Effect of a Personalized Music Intervention on Stress Reduction in the Paediatric Intensive Care Unit: a Pilot Study

1. Problem definition Admission into a pediatric intensive care unit (PICU) can be a highly stressful experience, with up to 62% of children demonstrating posttraumatic stress symptoms following a PICU admission. The PICU is for many critically ill children a toxic rather than a healing environment. Children needing invasive and/or painful procedures during their PICU stay are particularly at increased risk of these sequelae, with most requiring titration of pain and sedation medications to facilitate care. Caregiver and provider concern for the unclear impact of pain and sedative medications on the developing brain and increased health risks (e.g., physiologic instability, ICU acquired weakness, withdrawal and dependence, delirium, sleep-wake cycle disturbances due to patient-ventilator asynchrony, and long-term health outcomes) are energizing interest into trials investigating ancillary approaches to comfort. It is therefore crucial to explore and validate nonpharmacologic interventions toward child comfort in the PICU to alleviate some of these hazards.

One potential approach to decreasing stress and improving comfort is live-performed music therapy. Music and medicine have a long history of being entwined, going as far back as the Greek philosopher Pythagoras prescribing music to promote health. There is an increasing interest in studying music's impact on health outcomes. Among mechanically ventilated adults, music therapy decreased physiologic and psychologic responses to stress (e.g., vital signs, self-reported anxiety) and sedative use.

It is important to differentiate between "music therapy" and the general provision of music, sometimes referred to as "music medicine". Both music therapy and music medicine have been found to decrease pain, increase physical, cognitive, and speech recovery, and improve quality of life. Although music therapy is provided by a credentialed therapist who uses music-based interventions for individualized goal attainment, music medicine is typically prerecorded music provided by a medical. The use of live-performed music may be more advantageous than recorded music with a critically ill population because a music therapist is trained to manipulate musical elements to facilitate the desired outcomes and can respond immediately and adequately in response to the patient's reactions. Recorded music plays continuously regardless of circumstances.

Although music has been used for years in healthcare, the exact mechanisms by which it can reduce pain/anxiety are not well understood. It is known that music can modify emotional state by releasing anti-stress hormones and by activating the limbic system of the brain. According to the gate control theory of pain, distracters such as music can block certain neural pathways and diminish the amount of perceived pain. A systematic review on the use of music in mechanically ventilated adults found that music was associated with lower levels of anxiety, lower sedation requirements, improved vital signs suggesting relaxation, and improved sleep. Whether these observations can also be made in mechanically ventilated, critically ill children remains unclear as there is no literature on the efficacy of utilizing music therapy in this patient population.

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