Gullick Janice G, Kwan Xiu Xian
Master of Emergency and Intensive Care Nursing Programs, Sydney Nursing School, University of Sydney, Australia.
Sydney Nursing School, University of Sydney, Australia; Intensive Care Unit, Alexandra Hospital, Jurong Health Services, Singapore.
Aust Crit Care. 2015 May;28(2):103-5. doi: 10.1016/j.aucc.2015.03.003. Epub 2015 Mar 26.
This research appraisal, guided by the CASP Randomised Controlled Trial Checklist, critiques a randomised, controlled trial of patient-directed music therapy compared to either noise-cancelling headphones or usual care. This study recruited 373 alert, mechanically-ventilated patients across five intensive care units in the United States. The Music Assessment Tool, administered by a music therapist, facilitated music selection by participants in the intervention group. Anxiety was measured using the VAS-A scale. Sedation exposure was measured by both sedation frequency and by sedation intensity using a daily sedation intensity score. Context for the data was supported by an environmental scan form recording unit activity and by written comments from nurses about the patient's responses to the protocol. Patient-directed music therapy allowed a significant reduction in sedation frequency compared to noise-cancelling headphones and usual care participants. Patient-directed music therapy led to significantly lower anxiety and sedation intensity compared to usual care, but not compared to noise-cancelling headphones. This is a robust study with clear aims and a detailed description of research methods and follow-up. While no participants were lost to follow-up, not all were included in the analysis: 37% did not have the minimum of two anxiety assessments for comparison and 23% were not included in sedation analysis. While some participants utilised the intervention or active control for many hours-per-day, half the music therapy participants listened for 12min or less per day and half of the noise-cancelling headphone participants did not appear to use them. While the results suggest that patient-directed music therapy and noise-cancelling headphones may be useful and cost-effective interventions that lead to an overall improvement in anxiety and sedation exposure, these may appeal to a subset of ICU patients. The self-directed use of music therapy and noise-cancelling headphones means these findings may not transfer to sedated or cognitively-impaired patients.
本研究评估以CASP随机对照试验清单为指导，对一项将患者主导的音乐疗法与降噪耳机或常规护理进行比较的随机对照试验进行了批判。该研究在美国的五个重症监护病房招募了373名警觉的机械通气患者。由音乐治疗师管理的音乐评估工具帮助干预组的参与者选择音乐。使用VAS-A量表测量焦虑。通过镇静频率和使用每日镇静强度评分的镇静强度来测量镇静暴露情况。数据背景得到环境扫描表记录的单位活动以及护士关于患者对方案反应的书面评论的支持。与降噪耳机和常规护理参与者相比，患者主导的音乐疗法使镇静频率显著降低。与常规护理相比，患者主导的音乐疗法导致焦虑和镇静强度显著降低，但与降噪耳机相比则不然。这是一项目标明确、对研究方法和随访有详细描述的有力研究。虽然没有参与者失访，但并非所有人都纳入了分析：37%的人没有进行至少两次焦虑评估以供比较，23%的人未纳入镇静分析。虽然一些参与者每天使用干预措施或积极对照数小时，但一半的音乐疗法参与者每天收听时间为12分钟或更短，一半的降噪耳机参与者似乎并未使用它们。虽然结果表明患者主导的音乐疗法和降噪耳机可能是有用且具有成本效益的干预措施，可导致焦虑和镇静暴露总体改善，但这些可能只对一部分ICU患者有吸引力。音乐疗法和降噪耳机的自主使用意味着这些发现可能不适用于镇静或认知受损的患者。
