Florence rocks! Music therapy in ICU

Todd Fraser on 18-08-2011

Okay, I'm going out on a bit of a limb here. Some of you hard-core EBM-ers are going to have me in the gun, but here goes. I just read a systematic review of music therapy in ICU. The results were predictably difficult to assess. There were 8 trials identified, 5 of which were judged to be relatively poor methodology. The trend identified by the paper was that music therapy in ICU seemed to reduce blood pressure, respiratory rate and anxiety. The interest in sedation / anxiety management in ICU is growing with the recognition that delirium and sedatives can both cause harm. Here is a non-pharmacological, almost certainly harmless intervention that has the potential to abbrogate some of the dyscomfort imposed by ICU. There is almost no literature to guide its use. Music has been very successfully implemeted in a number of settings, most notably in palliative care and oncology. The above data makes one wonder whether this type of intervention could reduce anxiety, delirium, sedative requirements, vasopressor requirements etc etc. Have you used this? What other non-pharmacological interventions, even "alternative" interventions have you implemented in your practice?

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Anni Paasilahti wrote 08-28-2011 08:56:47 pm
Any Paediatric ICU people want to comment on the use of melatonin? At least in NZ it has been used for a long time with kids.

Oliver Arkell wrote 10-21-2011 01:49:24 pm
There is a Cochrane review of the available studies on Music Therapy in Ventilated Patients. Unfortunately the trials are small and methodology could be better.

Nonetheless, each of the trials was associated with measurable reductions in heart rate and respiratory rate.

Its a great shame studies aren't conducted on important interventions like this. I fail to see why it is more plausible that a drug will improve outcomes by reducing anxiety / stress / delirium compared with an intervention like music therapy. Like posts in other areas, it seems unlikely because it just isn't "sexy" enough.

Danielle Howe wrote 11-24-2011 12:02:48 am
"I think I should have no other mortal wants if I could always have plenty of music. It seems to infuse strength into my limbs and ideas into my brain. Life seems to go on without effort, when I am filled with music." George Eliot 1819-1880

Benjamin Moran wrote 08-18-2011 03:24:12 pm
Todd, it really depends on what music you're playing to the patient. I had a teenage girl TBI and I refused to go into her room because of the posters of Justin Bieber (quite a scary site at 3am from the corner of your eye!) and that guy from Twilight, with the tunes of Justin Bieber playing. It did nothing for my blood pressure, respiratory rate or anxiety! We've actually had arguments in the unit about which music to play. The 'older' nurses (ahem, ahem), just don't agree with the themes of the Hilltop Hoods (despite the fact that we are all in the Nosebleed Section). Then again, a bit of Bon Jovi's, 'Livin' on a Prayer' can be just what the patient needs to motivate them.

In terms of alternative therapy, I sometimes try some subliminal messaging to the young, drunk MVA/MBA's that I've intubated, telling them to give up drugs and alcohol. I rarely see a repeat offender, so maybe it's working!! Maybe some brainwashing like in Zoolander might be appropriate... (with a more positive endpoint, of course!)

Alex McKenzie wrote 08-21-2011 01:39:10 pm
Good point Todd - I'm sure there is a lot that we can do to improve the experience that patients have in ICU.

One of the things that interests me is sleep. I am sure we can do a better job of helping people sleep, and not pharmacologically. Setting up the environment for this is really important.

The other thing I like to do is give people a view. I'd hate to be sitting there looking out at a bunch of us clowns - turn them around to look at the view!

Kristine ESTENSEN wrote 08-22-2011 09:30:34 pm
I have wondered too about how to make things "nicer" for some of our patients who are with us a long time. The unit I work in at the moment plays music in the middle of the day (relaxing spa type stuff) and even has some aromatherapy....I think it is great....dont know whether it helps or not.

The getting patients to see light, trees - the "outside world" I have seen be very beneficial in motivating patients. We also try to take some patients into the sunshine (not always practical). I totally agree with Alex about the sleep. Temazepam sometimes makes things worse in the elderly I feel. Maybe attention to design of ICUs would be the way forward on this....other drugs ? Melatonin ? Has anyone used this to "re-set" ICU patients and help sleep ?

Someone must want to do a study on this....or we could have a competition for the best "interior design" for an ICU !!....one most conducive to patient sleep and not staff !!

Li Huey Tan wrote 08-22-2011 11:20:01 pm
This is fantastic! It's something I have been thinking about doing as my project and have some ideas on how to run it. Just need to apply for a grant. I'm glad this has been posted on this blog as most of the studies have been conducted by non-doctors...

Todd Fraser wrote 08-23-2011 02:56:07 pm
Agreed Li - this is a subject that I think we could pay much more attention to.

I think we're distracted by the bright lights and whistles too much and forget that non-tenchnological and non-pharmacological solutions to problems do exist. Elevating the head of the bed to 30 degrees to reduce the incidence of VAP is just one example.

Good luck with your study - I look forward to hearing about it!

Oliver Arkell wrote 08-23-2011 09:15:08 pm
I looked at melatonin a few years ago - there isn't a lot of data on it but what there is seems quite positive. I would love to see a study on this in ICU.

The society of critical care medicine has a "best designed ICU" award each year - you can check them out on the net. Some of the ideas are just fantastic.