It is common for critically ill patients on life support to develop delirium, a form of acute brain failure for which no effective treatment is known. A study from Indiana University School of Medicine and Regenstrief Institute researchers, led by DMU alumnus Sikandar Khan, D.O.’12, M.S., reports that music appears to decrease delirium in patients on mechanical ventilators in the intensive care unit (ICU).
A March 10, 2020, press release issued by the Regenstrief Institute described the study, which showed that critically ill individuals who listened to slow-tempo, relaxing music (60 to 80 beats per minute) had decreased need for sedatives, fewer days of delirium and were more awake — enabling them to receive physical therapy earlier. These results are encouraging, the release stated; a larger clinical trial is currently under way.
Mechanically ventilated patients — more than a million adults annually in the United States — are at increased risk for delirium, which is associated with prolonged ICU stays, higher health care costs and increased mortality. The intubated patient experiences pain, anxiety and physiologic stress for which they usually are treated with drugs, which can contribute to delirium. This perpetuates a cycle of pain, anxiety, sedation and delirium.
“Like kidney or heart failure, individuals can develop brain failure, but there is no treatment equivalent to dialysis or the ventilator for brain failure, a condition which can adversely affect an individual’s personality and quality of life for years,” said Dr. Khan, IU School of Medicine assistant professor of medicine and Regenstrief Institute research scientist. “Recent studies by our group and others have shown that drugs, including commonly prescribed antipsychotics, do not treat delirium or reduce its severity, so we desperately need a non-pharmacologic treatment. Our pilot study shows that music may hold promise to help save patients’ brains and allow them to experience less stress while critically ill.”
Existence of delirium and delirium severity were assessed twice daily in an Eskenazi Health medical-surgical ICU using the CAM-ICU-7, short for Confusion Assessment Method for the Intensive Care Unit 7, a tool developed by Regenstrief Institute and IU School of Medicine clinician-researchers.
Additionally, the new study is the first to determine the acceptability of music by patients on mechanical ventilators and the feasibility of administering music by non-specialists. Patients who listened to the slower-tempo, relaxing music two hours per day needed less sedation and had more delirium free days. ICU nurses could easily place noise-cancelling headphones and audio players with patients.
The researchers divided ICU patients on mechanical ventilators into three groups. Patients were randomized to (1) slow tempo playlists consisting of piano, guitar, Native American flute sounds and classical music; (2) patient preference for the selection of music (as conveyed by surrogates) or (3) an audio book. Patients in the audiobook arm of the study were further randomized to hear a reading of “Treasure Island,” the Harry Potter series, or Dr. Seuss’ “Oh the Places You’ll Go!” All three audiobooks were chosen for readability, broad appeal, quality of narration and high ratings on commercial websites.
Eighty percent of the patients in the study rated the music enjoyable, duration appropriate and indicated that they liked receiving sessions twice a day. Patients noted music had made them feel more normal and calm as well as giving them a sense of control. Slow-tempo music, which had a significantly greater effect than music selected by patient preference, was also more highly favored by study participants.
By contrast, no matter which of the three books they heard while on the ventilator, patients rated audiobooks poorly, with lower acceptance than music of any type.
“Our work is novel in that we explored the effect of music on critically ill, mechanically ventilated adults age 18 and older, a very different group for whom music and delirium has not been previously studied,” added Dr. Sikandar Khan. “It’s the first study of its type based on science — in previous work on biomarkers we had shown that slow-tempo music yielded less stress hormones in blood — and science won.”
“Decreasing Delirium through Music (DDM): A Randomized Pilot Trial,” is published in the American Journal of Critical Care. Authors in addition to Dr. Khan are Chenjia Xu, Ph.D.; Russell Purpura, M.D.; Sana Durrani, M.B.B.S.; Heidi Lindroth, Ph.D., R.N.; Sophia Wang, M.D.; Sujuan Gao, Ph.D.; Annie Heiderscheit, Ph.D.; Linda Chlan, Ph.D., R.N.; and Regenstrief Institute research scientists Malaz Boustani, M.D., M.P.H., and Babar A. Khan, M.D., M.S. The work was supported by a Regenstrief Innovations award.
Dr. Babar Khan and Dr. Chlan are the primary investigators (PIs) and Dr. Sikandar Khan is an investigator of an ongoing randomized controlled clinical trial that is evaluating the effectiveness of exposure to slow-tempo classical music versus simple noise cancellation in decreasing delirium in older adults. The five-year project is supported by the National Institutes of Health’s National Institute on Aging and National Eye Institute.
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. Its researchers are responsible for a growing number of major health care innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.