Trauma Surgery Department, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
Department of Surgery, University of California San Francisco, San Francisco, California, USA.
J Integr Complement Med. 2024 Nov;30(11):1047-1071. doi: 10.1089/jicm.2023.0483. Epub 2024 Jul 24.
Patients in intensive care units experience high symptom burden during mechanical ventilation (MV). Pharmacologic symptom management is associated with side effects and increased morbidity. Music-based interventions (MBIs) have been associated with reductions in both anxiety in MV adults and pain for critically ill adults, yet their use for the management of other burdensome symptoms has not been evaluated. The purpose of this scoping review is to map the state of evidence for the use of prerecorded music listening MBIs for symptom management in MV adults. A systematic search of the literature was conducted across four electronic databases (PubMed, EMBASE, CINAHL, and Web of Science) for experimental designed studies that measured the efficacy of MBIs for the management of physical and psychological symptoms including anxiety, sedation/agitation, dyspnea, distress, delirium, sleep, stress, fear, loneliness, or depression in critically ill, MV adults between January 1, 1998, and April 18, 2023. A total of 643 abstracts and 29 clinical trials were included. Overall, the risk of bias, assessed using the Evidence Project tool, was moderate. MBIs were mostly delivered with headphones using music selected either by investigators or from a limited selection. MBIs were associated with reduced pain, agitation, dyspnea, distress and anxiety, and improved tolerance of MV and sedative weaning. Outcomes of delirium were mixed. No studies explored sleep disturbances, fear, or loneliness. Use of MBIs improved symptom experience for critically ill adults during MV. Future studies employing unrestricted patient-preferred music selections and exploring outcomes of sleep quality, psychological distress, and delirium are needed in this highly symptomatic patient population.
重症监护病房的患者在接受机械通气 (MV) 时会经历高症状负担。药物治疗症状管理与副作用和发病率增加有关。基于音乐的干预 (MBIs) 与 MV 成人焦虑和危重病成人疼痛的减轻有关，但尚未评估其用于管理其他负担性症状的用途。本范围综述的目的是绘制使用预先录制的音乐聆听 MBIs 管理 MV 成人症状的证据状态图。对四个电子数据库（PubMed、EMBASE、CINAHL 和 Web of Science）进行了系统的文献搜索，以寻找评估 MBIs 对管理物理和心理症状（包括焦虑、镇静/激越、呼吸困难、痛苦、谵妄、睡眠、压力、恐惧、孤独或抑郁）的疗效的实验设计研究。MV 危重病成人的 1998 年 1 月 1 日至 2023 年 4 月 18 日。共纳入 643 篇摘要和 29 项临床试验。总体而言，使用证据项目工具评估的偏倚风险为中度。MBIs 主要通过耳机使用调查员选择或从有限选择中选择的音乐来提供。MBIs 与疼痛、躁动、呼吸困难、痛苦和焦虑减轻以及 MV 耐受性和镇静剂撤药改善相关。谵妄的结果喜忧参半。没有研究探讨睡眠障碍、恐惧或孤独。MBIs 改善了 MV 期间危重病成人的症状体验。在这个症状高度明显的患者群体中，需要进行未来的研究，使用不受限制的患者首选音乐选择，并探索睡眠质量、心理困扰和谵妄的结果。
