Music interventions for mechanically ventilated patients
Referencias
References to studies included in this review
References to studies excluded from this review
References to studies awaiting assessment
Additional references
Characteristics of studies
Characteristics of included studies [ordered by study ID]
| Methods | Randomized controlled trial Randomization method: Flip of coin Allocation concealment: Yes (personal communication with author) Blinding: No Design: Repeated measures control group design | |
| Participants | Adults with various diagnoses on mechanical ventilation: pulmonary related (80%), miscellaneous (20%) (e.g. cancer and kidney transplant) Average length of mechanical ventilation before onset of study: control group: 5.4 days; music group 14.5 days (due to one patient in music group with a ventilator length of 72 days) Ventilator mode: not reported Type of airway: not reported N music group: 11 N control group: 9 Sex: 7 F, 13 M Age in music group: 55.7; control group: 64.2 Setting: critical care units, USA | |
| Interventions | Two study groups:
Music selections provided: classical selections from Music for Relaxation (Helen Bonny) Number of sessions: 1 Length of session: 30 minutes Categorized as music medicine study | |
| Outcomes | Mood (Profile or Mood States): post‐test scores Heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, oxygen saturation, airway pressure: change scores from pre‐test to post‐test | |
| Notes | No standard deviations were reported for post‐test scores. Additional data was obtained from the lead author. Change scores were computed by JB. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Adequate sequence generation? | Low risk | Flip of coin |
| Allocation concealment? | Low risk | Achieved through use of flip of coin for each patient after consent was obtained |
| Blinding? | High risk | |
| Incomplete outcome data addressed? | Low risk | No subject loss |
| Free from financial conflict of interest | Low risk | |
| Methods | Randomized controlled trial Randomization method: Table of random numbers Allocation concealment: Yes (personal communication with author) Blinding: No Design: Repeated measures control group design | |
| Participants | Adults with various diagnoses on mechanical ventilation: pulmonary related (68%), cancer (4%), heart transplant (4%), trauma (5%), miscellaneous (19%) Average length of mechanical ventilation before onset of study: 7.39 days (SD 10.39) Most common ventilator mode: Synchronized Intermittent Mandatory Ventilation (SIMV) (70%). Other ventilator modes: Pressure support (PS), Positive and expiratory pressure (PEEP), Continuous positive airway pressure (CPAP), Assist/Control (A/C) Type of airway: not reported N music group: 27 N control group: 27 Sex: 59% F, 41% M Age: 57.1y Setting: critical care units, USA | |
| Interventions | Two study groups:
Music selections provided: classical, new age, country/western, religious, and easy listening. Number of sessions: 1 Length of session: 30 minutes Categorized as music medicine study | |
| Outcomes | State anxiety: post‐test scores on the Spielberger State Anxiety Inventory (6‐item version) Heart rate: post‐test scores (at 30 minutes) Respiratory rate: post‐test scores (at 30 minutes) | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Adequate sequence generation? | Low risk | Table of random numbers |
| Allocation concealment? | Low risk | Confirmed through personal communication with author |
| Blinding? | High risk | |
| Incomplete outcome data addressed? | Low risk | Authors described number of subject withdrawals and reasons for withdrawal |
| Free from financial conflict of interest | Low risk | |
| Methods | Randomized controlled trial Randomization method: Flip of coin Allocation concealment: Yes (personal communication with author) Blinding: No Design: Repeated measures control group design | |
| Participants | Adults receiving mechanical ventilation in critical care unit: pneumonia (5), respiratory failure (2), shortness of breath (1), ventricular tachycardia (1), and ischaemic bowel (1) Average length of mechanical ventilation before onset of study: 14.2 (15) days Ventilator modes: A/C (6), SIMV (2), and Pressure‐release (2) Type of airway: not reported N music group: 5 N control group: 5 Age: 64.9 (7.8) y Sex: 6 F, 4M Setting: critical care unit, USA | |
| Interventions | Two study groups: 1. music listening to patient‐selected music via headphone 2. rest quietly without headphones Number of sessions: 1 Length of session: 60 minutes Categorized as music medicine study | |
| Outcomes | Corticotropin, cortisol, epinephrine and norepinephrine blood samples were obtained from central venous catheter at 4 intervals: baseline, 15 minutes after baseline, 30 minutes after baseline, and 60 minutes after baseline Heart rate: at baseline, 15 minutes after baseline, 30 minutes after baseline, and 60 minutes after baseline | |
| Notes | The data of this study cannot be pooled with data from other studies in this review because of several confounding variables that likely impacted the outcomes at post‐test: wide variability in mean levels of biomarkers, a very small sample size, administration of intravenous morphine sulphate to 2 control subjects immediately prior to intervention, and 2 subjects in the experimental group needed endotracheal suctioning during the intervention. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Adequate sequence generation? | Low risk | Flip of coin |
| Allocation concealment? | Low risk | Achieved through use of flip of coin |
| Blinding? | High risk | |
| Incomplete outcome data addressed? | Low risk | No subject loss |
| Free from financial conflict of interest | Low risk | |
| Methods | Randomized controlled trial Randomization method: Alternate assignment (personal communication with author) Allocation concealment: Inadequate Blinding: Yes (personal communication with author) Design: Repeated measures control group design | |
| Participants | Critically ill adults on mechanical ventilation Average length of mechanical ventilation before onset of study: not reported Ventilator modes: not reported Type of airway: not reported N music group: 5 N control group: 5 Sex: 1 F, 9 M Age M: 59.9 y Setting: critical care unit | |
| Interventions | Two study groups:
Music selection: "slow‐moving" Mozart piano sonatas selected based on compositional elements of relaxation, according to the author: KV283, Andante; KV311, Andantino con espressione; KV330, Andante cantabile; KV332, Adagio; KV333, Andante cantabile; KV545, Andante; KV570, Adagio; and KV576, Adagio Number of sessions: 1 Length of session: 60 min | |
| Outcomes | Sedative drug intake, heart rate variability, arterial pressure, serum level of dehydroepiandrosterone (DHEAS), serum concentrations of growth hormone, interleukin‐6: for these variables, means and standard error of the mean (SEM) are given for the control group but not for the music group. Only general statements such as "serum levels of dehydroepiandrosterone remained unchanged during the music intervention" are provided for the music group. Exact P levels of between‐group changes are given for mean arterial pressure, growth hormone, interleukin‐6, epinephrine, and DHEAS, but no mean differences are reported. Prolactin, norepinephrine, adrenocorticotropic hormone (ACTH), cortisol, prolactin monomer: only P values are given. Because of the limited data reporting, results of this study are only discussed in narrative form in this review. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Adequate sequence generation? | High risk | Alternate assignment |
| Allocation concealment? | High risk | |
| Blinding? | Low risk | Nursing staff who performed outcome assessments were blinded as to whether the patient received music via the headphones |
| Incomplete outcome data addressed? | Low risk | No subject loss |
| Free from financial conflict of interest | Low risk | |
| Methods | Randomized controlled trial Randomization method: Table of random numbers Allocation concealment: Unclear Blinding: Yes Design: Cross‐over trial | |
| Participants | Adults with various diagnoses on mechanical ventilation: postsurgical (9), pancreatitis (2), respiratory issues (2), sepsis (2) Average length of mechanical ventilation before onset of study: not reported Ventilator mode: not reported Type of airway: oral endotracheal tube (87%), tracheostomy (13%) N music condition: 15 (ventilated patients only ‐ see notes) N control condition: 15 (ventilated patients only ‐ see notes) Age: 58 (7.8) y Sex: 7 F, 8 M Setting: critical care unit, France | |
| Interventions | Two conditions:
Music selection used: a compilation of patient‐preferred music was made by a music therapist according to the following tempo guidelines: the music started at 90‐100 beats per minute (bpm), then slowed down to 60‐60 bpm. The last 5 minutes, the tempo was increased to 70‐80 bpm to re‐energize the patient. The music therapist did not implement the music intervention sessions. Number of sessions: 1 Length of session: 20 minutes Categorized as music medicine study | |
| Outcomes | Heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure: at 15 minute intervals. Because the music selections followed a U‐curve (decreasing the tempo and then increasing during the last 5 minutes to re‐energize the patient), the data of the 15‐minute interval was used. The study report does not include standard deviations and precise data for each group. This information was obtained from the lead author. | |
| Notes | This study compared ventilated patients (n=15) with non‐ventilated patients (n=15). All patients were randomized to receive music listening followed by a period of rest or to first receive a period of rest followed by a period of music. Only data of the ventilated patients were used in this review. Group‐specific data was obtained from the author. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Adequate sequence generation? | Low risk | Table of random numbers |
| Allocation concealment? | Unclear risk | Not stated |
| Blinding? | Low risk | Outcome assessors were blinded to treatment (personal communication with author) |
| Incomplete outcome data addressed? | Low risk | Subject loss is described in detail |
| Free from financial conflict of interest | Unclear risk | Funding information is not provided. Conflict of interest statement is lacking. |
| Methods | Randomized controlled trial Randomization method used: Draw of lots Allocation of concealment: Yes Blinding: Yes Design: Repeated measures control group design | |
| Participants | Adults, 39% respiratory problems and 34.3% postoperative surgical problems Average length of mechanical ventilation before onset of study: 2.5 (3.3) days Most frequently used ventilator mode: Pressure Support (PS) (89%) Most common type of airway: oral endotracheal tube (91%). Other: nasal (4%) and tracheostomy (4%) Ethnicity: Chinese N music group: 32 N control group: 32 Sex: 18 F, 46 M Age: 69.4 y Setting: critical care unit, China | |
| Interventions | Two study groups:
Music selections provided: Chinese classical music, religious music (Buddhist and Christian), Western classical music and music with "natural sounds" Number of sessions: 1 Length of session: 30 minutes Categorized as music medicine study | |
| Outcomes | State anxiety: change scores from pretest to post test on the Spielberger State Anxiety Inventory (6‐item version) Heart rate: change scores from pre‐test to post‐test Respiratory rate: change scores from pre‐test to post‐test Systolic blood pressure: change scores from pre‐test to post‐test Diastolic blood pressure: change scores from pre‐test to post‐test | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Adequate sequence generation? | Low risk | Draw of lots |
| Allocation concealment? | Low risk | Achieved through use of draw of lots by independent group assigner after consent was obtained |
| Blinding? | Low risk | Researcher who completed outcome assessments was unaware of group assignment |
| Incomplete outcome data addressed? | Unclear risk | It is unclear whether number of participants analysed equals the number of participants recruited |
| Free from financial conflict of interest | Unclear risk | Funding information is not provided. Conflict of interest statement is lacking. |
| Methods | Randomized controlled trial Randomization method: Alternate assignment Allocation concealment: Inadequate Blinding: Unclear Design: Repeated measures control group design Intention to treat: Adequate | |
| Participants | Adults with various diagnoses on mechanical ventilation: cardiac problems (56%), pulmonary issues (21%), traumatic injury (8%), other (15%) Average length of mechanical ventilation before onset of study: not reported Ventilator mode: not reported Type of airway: no tracheostomy N music group (medical): 10 N music group (cardiac): 9 (not included in this review) N control group (medical): 10 N control group (cardiac): 10 (not included in this review) Sex: 10 F, 10 M (for medical, non‐cardiac patients) Age: 57.5 y Setting: critical care unit, USA | |
| Interventions | Two study groups:
Patient‐selected live music used. Music therapist used guitar and voice Number of sessions: 1 Length of session: 25 minutes Categorized as music therapy study | |
| Outcomes | Hear rate: change scores from pre‐test to post‐test Respiratory rate: change scores from pre‐test to post‐test Oxygen saturation level: change scores from pre‐test to post‐test Rapid shallow breathing: change scores from pre‐test to post‐test | |
| Notes | Only the data of the medical, non‐cardiac patients are included in this review. The cardiac patients were treated immediately following cardiac artery bypass grafting surgery and their physiological responses were still suppressed by the anaesthesia. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Adequate sequence generation? | High risk | Alternate group assignment |
| Allocation concealment? | High risk | |
| Blinding? | High risk | |
| Incomplete outcome data addressed? | Low risk | subject loss is described |
| Free from financial conflict of interest | Low risk | |
| Methods | Randomized controlled trial Randomization method: Draw of lots Allocation of concealment: Adequate Blinding: Unclear Design: Cross‐over trial | |
| Participants | Adults receiving mechanical ventilation in critical care unit. Most frequent primary diagnosis: pulmonary disease (no further details reported) Average length of mechanical ventilation before onset of study: 6.05 (3.65) days Ventilator mode: PS (80%), SIMV + PS (20%) Type of airway: tracheostomy (60%), oral endotracheal tube (40%) Ethnicity: Chinese Diagnosis: Pulmonary diseases N music condition: 20 N control condition: 20 Age: 58.25 y Sex: 5 F, 15 M Setting: inpatient critical care unit | |
| Interventions | Two study groups:
Music selection used: Chinese music (Chinese folk song, music played by Chinese instruments, Chinese music played by Western instruments, Buddhist music) and various Western music (classical, soundtrack, piano). Number of sessions: each subject participated in one music condition and one rest condition. Length of condition: 30 minutes Categorized as music medicine study | |
| Outcomes | State anxiety (short form; data was converted to full score): post‐test score on the Spielberger State Anxiety Inventory (6‐item version) Respiratory rate: post‐test score Mean blood pressure: post‐test score | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Adequate sequence generation? | Low risk | Draw of lots |
| Allocation concealment? | Low risk | Achieved through use of draw of lots for each patient after consent was obtained |
| Blinding? | High risk | |
| Incomplete outcome data addressed? | Unclear risk | It is unclear whether number of participants analysed equals the number of participants recruited |
| Free from financial conflict of interest | Unclear risk | Funding information is not provided. Conflict of interest statement is lacking. |
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
| Insufficient data reporting | |
| Not randomized controlled trial | |
| Not randomized controlled trial | |
| Not population of interest | |
| Programme description | |
| Not randomized controlled trial | |
| Not randomized controlled trial | |
| Not randomized controlled trial | |
| Programme description | |
| Not randomized controlled trial | |
| Not randomized controlled trial | |
| Not randomized controlled trial | |
| Not population of interest | |
| Not population of interest | |
| Not randomized controlled trial. In the thesis author explicitly states that only 4 CD players were available. If all CD players were in use, the next group of patients were placed in the control group | |
| Not population of interest |
Characteristics of studies awaiting assessment [ordered by study ID]
| Methods | Unknown |
| Participants | Mechanically ventilated patients |
| Interventions | Music therapy or music medicine (unclear) |
| Outcomes | Unknown |
| Notes | Study could not be obtained because of incorrect citation. |
| Methods | Randomized controlled trial |
| Participants | Mechanically ventilated patients |
| Interventions | Music therapy or music medicine (unclear) |
| Outcomes | Anxiety, heart rate, respiratory rate, blood pressure and oxygen saturation |
| Notes |
Data and analyses
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 State Anxiety Show forest plot | 3 | 135 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.06 [‐2.09, ‐0.04] |
| Analysis 1.1  Comparison 1 Music versus standard care, Outcome 1 State Anxiety. | ||||
| 2 Heart Rate Show forest plot | 5 | 167 | Mean Difference (IV, Fixed, 95% CI) | ‐4.75 [‐6.98, ‐2.51] |
| Analysis 1.2  Comparison 1 Music versus standard care, Outcome 2 Heart Rate. | ||||
| 3 Respiratory Rate Show forest plot | 6 | 187 | Mean Difference (IV, Fixed, 95% CI) | ‐3.18 [‐4.41, ‐1.95] |
| Analysis 1.3  Comparison 1 Music versus standard care, Outcome 3 Respiratory Rate. | ||||
| 4 Systolic Blood Pressure Show forest plot | 3 | 98 | Mean Difference (IV, Fixed, 95% CI) | ‐2.70 [‐6.84, 1.45] |
| Analysis 1.4  Comparison 1 Music versus standard care, Outcome 4 Systolic Blood Pressure. | ||||
| 5 Diastolic Blood Pressure Show forest plot | 3 | 98 | Mean Difference (IV, Random, 95% CI) | ‐4.51 [‐11.13, 2.10] |
| Analysis 1.5  Comparison 1 Music versus standard care, Outcome 5 Diastolic Blood Pressure. | ||||
| 6 Oxygen Saturation Level Show forest plot | 2 | 40 | Mean Difference (IV, Fixed, 95% CI) | ‐0.71 [‐3.08, 1.66] |
| Analysis 1.6  Comparison 1 Music versus standard care, Outcome 6 Oxygen Saturation Level. | ||||
Searching results
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Comparison 1 Music versus standard care, Outcome 1 State Anxiety.
Comparison 1 Music versus standard care, Outcome 2 Heart Rate.
Comparison 1 Music versus standard care, Outcome 3 Respiratory Rate.
Comparison 1 Music versus standard care, Outcome 4 Systolic Blood Pressure.
Comparison 1 Music versus standard care, Outcome 5 Diastolic Blood Pressure.
Comparison 1 Music versus standard care, Outcome 6 Oxygen Saturation Level.
| Music interventions compared to Standard treatment for mechanically ventilated patients | ||||||
| Patient or population: mechanically ventilated patients | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Standard treatment | Music interventions | |||||
| State Anxiety | The mean State Anxiety in the intervention groups was | 135 | ⊕⊝⊝⊝ | SMD ‐1.06 (‐2.09 to ‐0.04) | ||
| Heart Rate | The mean Heart Rate in the intervention groups was | 167 | ⊕⊝⊝⊝ | |||
| Respiratory Rate | The mean Respiratory Rate in the intervention groups was | 187 | ⊕⊕⊝⊝ | |||
| Systolic Blood Pressure | The mean Systolic Blood Pressure in the intervention groups was | 98 | ⊕⊕⊝⊝ | |||
| Diastolic Blood Pressure | The mean Diastolic Blood Pressure in the intervention groups was | 98 | ⊕⊕⊝⊝ | |||
| Oxygen Saturation Level | The mean Oxygen Saturation Level in the intervention groups was | 40 | ⊕⊝⊝⊝ | |||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 1 of these studies received a high risk of bias b/c of lack of blinding for physiological outcome assessment. However, anxiety was measured by means of self‐report (STAI) ‐ therefore, blinding was not possible. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 State Anxiety Show forest plot | 3 | 135 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.06 [‐2.09, ‐0.04] |
| 2 Heart Rate Show forest plot | 5 | 167 | Mean Difference (IV, Fixed, 95% CI) | ‐4.75 [‐6.98, ‐2.51] |
| 3 Respiratory Rate Show forest plot | 6 | 187 | Mean Difference (IV, Fixed, 95% CI) | ‐3.18 [‐4.41, ‐1.95] |
| 4 Systolic Blood Pressure Show forest plot | 3 | 98 | Mean Difference (IV, Fixed, 95% CI) | ‐2.70 [‐6.84, 1.45] |
| 5 Diastolic Blood Pressure Show forest plot | 3 | 98 | Mean Difference (IV, Random, 95% CI) | ‐4.51 [‐11.13, 2.10] |
| 6 Oxygen Saturation Level Show forest plot | 2 | 40 | Mean Difference (IV, Fixed, 95% CI) | ‐0.71 [‐3.08, 1.66] |
