News on Treatment of Delirium

New research suggests that for some hospitalized ICU patients on mechanical ventilators, using headphones to listen to their favorite types of music could lower anxiety and reduce their need for sedative medications.

In a clinical trial, the option to listen to music lowered anxiety, on average, by 36.5 percent, and reduced the number of sedative doses by 38 percent and the intensity of sedation by 36 percent compared to ventilated intensive care unit patients who did not receive the music intervention. These effects were seen, on average, five days into the study.

The research is published online in the Journal of the American Medical Association.

Researchers first assessed the patients’ musical preferences and kept a continuous loop of music running on bedside CD players. When patients wished to listen to music, they were able to put on headphones that were equipped with a system that time- and date-stamped and recorded each use.

Professional guidelines recommend that pain, agitation and delirium be carefully managed in the ICU, with the goal of keeping mechanically ventilated patients comfortable and awake. However, the researchers acknowledged that over-sedation is common in these patients, which can lead to both physiological problems linked to prolonged immobility and psychological issues that include fear and frustration over not being able to communicate, and even post-traumatic stress disorder.

“We’re trying to address the problem of over-sedation from a very different perspective, by empowering patients. Some patients do not want control, but many patients want to know what is going on with their care,” said Linda Chlan, distinguished professor of symptom management research in The Ohio State University’s College of Nursing and lead author of the study.

“But I’m not talking about using music in place of the medical plan of care. These findings do not suggest that clinicians should place headphones on just any ICU patient. For the intervention to have the most impact and to have the desired effect of reducing anxiety, the music has to be familiar and comforting to the patient – which is why tailoring the music collection for the patient to listen to was key to the success of this study.”

Chlan also presented the research Monday (5/20) at the American Thoracic Society International Conference in Philadelphia.

Chlan and colleagues conducted the study with 373 patients in 12 ICUs at five hospitals in the Minneapolis-St. Paul area. Of those, 126 patients were randomized to receive the patient-directed music intervention, 125 received usual care and 122 were in an active control group and could self-initiate the use of noise-canceling headphones. All patients had to be alert enough to give their own consent to participate.

A music therapist assessed each patient in the music group to develop a collection that met the patient’s preferences. This was no easy task, as the patients are not able to speak when they are on a ventilator. The research team developed a screening method specifically for this part of the study. Researchers purchased downloadable files and placed up to 1,000 selections on each patient’s mp3-compatible CD player.

Researchers instructed patients to use the intervention if they were feeling anxious, wanted to relax or needed quiet time. Nurses were asked to prompt patients twice during each shift about their interest in listening to music. In weaker patients, nurses helped with placement of the headphones.

In all patients, researchers performed daily assessments of anxiety and two measures of sedative exposure to any of eight commonly used medications: intensity of the medication and frequency of doses. Anxiety was measured with a visual analog scale that asked patients to describe their anxiety by pointing to a chart anchored by the statements “not anxious at all” and “most anxious ever.” Patients remained in the study as long as they were on ventilators, up to a maximum of 30 days.

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