Music

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Music therapy – A complementary treatment for mechanically ventilated

intensive care patients

Article  in  Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses · March 2003

DOI: 10.1016/S0964-3397(02)00118-0 · Source: PubMed

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Sofia Almerud Österberg

Linnaeus University

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Kerstin Petersson

Lund University

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Sofia Almerud RN MS, Department of Anaesthesiology and Intensive Care, Central Hospital, SE-351 85 Växjö, Sweden. Home address: Östregårdsgatan 10, SE-352 34 Växjö, Sweden. Tel.: +46 470 777266/702 092269. E-mail: sofia. almerud@telia.com

Kerstin Petersson RN Ph D, Unit for Caring Science, Lund University. Box 157, SE-221 00 Lund, Sweden

(Requests for offprints to SA)

Manuscript accepted: 29/11/02

Original article

Music therapy—a complementary treatment for mechanically ventilated intensive care patients Sofia Almerud and Kerstin Petersson

The aim of this study was to ascertain whether music therapy had a measurable relaxing effect on patients who were temporarily on a respirator in an intensive care unit (ICU) and after completion of respirator treatment investigate those patients’ experiences of the music therapy. In the study both quantitative and qualitative measurements were applied. Twenty patients were included using consecutive selection. It became apparent that the patients remembered very little of their time in ICU. The analysis of the quantitative data showed a significant fall in systolic and diastolic blood pressure during the music therapy session and a corresponding rise after cessation of treatment. All changes were found to be statistically significant. The conclusion was that intensive care nursing staff can beneficially apply music therapy as a non-pharmacological intervention. © 2003 Elsevier Science Ltd. All rights reserved.

Introduction Treatment in an intensive care unit involves many and constant medical tests and observations plus a host of procedures. Furthermore, the environment is one of technical apparatus, machinery and frequent medical testing. As a result it can be difficult for the patient to relax. To be seriously ill and confined in strange surroundings can be bewildering and even frightening. This can lead to fatigue and confusion of the patient (Bergbom-Engberg 1989; Fontaine 1994; Granberg Axèll 2001). The many routines and procedures can make the patient feel threatened and lose self control. Intensive care patients are sensitive, vulnerable and overwhelmed with a sense of fright and excitement. The intensive care nurse must therefore plan and implement treatment of the patient with both caution and care (Granberg Axèll 2001).

Environment and experiences

Intensive care units have a continuously high noise level, often over 60 dB. An alarm from commonly used technical apparatus can produce a sound level of up to 90 dB. Unexpected noise is stress producing, creates anxiety and leads to raised heart rate (Fontaine 1994). One of the foremost causes of displeasure is mechanical ventilation, the endotracheal tube and suctioning (Bergbom-Engberg 1989; Fontaine 1994; Butler 1995).

A proportion of intensive care patients suffer from so-called “intensive care syndrome” (ICU syndrome) which is characterised by perceptible disturbance. This can often lead to sight and hearing hallucinations, aggression, confusion and paranoia. The cause of ICU syndrome is unknown but it is likely that several factors contribute. Precipitating factors can be the illness or injury in itself with

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patho-physiological disturbance, the medical treatment, the unfamiliar environment or the normal routines and procedures on the unit. Pain-killing drugs and tranquillisers can contribute further to the ability to interpret stimuli (Bergbom-Engberg 1989; Granberg Axèll 2001). Between 20 and 60% of all intensive care patients develop some form of delusion (Granberg Axèll 2001).

To alleviate anguish and anxiety in respirator-treated patients sedatives are usually administered. Medication has a number of recognised adverse effects such as nausea, vomiting, muscle weakness and atrophy, need for extended time on the respirator, increased susceptibility to infection, changes in the mental state and even death (Chlan 1998; Ledingham et al. 1988). Undesired side effects of tranquillisers have prompted researchers to take interest in alternatives to pharmaceutical preparations (Fontaine 1994).

Music therapy

Biley (1992) defined music therapy as a controlled form of listening to music and it’s influence on the person, physiologically, psychologically and emotionally, during treatment of illness or injury. Chlan and Tracy (1999) describe music therapy as a reliable and efficacious treatment for certain critically ill patients, partly due to its capacity to reduce anguish and anxiety without the use of medication. Amir (1999) describes music therapy as a means of producing an intrinsic change in the way the patient experiences the situation. Music can also promote and encourage rest and sleep by way of creating a peaceful atmosphere. Furthermore, the use of headphones shuts out undesired background noise, which is common in intensive care units (Chlan 2000). Music provides a way of filtering out unpleasant and unfamiliar sounds which are part of the hospital environment, and in that way can reduce the need for sedative drugs, thus leading to a speedier recovery (Bonny 1978).

Physiological and psychological effects of music therapy

Music influences the brain by prompting the secretion of endorphins, the body’s own

morphine (Fontaine 1994). Music therapy leads to slower heart rate, calmer and more regular respiratory rate and lower blood pressure (Bonny 1978; Chlan 1998; Updike 1990) and has even been shown to result in lower adrenaline levels and reduced neuromuscular activity (Chlan 1998).

Compared to a short rest, music therapy was shown to be more effective in relieving stressful situations which respirator patients experience (Chlan 1998). Music should not be played continuously as it can lead to irritation rather than a state of wellbeing (O’Sullivan 1991). According to literature, 25–90 minutes music therapy seemed to be an adequate treatment period (Guzzetta 1989; Henry 1995).

There are a limited number of published studies on this topic. The music therapy studies carried out in Sweden are on patients other than intensive care patients on respirators. The present study was carried out in order to develop music therapy as an intervention within intensive care.

Objective The aim of this study was to ascertain whether music therapy had a measurable relaxing effect on patients who were temporarily on a respirator in an intensive care unit (ICU) and after completion of respirator treatment investigate those patients’ experiences of the music therapy.

Methods Design

In the study both quantitative and qualitative methods were applied. By combining both methods the weaknesses of one method can be compensated by the other. Qualitative method describes quality, contents and character (nature). Quantitative method gives cognizance of extent and comparisons of phenomena. Qualitative method is especially of importance in evaluating complex interventions (Polit & Hungler 2001).

Context

The intensive care unit under study is part of a moderately large hospital in southern Sweden.

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Music therapy—a complementary treatment for mechanically ventilated intensive care patients

The total number of respirator hours is in the region of 12,000 annually, which corresponds to 500 days. The usual reasons for patients’ requiring respirator help are chronic obstructive lung disease, sepsis, major surgery and trauma. The unit has 16 beds. Staffing levels vary considerably although there are seldom fewer than eight persons per shift. The staff comprises nurses (equivalent to both SRN and SEN), doctors and physiotherapists. The majority of respirator-treated patients are nursed in single rooms with closed doors. Generally the light level is high, as is the noise level, especially during the day. Patients are connected up to extensive technical equipment such as ECG, blood pressure apparatus, tracheal tube, respirator and central venous catheter.

Intervention

Patients in the study group listened to music via headphones, which allowed the patient a moment free from disturbance. Headphones also shut out unfamiliar and unwelcome noise from the unit (Chlan 1995). Another advantage is that no one else can hear the music whilst the patient is using the headphones. This is important in intensive care where several critically ill patients may be in the same open area or with beds close together. If the music is openly broadcast it could be a source of irritation for other patients and staff (Chlan & Tracy 1999). The study group listened to the music whilst the control group rested under similar circumstances but without the headphones with music. The control group was only used in the quantitative part of the study to determine if there were any differences between music therapy and a period of tranquillity under similar circumstances.

Classical music was played for 30 minutes in conjunction with night sleep (Table 1). Each patient listened to music on two separate occasions. A portable cassette tape recorder with headphones was used. All patients wore headphones during the entire measurement period. The ambition was that the patient, during intervention, be free from pain and afforded a comfortable lying position. The lighting was dimmed as far as practically possible. No planned interruptions by nursing

Table 1 Musical compositions used in the study

Composer Composition

Beethoven Suite 1 from Sonata in C-sharp minor (Moonlight sonata)

Pachebel Canon Debussy Claire de lune Bach Air from suite for orchestra no. 3 Vivaldi Spring: Largo Seymer Solöga [Suneye] Marcello Concerto for oboe in D minor: Adagio

or medical staff were made during the intervention period unless the patient’s condition demanded it.

Pieces of music from previous studies (Henry 1995; Johnston & Rohaly-Davis 1996; Updike 1990) were chosen for this study.

Patient selection

Adults, intensive care patients who were temporarily in need of mechanical ventilation and whose condition was physically stable was included. Selection was consecutive. Patients were excluded if it was known that they were suffering from a severe psychiatric condition, severe depression or were mentally retarded. Patients with cerebral haemorrhage thought to be at risk of psychological effects were also excluded. The reason for excluding these patients was that their condition could render a follow-up interview more difficult or even impossible. Ten patients were included in each group (Table 2).

Each patient received sedatives during respirator treatment. In accordance with ICU routine, sedatives were discontinued a set time before extubation. However, two patients in each group were receiving a continuous supply of analgesics. At the time of music therapy the patients’ conditions were anything from totally awake and alert, to drowsy but receptive after stimulation.

Procedures

The quantitative part of the study was concerned with measurement of pulse, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation, SpO2 (Chlan 1998;

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Table 2 Demographic data

Study group (n = 10) Control group (n = 10)

Men/women 5/5 3/7

Age (years) mean/median 68.7/67 64.2/73 Range 54–81 27–81 Time on mechanical ventilation (days)

Mean/median 13.95/11 9.1/9.5 Range 1–31 2–19

Diagnoses Infection 3 2 Respiratory distress 3 4 Trauma 1 2 Postoperative care 3 2

Updike 1990). In accordance with a special protocol, the various values were recorded at 5-minute intervals during the period of intervention. The qualitative part of the study consisted of interview questions concerning recollections and experiences of respirator treatment and music therapy. The interviews were conducted by one of the leading author 2–4 days after the patient was returned to the ward.

Six of the 10 patients in the study group were interviewed. Two patients died just after returning to the ward, one declined to be interviewed and one patient was unable to communicate for several days after returning to the ward.

The interview situation was relaxed. All patients were interviewed in the single rooms where they were nursed. The patients were encouraged to speak freely in answer to the questions they were asked. In the case of the patient not recollecting, further, more in-going questions were asked. The time taken for interviews was between 20–30 minutes.

The leading author is a trained and experienced worker in this area. At interview, the leading author endeavoured to counterbalance this by not posing leading questions but by allowing the patients to freely recount their experiences.

The questions posed at interview were; Do you remember your time on the

respirator? How would you describe your experience?

Do you remember that you listened to music? How would you describe your experience?

Analysis of the data

Quantitative data was analysed using repeated measurements and paired samples. Repeated measurement analysis of variance was used to determine if there were any differences between or within the groups over time. Paired t-tests were used to examine differences between two points of measurement (Altman 1992).

For data analysis, the computer programme SPSS-PC 11.0 for Windows was used. The diagrams were created in Microsoft Excel.

Patients in the study group listened to music on two different occasions and objective parameters were noted at both times. Mean values were then determined from the collected data. In the control group one measurement per patient was made.

Qualitative data, i.e. the interview material, was analysed by content analysis, partially according to Burnard (1991). The interviews in this study were recorded on cassette tape except in one instance when the patient expressed a wish not to be recorded. Instead, written notes were made. Transcription was carried out in every case by the leading author herself and immediately on completion of the interview. Firstly, short notes were made on what was discussed, and then the interview was written out in full. The transcriptions were then read through so that the leading author could acquaint herself with the contents. The text content was then coded, headings created and the data characterised. In stage 4 the numbers of categories were reduced; those similar in content being

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Music therapy—a complementary treatment for mechanically ventilated intensive care patients

combined. Headings or categories were further reduced in order to create a final list. Both authors read through the entire material and produced their own categories; those two lists were then compared with each other and requisite changes made. The transcripts were then read through yet again with the final list of categories in order to check that they represented the content of the interviews. The text content was divided and placed under appropriate headings keeping together those parts of the interviews which belonged together, and retaining the context. The following categories were created; recollection, anxiety and discomfort, illusory feelings and close relationship. This final list of categories was established after repeated discussions and comparisons of the authors’ individual lists. Examples of each of these categories, using direct citations are given in the result section. The citations are numbered to show that each patient is quoted (Burnard 1991).

Ethical aspects

Data was collected before, during and after treatment and was normally registered via the monitoring equipment. The patient was therefore undisturbed by registrations being made more frequently.

Informed consent, both verbal and written, was obtained prior to the interviews.

Data from the control group was used only to compare the quantitative material with the study group and is not a part of the procedure. No personal data was registered in the control group.

Consent for the study was obtained from the Regional Committee for Medical Research Ethics at Lund University. Diary number LU 547-00.

Results Repeated measurements showed no significant differences between the two groups, nor were there any differences over time. Paired t-tests, however, showed significant mean differences between two points of measurement on systolic, diastolic and heart rate in the study group. No significant differences were found in the control group.

In the study group, both systolic and diastolic blood pressure fell during music therapy only to rise again after completion of treatment (P = 0.005). The differences were statistically significant (P < 0.005). The mean systolic blood pressure fell from 136 to 124 mmHg during treatment. Sixty minutes after the completion of treatment, systolic blood pressure had risen from 124 to 131 mmHg (P < 0.017) (Figs. 1 and 2).

Heart rate fell, during music therapy but this was not significant (P = 0.065). The increased pulse rate that occurred after completion of the session was statistically significant (P < 0.002) (Fig. 3). These changes did not occur in the control group.

No statistically significant results were found for respiratory rate and SpO2 for either group.

During interviews, in the category recollection, it was shown that the patients remembered little of their time on the respirator. One patient (no. 6) who was ventilated overnight postoperatively had “no recollection at all.” Another patient (no. 1) who was ventilated for 10 days due to respiratory obstruction said that her recollections merged together, were vague and were “in zigzag.” This patient wondered why she couldn’t remember and wished that she could remember more. One woman (no. 2) who was on a respirator for 48 hours postoperatively said “I don’t remember being on a respirator, it’s totally erased.” Her first recollections were after being returned to the ward. One woman (no. 4) who was mechanically ventilated for 21 days due to trauma said: “I remember the ICU, well, I think I do . . . but it’s a bit blurred . . . .” One man (no. 3) with an infection, and was nursed for 10 days on the respirator, related that: “everything is so blurred, I think I remember sometimes, a few things/ . . . /it’s not gaps, I just can’t remember.” He wondered, towards the end of the interview, whether it was usual that other patients remembered more than he did. None of the patients recalled that they had listened to music.

In the category anxiety and discomfort, two patients recounted their feelings of anxiety and discomfort in connection with respirator treatment. “It was unpleasant when they took away the phlegm in my throat. I had a sort of panic attack and couldn’t get any air, I remember that.”

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Fig. 1 Mean systolic blood pressure over time.

It was apparent also that constant light and noise was a source of discomfort.

After 48 hours nursing on a respirator, in the category illusory feelings, one woman (no. 2) said: “. . . I make such a mess of things. I said lots of stupid things.” She recalled her illusory experiences saying: “I accused them of

Fig. 2 Mean diastoilc blood pressure over time.

theft/ . . . /my door, I couldn’t open it/ . . . /I’m totally mixed up.” From the interviews it was apparent that there were also difficulties in distinguishing night and day.

In the category close relationship, one patient (no. 5), after one month on a respirator, considered that there was a great sense of

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Music therapy—a complementary treatment for mechanically ventilated intensive care patients

Fig. 3 Mean heart rate over time.

security when he had his family around him. He said that: “it felt good when my family came . . . .” This patient felt secure also with the members of staff who nursed him.

Discussion This study demonstrated significant changes in systolic blood pressure in the study group. Both systolic and diastolic blood pressure fell during music therapy sessions only to rise again on completion, as is shown in paired samples t-test. That no significant differences were shown in repeated measurements between the two groups could be due to the limited population. The qualitative part of the study showed that the patients remembered little of their time on the respirator.

It can be beneficial to allow the patient, as far as possible, to choose the music category. Bonny (1986) is of the opinion that critically ill patients tend to prefer, and respond better to classical music. In this study, patients were semiconscious and could not actively choose for themselves. The choice of music in the study has adhered to that described in the literature: full of character, slow, repetitive rhythm, predictable dynamics, low tonic register, pleasant harmony with no vocal content.

Although music therapy is considered to be free from side effects, the intervention must be used with caution. A patient can have an intense, emotional response to a specific piece of music. Nurses must therefore be on the alert for this (Chlan 2000). In future studies one should consider using newly composed music in order to avoid emotionally strong responses.

The interviews revealed that the patients had no recollections of the music therapy. However, clinical effect could be shown by the quantitative data collected. It is conceivable that the relaxing effect of music contributed to the lack of recall in those patients. A second interview ought to have been carried out after discharge from hospital in order to make known experiences which the patients did not recall in the first interview in hospital. In the surrounds of their own home, patients can recount their experiences in a more relaxed way. The interview duration was rather short (20–30 minutes) due to the patients showing signs of fatigue, sometimes in the form of delay in answering or at other times actually falling asleep. The leading author waited for the patient to add more information and if not, the interview was terminated. Had the patient been given more time it is possible that more information had been elicited. Letting the patients listen to music during the interview

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may have been another means of prompting memory recall. It may even have been of interest to enquire as to the patients’ music interests; if they listened to music, how often and of which sort. It is possible that the patient is more inclined to remember music therapy if he or she is a habitual listener to music.

A validation problem with qualitative methods may be the researcher’s inability to set aside his own preconceived ideas and produce objective and accurate reports (Polit & Hungler 2001). In order to insure validity and reliability in this material the co-author scrutinised the interview transcripts and categorised them independently before comparing them to the leading author’s findings, and reaching a consensus (Burnard 1991). From the separate sentence sub-units the authors constantly referred back to the interview transcripts to get an overall picture. The number of patients was small; a greater number would be required to guarantee the categorisation.

The findings were similar to those of White (1992) who showed, in a group of patients in ICU, a reduction of heart rate and blood pressure when they listened to relaxing classical music. Patients who have been interviewed after respirator treatment have stated that listening to music helped them to relax and improved their emotional status, irrespective of whether significant differences in physiological values were demonstrated or not (Guzzetta 1989; Chlan 1998).

In the present study it was apparent that the patients remembered little of their time in intensive care. Butler (1995) suggested that most patients in intensive care have recollections of their time on the respirator but they are in general vague. Butler attributed this lack of recall to the medication administered. After the patients have regained consciousness and no longer require intensive care it is important to appreciate that they may have difficulty in remembering. The patients may even be ashamed of not being able to recall accurately and choose therefore to say that they do not remember at all. Memory images can be of “jigsaw puzzle memory” which is a common occurrence (Granberg Axèll 2001). An explanation of memory failure may be that certain patients, at interview could only recall fragments of their

experiences, could not find the right words, or simply were too tired to recount their experiences. The ability to remember can, according to studies, be related to sedation routines or other treatment. Memory can return much later when the patient feels relaxed and secure (Granberg Axèll 2001).

The interviews in this study were carried out only 2–4 days after discharge from ICU. This may not be sufficient time for the patients to consider what they have experienced and they may not be prepared to be confronted with their memories, thoughts and reflections on their situation, past and present. This could explain the patients’ limited recall. Furthermore, the patients’ debilitated condition may have influenced their powers of recollection. Granberg Axèll (2001) suggests that interviews be conducted ideally 6–10 days after discharge from ICU. By this time, patients are no longer considered affected by analgesics, sedatives or other medication administered in intensive care.

One patient in this study said that her door would not open. Whether this is correct is of course difficult to know, but since she was bed-ridden it is not likely she could have got up to try to open the door. She said she had been “totally mixed up” probably meaning that her thoughts were jumbled and that the images she experienced had been unreal. Delusion is a phenomenon described by Granberg Axèll (2001). The patients have difficulty in grasping time and the difference between night and day. It is also difficult for them to feel the passing of time. Time “vanishes.” There may be a connection between lost or deranged perception of time and the interruption of the sleep pattern i.e. the rhythm of normal sleep and wakefulness. The technical equipment can further contribute to anxiety. To be unable to sleep creates vulnerability, fatigue and exhaustion leading to an increased inability to relax and go to sleep; a heightening of inner tension and the negative spiral.

One factor which can reduce anxiety feelings and fear, is close relationship. In this study one patient describes the security of having his family nearby. The patient’s family and friends are considered important in reducing fear and controlling emotions, raising hopes and providing an assurance against anxiety and

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Music therapy—a complementary treatment for mechanically ventilated intensive care patients

confusion (Granberg Axèll 2001). The patient in this study, in describing togetherness with his family also said that he felt secure with the nursing staff who looked after him.

Clinical implications

Patients in the study group wore headphones during the entire measurement period i.e. before, during and after the session. Both blood pressure and heart rate rose significantly after completion of music therapy even with the headphones still in place. From these results it seems reasonable to draw the conclusion that music therapy may have a better relaxing effect than the use of headphones without music. The result motivates a larger study with more patients included.

Had more patients been included, the prognostic value of the results would have increased. It would be interesting to see if music therapy can be an effective complement to pharmacological treatment. In the future, perhaps the dosage of sedatives and thereby their negative effects, could be reduced and combined with a non-pharmacological intervention such as music therapy.

Further research in the subject should include increased quantitative measurements to lend a greater degree of certainty and credibility to the findings. A more comprehensive study is recommended with the inclusion of a greater number of parameters e.g. cortisol and immunoglobulin values. McKinney (1997) found that music stimulated the immune system. This was demonstrated by measuring immunoglobulin A in saliva. A lowering of beta-endorphin levels has also been found in conjunction with music therapy. Myskja and Lindbaek (2000) is of the opinion that music can influence the balance of hormones such as a reduction of ACTH and other stress hormones. Miluk-Kolasa et al. (1994) found that listening to music produced a marked reduction in saliva cortisol in patients subjected to preoperative stress.

The noise level in intensive care units could be an interesting research subject for the future; likewise a study of the effect which a change in the interior environment could have on the patient. It would also be of interest to

carry out a similar study on ICU staff who work in this stressful environment.

Clinical care studies support the use of music to alleviate anxiety and fear (Chlan 1998; Guzzetta 1989; Updike 1990). Music therapy is an intervention that constitutes a part of the holistic approach to nursing the critically ill patient. Relaxing music, carefully chosen, should be offered to all patients undergoing mechanical ventilation in the intensive care unit. Music therapy can produce positive effects in this patient group, for example by promoting relaxation and reducing anxiety by non-pharmacological means. This conclusion is supported by Chlan (1995).

Music therapy is a simple, inexpensive and reliable tool which can be applied with advantage in the nursing of intensive care patients without risking unwanted side-effects.

References

Altman DG 1992 Practical Statistics for Medical Research. Chapman & Hall, London

Amir D 1999 Musical and verbal interventions in music therapy: a qualitative study. Journal of Music Therapy 36(2): 144–175

Bergbom-Engberg I 1989 Patients’ experience of respirator treatment. A retrospective study of the influence of medical and nursing care factors on recall, experience of discomfort and feelings of security or insecurity. Dissertation from the Department of Anaesthesiology, Gothenburg University

Biley F 1992 Using music therapy in hospital settings. Nursing Standard 6: 37–39

Bonny HL 1978 The role of the taped music program in the guided imagery in music (GIM) process. Baltimore ICM press 4: 57–63

Bonny HL 1986 Music and healing. Music Therapy 6(1): 3–12

Burnard P 1991 A method of analysing interview transcripts in qualitative research. Nurse Education Today 11: 461–466

Butler K 1995 Psychological care of the ventilated patient. Journal of Clinical Nursing 4(6): 398–400

Chlan L 1995 Psychophysiologic responses of mechanically ventilated patients to music: a pilot study. American Journal of Critical Care 4(3): 233–238

Chlan L 1998 Effectiveness of a music therapy intervention on relaxation and anxiety for patients receiving ventilatory assistance. Heart and Lung 27(3): 169–176

Chlan L 2000 Music therapy as a nursing intervention for patients supported by mechanical ventilation. AACN Clinical issues 11(1): 128–138

Chlan L, Tracy MF 1999 Music therapy in critical care: indications and guidelines for intervention. Critical Care Nursing 19(3): 35–41

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Fontaine DK 1994 Nonfarmacological management of patient distress during mechanical ventilation. Critical Care Clinics 10(4): 695–708

Granberg Axèll A 2001 The intensive care unit syndrome/delirium, patients’ perspective and clinical signs. Dissertation from the Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Lund University

Guzzetta CE 1989 Effects of relaxation and music therapy on patients in a coronary care unit with presumptive acute myocardial infarction. Heart & Lung 18: 609–616

Henry L 1995 Music therapy: a nursing intervention for the control of pain and anxiety in the ICU: a review of the research literature. Dimensions of Critical Care Nursing 14(6): 295–304

Johnston K, Rohaly-Davis J 1996 An introduction to music therapy: helping the oncology patient in the ICU. Critical care nursing 18(4): 54–60

Ledingham I, Bion J, Newman J, McDonald J, Wallace P 1988 Mortality and morbidity amongst sedated intensive care patients. Resuscitation 16: 69–77

McKinney CH 1997 The effect of selected classical music and spontaneous imagery on plasma beta-endorphin. Journal of Behavioural Medicine 20: 85–99

Miluk-Kolasa B, Ombinski Z, Stupnicki R, Golec L 1994 Effects of music treatment on salivary cortisol in patients exposed to pre-surgical stress. Experimental and Clinical Endocrinology 102: 118–120

Myskja A, Lindbaek M 2000 Hvordan virker musikk på menneskekroppen? [How does music work on the human body?]. Tidskriften Norsk Laegeforening 120(10): 1182–1185

O’Sullivan RJ 1991 A musical road to recovery: music in intensive care. Intensive Care Nursing Sept 7(3): 160–163

Polit D, Hungler B 2001 Nursing Research Principles and Methods, Appraisal and Utilization, 6th ed. Lippincott, Philadelphia

Updike P 1990 Music therapy results for ICU patients. Dimensions of Critical Care Nursing 9(1): 39–45

White JM 1992 Music therapy: an intervention to reduce anxiety in the myocardial infarction patient. Clinical Nurse Specialist 6: 58–63

30 Intensive and Critical Care Nursing (2003) 19, 21–30 © 2003 Elsevier Science Ltd. All rights reserved.

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  • Music therapy-a complementary treatment for mechanically ventilated intensive care patients
    • Introduction
      • Environment and experiences
      • Music therapy
      • Physiological and psychological effects of music therapy
    • Objective
    • Methods
      • Design
      • Context
      • Intervention
      • Patient selection
      • Procedures
      • Analysis of the data
      • Ethical aspects
    • Results
    • Discussion
      • Clinical implications
    • References