Music could help treat delirium in ICU

Playing slow-tempo music may be an acceptable and feasible strategy for reducing delirium among patients staying in the ICU, according to research published in the American Journal of Critical Care.

Sikandar H. Khan, DO, MS, an assistant professor in the division of pulmonology, critical care, sleep and occupational medicine at the Indiana University School of Medicine, and a research scientist at the Regenstrief Institute, told Healio Primary Care that this study follows previous research that showed music lowered pain and anxiety in patients in the ICU, which led researchers to believe that they “could find a benefit for delirium, because if we reduce [patients’] stress using music, they would require less sedatives,” which are also associated delirium.

Khan and colleagues conducted a three-armed, single-blind randomized control trial that enrolled critically ill adults who were admitted to the ICU and received mechanical ventilation for a minimum of 24 hours.

Participants were randomly assigned to receive two 1-hour sessions per day for up to 7 days of personalized music, non-personalized slow-tempo music or audiobooks using noise-cancelling headphones that were connected to an mp3 player.

Personalized music was based on patients’ preferences and slow-tempo music was piano, guitar, classical or Native American flute sounds ranging from 60 to 80 beats per minute. Those assigned to audiobooks were randomly assigned to listen to Treasure Island by Robert Louis Stevenson, Harry Potter and the Chamber of Secrets by J.K. Rowling and Oh the Places You’ll Go! by Dr. Seuss.

Participants received sessions until they were transferred out of the ICU, discharged or died.

Researchers assessed patients’ delirium twice a day after each intervention session. They also recorded patients’ vital signs before and after each session. After discharge, patients were randomly surveyed over the phone to determine the acceptability of the session, headphone comfort and whether they would enroll again.

Fifty-two of the 1,589 patients who were screened were eligible for enrollment and randomly assigned to a session.

Khan and colleagues found adherence to the sessions was higher among patients who were assigned to music — 80% of those who received personalized music and non-personalized music adhered to treatment compared with 30% of those who were assigned to audiobooks.

Among patients who were surveyed after receiving treatment, 80% reported the music was enjoyable.

Khan and colleagues found patients assigned to slow-tempo music had the highest median number of delirium/coma-free days (IQR = 3 days; 1-6), followed by those who received personalized music (IQR = 2 days; 1-6) and audiobooks (IQR = 2 days; 0-3).

They found medium delirium severity was lowest among those who receive slow-tempo music (IQR = 3.5; 0-7), followed by those who received audiobooks (IQR = 4; 1-6.5) and those assigned personalized music (IQR = 5.5; 1-7).

However, researchers noted the differences in both delirium/coma-free days and delirium severity were not statistically significant.

“We found that the slow-tempo music group, which we had scientifically designed, was better than the audiobook and even the personalized music,” Khan said.

“What this shows is that science won out here, because we had designed this playlist to be relaxing,” he continued.

He noted that these are pilot results, and that the researchers are going to conduct an NIH-funded randomized clinical trial with 160 participants to confirm the findings. – by Erin Michael

Disclosures: Khan reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.