者纳入初步分析。音乐没有显著减少干预组的焦虑(VAS-A);2.5 (IQR 1.0 - -4.5), 1.8(0.0 - -3.6),和2.5(0.0 - -3.6)1天,2,和3和3.0(0.6 - -4.0),1.5(0.0 - -4.0),和2.0(0.0 - -4.0),对照组;p > 0.92)。VAS-A总中位数每日评分从1.5到3.0不等。在研究第一天，音乐组需要阿片类药物的患者较少(21人对29人，p = 0.03)，睡眠质量较低[5.0(4.0-6.0)对4.5 (3.0-5.0)，p = 0.03]。两组之间的其他结果相似。结论:ICU患者的焦虑水平较低，3天的音乐并没有减少焦虑。这项研究表明，音乐的效果是环境和干预依赖的，因为之前的证据表明，音乐可以减少焦虑。荷兰试验注册:NL8595，已注册，2020年4月1日。临床试验:gov ID: NCT04796389，回顾性注册，2021年3月12日。

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来源期刊

Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine

CiteScore

11.90

自引率

1.40%

发文量

审稿时长

15 weeks

期刊介绍： "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.