WHAT Live musical performances as a non-pharmacological intervention in the therapy of mechanically ventilated patients admitted to the ICU.
WHO Principal investigator: Dr. Juan Carlos Montejo, head of the Intensive Care Unit at Hospital 12 de Octubre.
WHY The study sought to find evidence on the effects of regular and ongoing live musical performances in mechanically ventilated patients admitted to the ICU and verify whether this may be an effective non-pharmacological intervention in therapy.
HOW This was achieved by measuring and observing different critical vital signs of patients that were already being routinely monitored in the ICU, such as blood pressure, brain activity through basic electroencephalography, the amount of sedation/analgesia required and, using validated scales, agitation, confusion, and other expected complications in patients in this setting. Thus, the study aimed to verify whether the intervention is valid at the time of exposure to music and to explore the cumulative effectiveness of the presence of live music.
WHEN The study period ran from 1 February 2017 to 28 February 2020.
Situation of the patients
Intensive care units
are unique environments where patients are generally intubated, connected to mechanical ventilation, receive sedation/analgesia and require continuous haemodynamic monitoring, multiple vascular devices, nasogastric tubes, bladder tubes, with the application of renal clearance techniques, external temperature control systems, etc. Mechanically-ventilated patients present high levels of stress and anxiety. This is largely due to a variety of factors, including shortness of breath, frequent aspiration of secretions, inability to speak, altered circadian rhythms, high noise levels, uncertainty, discomfort, isolation and fear.
“Incorporating live music into the daily routine of our units is actually
not very easy”, says Dr. Carlos Montejo. “ICUs are hives of continuous activity, where patients come and go,
techniques and procedures that have to be performed… and it’s very difficult to find a peaceful place for the musician to give a good performance that can be adequately transmitted to the patient. Even so, it can be done, provided we’re aware of these problems—it can be done”. Dr. Juan Carlos Montejo.
The MIR Project was carried out in three different areas within the Intensive Care Unit: the Multi-purpose ICU, the Cardiology ICU and the Trauma and Emergency ICU. The Cardiological Care ICU has 13 beds where medically-treated heart failure patients and post-cardiac surgery patients are admitted. The Trauma and Emergency ICU has 8 beds where patients with traumatic pathologies are admitted. The Multi-purpose ICU has 14 acute care beds and 3 intermediate care beds.
Analyse whether the implementation of live musical performances can be an effective non-pharmacological intervention in the therapy of mechanically ventilated patients admitted to an Intensive Care Unit (ICU) at a high complexity hospital.
– Evaluate the effects of live musical performance on anxiety and
pain in patients on invasive mechanical ventilation.
– Assess whether the early implementation of live musical performances in mechanically ventilated patients reduces mechanical ventilation time.
– Analyse the duration of the effect of live musical performances in
mechanically ventilated patients.
– Evaluate whether live musical performance has a cumulative effect in
mechanically ventilated patients.
– Analyse whether the implementation of live musical performances in mechanically ventilated patients admitted to an ICU at a high complexity hospital:
– Analyse whether the time of day when the live music performance is given bears an influence in these patients.
– Evaluate whether there are any differences depending on the repertoire chosen
for the live music performances.
At the time of this publication, the data gathered were still being analysed for their detailed study. So far, the interim analyses have not revealed any statistical significance in the objectives set out in the project. The final results and detailed analysis will be the subject of a doctoral thesis supervised by the principal investigators.
Según explica el Dr. Juan Carlos Montejo, investigador principal: «Se trata de un estudio clínico unicéntrico en el que se ha introducido una intervención musical con música interpretada en directo en la UCI. “For a period of 3 years, the study enabled the inclusion of music to be considered as another element of the daily treatment of patients in a very high-tech part of the hospital, dominated by the sound of monitors, respirators, haemofilters, ECMOs, etc.