Sound isolation and music on the comfort of mechanically ventilated critical patients

Abstract

Objectives To assess the effect of sound isolation versus music on the comfort of mechanically ventilated patients admitted to the intensive care unit (ICU) as a combined measurement of the hypnotic level, the level of sedation and the alteration of behaviour because of pain. Introduction Patients admitted to the ICU who require mechanical ventilation are surrounded by an ambient noise level ranging from 60 to 90 dB, well above the 40 dB recommended by the World Health Organization (WHO). Methods This was a randomized crossover clinical trial. Group A: sound isolation (1 h) followed by music (1 h); Group B: music (1 h) followed by sound isolation (1 h). Interventions were administered using noise‐cancelling headphones. The hypnotic level, the level of sedation and the alteration of behaviour because of pain was assessed using the bispectral index (BIS), the Ramsay scale and the behavioural pain scale (BPS), respectively. Statistical analysis of correlated data was performed using a generalized estimating equations (GEE) model. Results Of 130 patients assessed for eligibility, 82 were randomized to Groups A (n = 40) or B (n = 42). Mean age was 69 years (SD = 14), and 77·3% were men. A decrease of 4–5 points out of 100 during sound isolation and music therapy was recorded in BIS in both groups; the differences were not statistically significant compared with baseline scores. Likewise, no differences were observed in the scores obtained in the Ramsay scale and BPS. Conclusions Sound isolation and music intervention did not modify the comfort or physiological variables of mechanically ventilated critical patients from their respective baseline values. Relevance to clinical practice Music and sound isolation are potential strategies that could be used in nursing care to provide comfort to critical patients. Further studies should be undertaken to define the role of these new approaches and determine which groups of patients can benefit most from music or sound isolation.

The Effect of Music on Pain in the Adult Intensive Care Unit: A Systematic Review of Randomized Controlled Trials

“…Table 1 presents the characteristics of the 18 RCTs conducted across seven countries (USA, n = 5; Iran, n = 5; France, n = 2; Spain, n = 2; Turkey, n = 2; China, n = 1; and Australia, n = 1), arranged chronologically from 1999 to 2018 (years of publication). [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Sample sizes ranged from 17 to 156, totaling 1173 participants.…”

“…More specifically, eight RCTs 24,25,[27][28][29][30][31][32] reported a low mean baseline pain score (zero to three of 10) and five RCTs [33][34][35][36][37] reported a moderate pain score (four to six of 10). For the trials that used behavioral scales, two RCTs 26,38 reported their participants' mean baseline behavioral pain scores to be below the cut-point score (i.e. CPOT <3 or BPS <5), and two RCTs 39,40 reported the scores to be above the cut-point scores (CPOT >3 or BPS >5).…”

“…In the other 10 studies, prerecorded or live music was administered while the patient was at rest, that is at a time when no predetermined standard ICU procedure was reported to occur. 25,29,31,[33][34][35][36]38,40,41 A single music session was administered in 15 studies [24][25][26][27][28][29][30]32,[34][35][36][37][38][39]41 , and multiple sessions (three to eight) were administered in three studies. 31,33,40 Five studies reported that none of their participants received any pain medication during the music intervention (patients requiring analgesia at the time of the music delivery were excluded), whereas nine studies reported that their participants received opioids as needed, according to their pain management protocol.…”

Innovative ICU Solutions to Prevent and Reduce Delirium and Post–Intensive Care Unit Syndrome

“…Whereas the WHO recommends no more than 35 dB of A-weighted energy equivalent (LAeq) SPL during the day and the A-weighted maximum SPL with fast constant (LAFmax) not exceeding 40 dB at night, studies show that LAeqs in most ICUs range from 60 to 90 dB. 41 The ICU environment has evolved over the years to provide information and security. To draw staff attention to potential dangers, acoustic alarms have become commonplace.…”

What's in this issue

“…The issue of excess noise pollution within critical care environments is also addressed by Mateu‐Capell et al . (), who undertook a randomized crossover clinical trial with 82 mechanically ventilated ICU patients to assess the effectiveness of two interventions in reducing noise levels. Using noise‐cancelling headphones, Group A ( n = 42) underwent sound isolation for an hour, followed by an hour of music.…”