Reciently, the section What´s new in Intensive Care of Intensive Care Medicine journal has published Adjuvant therapies in critical care: music therapy.
The authors reflect on the increasing introduction of music in the ICU, with the aim of reducing patient anxiety and pain.
They explain the differences between patient-directed music interventions and music therapy, with different objectives and basically lies in the relationship run by a credentialed profesional in music therapy.
In their review of the literature, most studies have developed musical interventions aimed at patients, asking the type of music through a questionnaire and duration of the intervention or in a period of time between 20 and 60 minutes. The best music to play or if it is necessary to compose a specific one remain unknow, but it must share common characteristics: slow rhythm (60 to 80 beats per minute, like the normal heart rate), a peaful setting, with reduced light or use of eye masks.
Related to the evidence: music has been shown to reduce respiratory, cardiac and blood pressure frequencies in response to the reduction of stress hormones. In a randomized clinical trial, it was shown to reduce anxiety and sedation doses/intervals in patients receiving mechanical ventilation, but showed no superiority against noise-cancelling headphones. In addition, the study was criticized for having several limitations.
In another study published in Critical Care Medicine, these results were not found and no reduction in anxiety, greater relaxation or improvement of physiological parameters was demonstrated.
In Spain and Latinoamérica, we know that 42% of the 103 ICU that have completed the form of good practices in humanization of Project HU-CI carry out musical interventions or music therapy. Of all known is the work of Música en Vena or Músicos por la Salud, but there are many more people working to bring music to the hospitals and recognized musictherapists, as Patxi del Campo or Javier Alcántara and Aránzazu Benitez. And we especially value the exciting interventions carried out in Venezuela, Bolivia, Colombia, Argentina, Ecuador or Peru, which have been added to this #benditalocura without any organized structures or economic budgets.
Music as a therapy, either in one way or another, requires interaction with the patient. And there are many fields to study: the effect during stressful or painful interventions, in patients with low level of consciousness or during their entire ICU stay. Also the benefit for families and professionals should be studied. To date, there is only evidence in awake patients under mechanical ventilation, but there are several studies underway: on the reduction of delirium and to improve sleep quality, on agitation in postoperative patients, to improve post-ICU syndrome or in patients with non-invasive ventilation.
We need information not only of physiological variables, but also in patient-centered outcomes. And also to demonstrate the superiority of music/music therapy on the use of uncontrolled music, not focused on the therapeutic relationship and with the purpose of reducing anxiety and improving the patient’s experience.
Five years ago it was unthinkable to see a piano in an ICU, as it would be now to see an ashtray on a plane. Fortunately, health care also evolves.
Let the music sounds, data are coming!
By Gabi Heras