[Effects of Five-Element music intervention on anxiety and depressive disorders and successful rate of extubation in intensive care unit patients with difficult weaning].

Objective: To investigate the effects of Five-Element music intervention on anxiety, depression, and weaning successful rate in intensive care unit (ICU) patients with difficult weaning.

Methods: A prospective randomized controlled trial was conducted. Eighty patients with difficulty in weaning accompanied by anxiety and depression disorders admitted to the respiratory intensive care unit (RICU) of Henan Provincial People's Hospital from January 2019 to January 2021 were enrolled as research subjects. They were divided into an observation group and a control group using a random number table method, 40 cases in each group. The patients in the control group received routine respiratory rehabilitation treatment, with daily assessments of weaning and gradual reduction of mechanical ventilation support until weaning was achieved. The patients in the observation group received additional Five-Element music therapy, in addition to routine respiratory rehabilitation treatment. Based on the clinical manifestations of the patients and applying traditional Chinese medicine theory for syndrome differentiation, music therapy was applied accordingly. The intervention used traditional Chinese Five-Element music (composed by Shi Feng, published by China Medical Electronic Audio and Visual Publishing House). Baseline data including the gender, age, etiology of acute respiratory distress syndrome (ARDS), and acute physiology and chronic health evaluation II (APACHE II) score of patients were recorded. A twelve-lead synchronous Holter monitor continuously recorded the R-wave dominant electrocardiogram signal for 24 hours or more. Heart rate variability (HRV) indices [standard deviation of all normal sinus R-R intervals (SDNN), standard deviation of 5-minute average R-R intervals (SDANN), percentage of continuous normal R-R intervals with differences greater than 50 ms (PNN50), and the root mean square of successive differences in adjacent R-R intervals (RMSSD)] were calculated, as well as HRV frequency domain parameters [low-frequency band (LF, 0.05-0.15 Hz), high-frequency band (HF, 0.16-0.50 Hz), and LF/HF ratio]. Additionally, the incidence of delirium, weaning successful rate, reintubation rate within 7 days, length of ICU stay, and hospital mortality were documented.

Results: There were 8 cases in the control group dropping out, and resulting in 32 were participated, and the 40 cases in the observation group were all enrolled the analysis. There were no statistically significant differences in terms of gender, age, ARDS etiology, and APACHE II score between the two groups, indicating balanced baseline data for comparison. There were also no significant differences in HRV indices and frequency domain parameters before the intervention between the two groups. After the intervention, the observation group showed significant increases in HRV indices and frequency domain parameters as compared with the control group [SDNN (ms): 77.21±11.75 vs. 63.81±13.50, SDANN (ms): 83.51±19.45 vs. 50.40±14.55, PNN50: (10.75±3.42)% vs. (7.79±3.13)%, RMSSD (ms): 47.15±6.57 vs. 31.74±6.37, HF (ms²/Hz): 568.50±144.48 vs. 496.94±151.56, LF (ms²/Hz): 840.13±110.76 vs. 587.81±144.51, LF/HF ratio: 1.60±0.60 vs. 1.22±0.21, all P < 0.05]. Seventeen patients in the control group developed delirium, including 12 cases of hyperactive delirium, 3 cases of hypoactive delirium, and 2 cases of mixed-type delirium; whereas in the observation group, 9 patients developed delirium, including 7 cases of hyperactive delirium, 1 case of hypoactive delirium, and 1 case of mixed-type delirium. There was no significant difference in the types of delirium between the two groups (P > 0.05); however, the incidence of delirium in the observation group was significantly lower than that in the control group (22.50% vs. 53.12%, P < 0.01). The weaning successful rate in the observation group was significantly higher than that in the control group [95.00% (38/40) vs. 78.12% (25/32), P < 0.05], the reintubation rate within 7 days and hospital mortality were slightly lower than those in the control group [reintubation rate within 7 days: 5.00% (2/40) vs. 15.62% (5/32), hospital mortality: 0% (0/40) vs. 3.12% (1/32), both P > 0.05], and the length of ICU stay was also slightly shorter than that in the control group [days: 18.00 (17.00, 25.75) vs. 22.50 (15.00, 34.50), P > 0.05].

Conclusions: Five-Element music therapy is beneficial in improving anxiety and depression disorders in ICU patients with difficult weaning, reducing the incidence of delirium, and increasing the weaning successful rate.