Music interventions for mechanically ventilated patients

Joke Bradt; Cheryl Dileo

doi:10.1002/14651858.CD006902.pub3

Cochrane Database of Systematic Reviews

Intervenciones con música para los pacientes con asistencia respiratoria mecánica

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DOI:

https://doi.org/10.1002/14651858.CD006902.pub3 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

09 diciembre 2014see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Atención crítica y de emergencia

Copyright:

Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

Joke Bradt

Correspondencia a: Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, USA

[email protected]
Cheryl Dileo

Department of Music Therapy and The Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, Philadelphia, USA

Contributions of authors

Joke Bradt (JB), Cheryl Dileo (CD) (and in original review Denise Grocke (DG) (Bradt 2010))

Conceiving the review: CD
Co‐ordinating the review: JB
Undertaking manual searches: JB, DG, and graduate assistants
Screening search results: CD,JB, and graduate assistants
Organizing retrieval of papers: JB
Screening retrieved papers against inclusion criteria: JB
Appraising quality of papers: CD and JB
Abstracting data from papers: JB and research assistant
Writing to authors of papers for additional information: JB
Providing additional data about papers: JB
Obtaining and screening data on unpublished studies:CD
Data management for the review: JB
Entering data into Review Manager (RevMan 5.2): JB and research assistant
RevMan statistical data: JB
Other statistical analysis not using RevMan: JB
Double entry of data: (data entered by person one JB; data entered by person two: research assistant)
Interpretation of data: CD, JB, DG for original review; JB and CD for update
Statistical inferences: JB
Writing the review: CD, JB, DG for original review; JB and CD for update
Securing funding for the review: CD for original review; no funding for update
Guarantor for the review (one author): JB
Person responsible for reading and checking review before submission: JB

Sources of support

Internal sources

No sources of support supplied

External sources

State of Pennsylvania Formula Fund, USA.

Financial support for the original review (Bradt 2010)

Declarations of interest

Joke Bradt and Cheryl Dileo are music therapists

The original review (Bradt 2010) was partly supported by a grant of the State of Pennsylvania Formula Fund. No funding was received for the update of the review.

Acknowledgements

We would like to thank Harald Herkner (content editor), Nathan Pace (statistical editor), Theresa Davis and Janet Sit (peer reviewers) for their help and editorial advice during the preparation of the update of this systematic review.

We would like to thank Karen Hovhannisyan (Trials Search Co‐ordinator Cochrane Anaesthesia Review Group (CARG)) for his help with the development of the search strategy and Jane Cracknell (Managing Editor, CARG), Prof Harald Herkner (content editor), Dr Marialena Trivella (statistical editor), Dr Megan Prictor (peer reviewer), Yusra Badr and Ann Fonfa (Cochrane Consumer Network) for their help and editorial advice during the preparation of the original review (Bradt 2010).

We would like to thank Dr Linda Chlan (peer reviewer), Clare Jeffrey (consumer), Janet Wale (consumer), Anne Lyddiatt (consumer), and Naseem Akhtar Qureshi (consumer) for their help and editorial advice during the preparation of the protocol of the review.

We would also like to acknowledge Mike Viega, research assistant at Temple University, for his help in the data extraction and data input, and Patricia Gonzalez and Cassandra Mulcahey, graduate assistants at Temple University, for their help with handsearching and article retrieval in the original review. We would like to thank Noah Potvin, research assistant, for his help with handsearching, article retrieval, and screening of search outputs, and Sheau‐Ling Duh for translating studies in the Chinese language. Both are doctoral students in the Department of Creative Arts Therapies at Drexel University.

Finally we would like to thank Dr Denise Grocke for her contributions as co‐author of the original review (Bradt 2010).

Version history

Published

Title

Stage

Authors

Version

2014 Dec 09

Music interventions for mechanically ventilated patients

Review

Joke Bradt, Cheryl Dileo

https://doi.org/10.1002/14651858.CD006902.pub3

2010 Dec 08

Music interventions for mechanically ventilated patients

Review

Joke Bradt, Cheryl Dileo, Denise Grocke

https://doi.org/10.1002/14651858.CD006902.pub2

2008 Jan 23

Music interventions for mechanically ventilated patients

Protocol

Cheryl Dileo, Joke Bradt, Denise Grocke

https://doi.org/10.1002/14651858.CD006902

Differences between protocol and review

Bradt 2010

In the protocol (Bradt 2008), we stated that we would exclude studies that used systematic methods of randomization. However, because only a small number of studies met all inclusion criteria, we decided to include studies that used systematic randomization (for example, alternate assignment). We analysed the impact of these studies by means of sensitivity analysis.

The Specialist Music Therapy Research database is no longer a functional database. However, archives of research reports, dissertations, and conference proceedings are still available for handsearching. The authors handsearched these files.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

Study Flow Diagram ‐ Original Review.

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Figure 2

Study flow diagram ‐ updated review.

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Figure 3

Funnel plot of comparison: 1 Music versus standard care, outcome: 1.4 Respiratory rate.

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Figure 4

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 5

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Analysis 1.1

Comparison 1 Music versus standard care, Outcome 1 State Anxiety (change scores).

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Analysis 1.2

Comparison 1 Music versus standard care, Outcome 2 Heart Rate.

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Analysis 1.3

Comparison 1 Music versus standard care, Outcome 3 Heart Rate (adequate randomization).

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Analysis 1.4

Comparison 1 Music versus standard care, Outcome 4 Respiratory Rate.

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Analysis 1.5

Comparison 1 Music versus standard care, Outcome 5 Respiratory Rate (adequate randomization).

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Analysis 1.6

Comparison 1 Music versus standard care, Outcome 6 Systolic Blood Pressure.

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Analysis 1.7

Comparison 1 Music versus standard care, Outcome 7 Diastolic Blood Pressure.

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Analysis 1.8

Comparison 1 Music versus standard care, Outcome 8 Mean Arterial Pressure.

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Analysis 1.9

Comparison 1 Music versus standard care, Outcome 9 Oxygen Saturation Level (change scores).

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Analysis 1.10

Comparison 1 Music versus standard care, Outcome 10 Mortality.

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Summary of findings for the main comparison. Music compared to standard care for mechanically ventilated patients

Music compared to standard care for mechanically ventilated patients
Patient or population: mechanically ventilated patients Settings: intensive care units Intervention: music Comparison: standard care
Outcomes	Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)
State anxiety STAI, VAS	The mean state anxiety in the intervention groups was 1.11 standard deviations lower (1.75 to 0.47 lower)	288 (5 studies)	⊕⊕⊝⊝ low^1,2,3,4
Heart rate beats per minute	The mean heart rate in the intervention groups was 3.95 lower (6.62 to 1.27 lower)	338 (8 studies)	⊕⊝⊝⊝ very low^1,5,6
Respiratory rate breaths per minute	The mean respiratory rate in the intervention groups was 2.87 lower (3.64 to 2.10 lower)	357 (9 studies)	⊕⊝⊝⊝ very low^1,6
Systolic blood pressure mmHg	The mean systolic blood pressure in the intervention groups was 4.22 lower (6.38 to 2.06 lower)	269 (6 studies)	⊕⊝⊝⊝ very low^1,7
Diastolic blood pressure mmHg	The mean diastolic blood pressure in the intervention groups was 2.16 lower (4.4 lower to 0.07 higher)	269 (6 studies)	⊕⊝⊝⊝ very low^1,7
Mean arterial pressure mmHg	The mean arterial pressure in the intervention groups was 1.79 lower (4.56 lower to 0.99 higher)	98 (3 studies)	⊕⊝⊝⊝ very low^1,7
Oxygen saturation level	The mean oxygen saturation level in the intervention groups was 0.05 lower (0.67 lower to 0.57 higher)	193 (4 studies)	⊕⊕⊝⊝ low¹
CI: Confidence interval
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
¹ The majority of the trials were assessed as high risk of bias studies ² All point estimates favour music although the magnitude of the effect differs across studies ³ Wide confidence interval, however, this is due to the fact that some studies reported very large beneficial effects of music on anxiety ⁴ Large reduction in anxiety as evidenced by SMD of 1.11 ⁵ Results were inconsistent across studies as evidenced by I² = 62% ⁶ Somewhat wide confidence interval ⁷ Wide confidence interval

Summary of findings for the main comparison. Music compared to standard care for mechanically ventilated patients

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Comparison 1. Music versus standard care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 State Anxiety (change scores) Show forest plot	5	288	Std. Mean Difference (IV, Random, 95% CI)	‐1.11 [‐1.75, ‐0.47]

2 Heart Rate Show forest plot	8	338	Mean Difference (IV, Random, 95% CI)	‐3.95 [‐6.62, ‐1.27]

2.1 Final score	2	63	Mean Difference (IV, Random, 95% CI)	‐5.26 [‐13.56, 3.03]
2.2 Change score	6	275	Mean Difference (IV, Random, 95% CI)	‐3.82 [‐6.83, ‐0.82]
3 Heart Rate (adequate randomization) Show forest plot	7	318	Mean Difference (IV, Random, 95% CI)	‐4.01 [‐6.80, ‐1.22]

4 Respiratory Rate Show forest plot	9	357	Mean Difference (IV, Random, 95% CI)	‐2.87 [‐3.64, ‐2.10]

4.1 Final score	3	83	Mean Difference (IV, Random, 95% CI)	‐2.14 [‐4.06, ‐0.22]
4.2 Change score	6	274	Mean Difference (IV, Random, 95% CI)	‐3.01 [‐3.85, ‐2.17]
5 Respiratory Rate (adequate randomization) Show forest plot	8	337	Mean Difference (IV, Random, 95% CI)	‐2.87 [‐3.64, ‐2.09]

6 Systolic Blood Pressure Show forest plot	6	269	Mean Difference (IV, Random, 95% CI)	‐4.22 [‐6.38, ‐2.06]

6.1 Final score	1	14	Mean Difference (IV, Random, 95% CI)	‐9.0 [‐22.40, 4.40]
6.2 Change score	5	255	Mean Difference (IV, Random, 95% CI)	‐4.09 [‐6.28, ‐1.90]
7 Diastolic Blood Pressure Show forest plot	6	269	Mean Difference (IV, Random, 95% CI)	‐2.16 [‐4.40, 0.07]

7.1 Final score	1	14	Mean Difference (IV, Random, 95% CI)	‐3.70 [‐15.17, 7.77]
7.2 Change score	5	255	Mean Difference (IV, Random, 95% CI)	‐2.13 [‐4.58, 0.31]
8 Mean Arterial Pressure Show forest plot	3	98	Mean Difference (IV, Random, 95% CI)	‐1.79 [‐4.56, 0.99]

8.1 Final score	1	20	Mean Difference (IV, Random, 95% CI)	‐4.75 [‐17.81, 8.31]
8.2 Change score	2	78	Mean Difference (IV, Random, 95% CI)	‐1.65 [‐4.49, 1.20]
9 Oxygen Saturation Level (change scores) Show forest plot	4	193	Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.67, 0.57]

10 Mortality Show forest plot	2	271	Risk Ratio (M‐H, Random, 95% CI)	0.76 [0.38, 1.51]

Comparison 1. Music versus standard care

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Intervenciones con música para los pacientes con asistencia respiratoria mecánica

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