Impact of Music Intervention or Usual Care on Sedative Exposure During a Spontaneous Awakening Trial among Intensive Care Unit Patients Receiving Mechanical Ventilation: A Prospective Randomized Feasibility Study

Abstract

Purpose of Research: The objective of this study was to determine if protocolized music intervention paired with spontaneous awakening trial (SAT) is a feasible intervention for mechanically ventilated and sedated intensive care unit (ICU) patients to reduce overall sedation exposure. Major Findings: Patients were admitted to the medical ICU (MICU) or surgical ICU (SICU), mechanically ventilated for at least 24 h with anticipated duration of at least 72 h, and with hearing optimized to baseline disposition. Patients were excluded if they had a specified prior to admission diagnosis, traumatic or medical encephalopathy, or need for deep sedation. Eligible patients were randomized to music intervention or usual care during SAT. Patients in the music intervention group underwent a second randomization to Commercial Music Intervention (CMI) or Preference Music Intervention (PMI).The primary outcome was sedation exposure via sedation intensity score (SIS), an aggregate of the frequency and intensity of sedatives from disparate drug classes such as opioids, anxiolytics, antipsychotics, and others, which was summed for exposure comparison. The usual care group had significantly higher median SIS compared to the music intervention group (4 [IQR 4.9-6.4] vs 3 [IQR 3.1-4.2], P = .0006). Patients who received PMI had significantly higher mean SIS compared to the CMI group (5 ± 2.4 vs 2.3 ± 1.7, P = .0002). Compared to usual care, the music intervention group had a higher percentage of delirium-free ICU days (37% vs 22%, P = .009) and a higher percentage of CPOT scores at goal (69% vs 52%, P = .002), but no difference in percentage of goal sedation scores (64% vs 67%, P = .7). Conclusions: Protocolized music intervention paired with daily spontaneous awakening trial is a feasible routine intervention for mechanically ventilated patients. Future studies are needed to confirm if this intervention may reduce overall sedation requirements.