Music for Sedation in Critically ill Children

• Author / Creator

  Garcia Guerra, Gonzalo

• Stress induced by pain and anxiety is common in pediatric intensive care unit (PICU) patients and can impede the delivery of critical care to children as well as their recovery. Sedation and analgesia in PICU is usually achieved through the use of various analgesics and sedatives, often narcotics and benzodiazepines. Excessive use of these drugs can put patients at risk for hemodynamic and respiratory instability, prolonged mechanical ventilation, withdrawal symptoms, nosocomial infection, delirium and critical illness polyneuromyopathy. These negative consequences lead to prolonged PICU stay and increase health care costs. Non-pharmacologic measures for analgesia and anxiolysis are those interventions that do not involve drugs, and thus may reduce the total medication requirement and their side effects. The use of non-pharmacologic interventions has been recommended by sedation guidelines for critically ill patients. Despite this, there is little evidence on which interventions should be implemented or how. The use of non-pharmacologic measures in PICU, including music, has been inadequately studied.
  Available evidence has demonstrated an association between the use of music and reduced need for analgesics and anesthetics as well as lower anxiety in patients. Studies conducted in critically ill adults suggest that music reduces anxiety, sedation requirements, and may help to promote sleep in the ICU. In pediatrics, music has been studied mainly in awake children undergoing invasive or surgical procedures and has shown beneficial effects by reducing pain, stress and anxiety. However, information about the use of music in the pediatric critical care setting is scarce. Several neonatal studies have investigated the effects of music on vital signs, pain, growth and sleep, but the majority of these studies involve stable premature infants who are not sedated or mechanically ventilated.
  The use of music in critically ill children has only been explored in the recent years. Only a few small studies have used music in the PICU environment, but these studies have not clearly addressed the relationship between the use of music and sedation and analgesia requirements. Several questions about the feasibility and effectiveness of a music intervention that attempts to reduce the use of sedation and analgesia drugs in critically ill children during the acute phase of their illness remain unanswered. To answer some of these questions, this thesis includes four research studies that contribute to the current knowledge about the use of music in PICU. The study in Chapter 2 sets the stage and addresses current practice around sedation/analgesia in Canadian PICUs. Moreover, it establishes that pediatric intensivists are interested to formally investigate the use of music in PICU and suggest the most appropriate outcome for research on this topic. Chapter 3 presents evidence for the association between sound levels and sedation requirements in critically ill children. This information was needed in order to plan a study involving music and headphones, as noise is a potential confounder. In order to synthesize the available evidence on the efficacy of music on sedation, analgesia and delirium in critically ill patients, we conducted a systematic review that is presented in Chapter 4. This review revealed limited evidence to support or refute the use of music to reduce sedation/analgesia requirements, or to prevent delirium in critically ill adults, and no evidence in pediatric and neonatal critically ill patients. Hence, the first 3 studies of this thesis demonstrate: interest from the pediatric critical care community to address the issue of whether music can be used to reduce sedation/analgesia requirements in PICU; that noise is associated with sedation/analgesia requirements and needs to be treated as a confounder; and that there is no available evidence to support or refute the use of music to reduce sedation/analgesia requirements, or to prevent delirium, in in pediatric critically ill patients. This information led to the pilot study presented in Chapter 5. In this pilot randomized controlled trial we demonstrate that a music intervention in critically ill children is feasible, and we collected the necessary information to plan a larger trial.
  In summary, the four research projects presented in this thesis address important knowledge gaps around the use of music as a non-pharmacologic intervention to reduce the use of sedation/analgesia drugs in critically ill children.
  

• Subjects / Keywords

  • critical care
  • sedation
  • music
  • paediatric

• Graduation date

  Spring 2020

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-5hd5-yg84

• License

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