Listening to music appears to have a calming effect on hospital patients hooked up to breathing machines, according to a new report.
Mechanical ventilation can be a distressing experience for critically ill patients, but researchers say tranquilizers will only prolong their hospital stay.
To investigate whether listening to pleasing tunes could help, a group of American and Australian researchers reviewed studies that tested music plus standard care against standard care alone.
Although they only found eight studies, including 213 patients, music turned out to curb anxiety and reduce heart rates.
Study author Dr Joke Bradt, of Drexel University in Philadelphia, said anything that lowers stress in patients on ventilation is a welcome advance.
300,000 in ventilators each year
Each year, more than 300,000 Americans are put on mechanical ventilation in intensive care units across the country, many recovering from a serious accident, surgery, cancer, or any number of life-threatening events.
Ventilators make it difficult for them to communicate their needs, or ask questions about their treatment or survival chances.
Dr Linda Chlan of the University of Minnesota, who has worked with music therapy, agreed that it can be a big help to patients on mechanical ventilators.
She said it was a safe intervention without side effects "that is soothing and familiar to patients in a very high-tech, stress-filled environment."
Unclear reason why music helps
While the reason music works is still unclear, Bradt said, it might provide a distraction, or somehow communicate with the brain regions responsible for emotional regulation.
This is not the first study to show that people in difficult circumstances may feel better after turning on the stereo.
According to some research, for instance, it appears to help premature babies cope with pain, nurse better, and relax. Indeed, neonatal units are increasingly turning to music to calm infants during common painful procedures, such as blood sampling with heel pricks.
Other studies show pregnant women may be able to ease their stress and anxiety by simply kicking back with some relaxing tunes.
All eight studies reviewed for the new report, published in The Cochrane Library, looked at how people felt after one session of music. Seven studies allowed patients to choose their own music, and one used an actual music therapist, who will sing or play music with the patient and tailor the session to specific needs.
In the studies that asked patients to rate their anxiety, patients who had listened to music reported feeling better than those who hadn't by a margin of 1.06 -with anything above 0.8 being considered a "large effect," according to Bradt.
The five studies that examined heart rates found music lowered it by five beats per minute, which Bradt said is enough to help critically ill people. Some studies also showed patients had a lower respiratory rate after listening to music.
Of course, patients couldn't be blinded to what treatment they got, standard or music, so it's possible they fared better solely because they believed music would help, Bradt explained.
But if people improve after listening to music, that's what matters, regardless of whether it's placebo or not, she added. "As a therapist, you hope that there's going to be plenty of placebo there, that the patient believes it will work."
No side effects
Plus, music is easy and cheap to provide, with no side effects, Bradt added. The one concern would be to ensure the patients liked the selected music, since listening to music they didn't enjoy could actually increase their stress. "So really someone should be there to monitor the effect of the music," asking patients to give a thumbs-up or down, or adjust the volume if necessary.
And given how important music preference is, Chlan said she wouldn't recommend providing music for unconscious patients, who cannot say either way if they like it.
"Given that everyone has musical memories and music preferences, I personally do not recommend music for unconscious ICU patients unless family members have extensive knowledge about a loved one's likes and dislikes of music," she said in an e-mail.
(Reuters Health, Alison McCook, December 2010)