Music interventions for mechanically ventilated patients

Joke Bradt; Cheryl Dileo

doi:10.1002/14651858.CD006902.pub3

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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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