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MUSIC Project MUS icotherapy at the I ntensive C are unit Geneviève Beaulieu-Boire R5, Solange Bourque R5, Catherine St-Pierre MD, Olivier Lesur MD PhD. Methods. Results. Background.

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MUSIC Project

MUSicotherapy at the Intensive Care unit

Geneviève Beaulieu-Boire R5, Solange Bourque R5, Catherine St-Pierre MD, Olivier Lesur MD PhD

Methods

Results

Background

We performed a prospective randomised controlled study in the medical ICU of the CHUS. The study was single blinded. We included adult patients requiring intubation for more than 3 days. The exclusion criteria were deafness, pregnancy and necessity of vasopressin or neuromuscular blockers. Patients were divided in 2 groups (A and B) with a cross-over design. They were assigned to listen to music or placebo for 1 hour 2 times a day.

Recruitment:

Day 1: inclusion in the study

Day 2: Gr A= music, Gr B= placebo

Day 3: wash-out

Day 4: Gr A= placebo, Gr B= music

Blood samples were taken each morning before and after treatment period (10h and 11h).

Modification in administration of sedatives and vasopressors were noted. We calculated the total dosage per day of each medication. A decrease of 20% of medication was judged to be significant.

Music has a lot of virtues. It was recently suggested that listening to music lower stress and has anti-inflammatory effects. It also lowers level of IL-6, epinephrine and DHEA.

Intensive care units are stressful environments: they are noisy and crowded with staff and patients are acutely ill.

Being under mechanical ventilation is even worse because the patient can’t communicate and the procedure is invasive and painful.

To minimise these effects, we give sedative drugs that have many potential side-effects.

Conclusion

In our study, music therapy at the ICU did not lower the use of sedative drugs for intubated patients. It had mild effects on the hemodynamic parameters, but this was not statistically significant; this likely reflects our lack of power (38 patients to date). We will continue recruitment until we will have 60 patients included (calculated sample). We also believe that we did not succeed to have the personnel of the ICU consistently make sedation adjustments in response to clinical changes in the patient. However, we demonstrated an effect of music on the biological parameters of stress, particularly on the cortisol and the ACTH/ cortisol ratio. An higher ratio is a validated parameter reflecting stress reduction in sepsis patients in ICU. We demonstrated that only survivors activated their stress axis in response to music (higher ratio). More studies are needed to fully understand these results.

1 2 3 4

No significant reduction of narcotics, benzodiazepines and propofol was associated with music listening. Some trends were noted on hemodynamic parameters (BP, RR), but were not statistically significant. (p=0.1)

CRP and IL-6 were similar in both groups. Cortisol levels decreased and ACTH/cortisol ratio increased in the group of music listeners. PRL did not change. We also noted that the ratio increased only in survivors.

Objectives/Outcomes

  • 1- To assess if listening to relaxing music lowers sedation needs in intubated patients of the medical ICU
  • 2- To assess the effect of music on hemodynamic parameters (BP, HR, RR, SAO2)
  • 3- To assess the impact of music on biologic markers of inflammation (IL-6, CRP) and stress markers (ACTH, cortisol, PRL)

Results

We did an interim analysis. To this point, we randomized 38 patients in two groups. They exhibited similar baseline characteristics (table 1).

Founded by PAFI foundation, Centre de recherche clinique Étienne-Lebel