Discussion Guide for the Golino Article

Abstract

Between their underlying illness and the intensive care unit (ICU) environment, patients receiving mechanical ventilation (MV) are exposed to numerous stressors. Stress often elicits negative emotional symptoms, such as anxiety—reported by 80% of MV patients—and predisposes patients to posttraumatic stress disorder. Mainstay treatments for managing stress responses among MV patients (antipsychotics, analgesics, and sedatives) have not changed in more than 2 decades. Yet these medications increase the risk of adverse effects (eg, respiratory depression, hemodynamic instability, delirium) that ultimately impede liberation from MV and contribute to long-term disability. Nonpharmacologic interventions are emerging as a promising means of alleviating stress responses among MV patients. For example, live music therapy (LMT) interventions diminish physiological stress responses and reduce pain intensity in MV patients. But these findings were from an isolated study and should be replicated in more rigorous study conditions. Therefore, the authors examined the influence of LMT on physiological stress parameters, pain, and agitation of critically ill adults receiving MV.Once the patient’s legally authorized representative gave consent, participants were randomized into 2 groups: LMT and usual care. Those assigned to the LMT group received a needs assessment from a board-certified music therapist that was used to tailor a 30-minute LMT intervention. Usual care was defined as care that would typically occur during the 30-minute study period. Immediately before and after the study period, critical care nurses would record the patient’s heart rate, respiratory rate, oxygen saturation level, pain intensity, and agitation level. Notably, the investigators stopped study recruitment prematurely owing to a salient change in patient characteristics and research limitations related to the COVID-19 pandemic—with 61 patients randomized to the LMT group and 57 patients to the usual care group. Once preintervention scores were adjusted for, MV patients in the LMT group had significantly lower heart rates and agitation levels than patients in the usual care group. Patients in the LMT group had 6 times higher odds of having less pain than patients in the usual care group. The authors conclude that LMT is a low-risk, cost-effective nonpharmacological treatment that can be used as a supplemental intervention to mitigate pain, anxiety, and agitation in MV patients.Amanda J. Golino, MSN, RN, CCRN, CCNS, PMGT-BC, TCRN, first started her research journey in 2015 as a subinvestigator for her current mentors: Drs Mary Ann Friesen and Theresa M. Davis (coauthors). Around that time, the hospital where Ms Golino worked pilot tested the addition of a board-certified music therapist, Ray Leone. As a critical care nurse specialist certified in pain management, Ms Golino “wanted to explore the benefit of this nonpharmacologic integrative modality, having … observed the powerful impact Ray had when he worked with critically ill patients.” Mr Leone and Ms Golino ultimately partnered to conduct a pilot study examining the feasibility and benefits of using an MT intervention for critically ill adults.1 This initial study, however, excluded MV patients. After completing the pilot study and publishing her team’s findings, Ms Golino planned the present study, which included only MV patients: “I was curious to learn whether this population would respond to MT like the nonvented group [did]…”Although Ms Golino and her team had experience conducting similar research, conducting this work still presented valuable learning opportunities. “An initial challenge