Music Therapy During Basic Daily Care in Critically Ill Children: A Randomized Crossover Clinical Trial

Abstract

To assess whether music therapy is effective to reduce pain during daily personal hygiene care (DPHC), a procedure performed in all patients in a pediatric intensive care unit. Fifty critically ill children were enrolled in a crossover controlled clinical trial with random ordering of the intervention, i.e., passive music therapy, and standard conditions, and blind assessment of pain on film recordings. Primary outcome was variation of the Face Legs Activity Cry Consolability (FLACC) score (range 0 to 10) comparing before and during DPHC. Secondary outcomes were changes in heart rate, respiratory rate, and mean arterial blood pressure, and administration of analgesic or sedative drugs during DPHC. Mixed-effects linear model analysis was used to assess effect size (95% CI). Median (Q25-Q75) age and weight of the patients were 3.5 (1.0, 7.6) years and 15.0 (10.0, 26.8) kg. Consecutive DPHC were assessed the 3rd (2, 5) and 4th days (3, 7) of hospitalization. In standard conditions, FLACC score was 0.0 (0.0, 3.0) at baseline and 3.0 (1.0, 5.5) during DPHC. With music therapy, these values were, respectively, 0.0 (0.0, 1.0) and 2.0 (0.5, 4.0). Rates of FLACC scores >4 during DPHC, which indicates severe pain, were 42% in standard conditions and 17% with music therapy (p=0.013). Mixed-effects model analysis found smaller increases in FLACC scores (-0.54 [-1.08 to -0.01]; p= 0.04) and heart rate (-9; [-14.53; -3.4]; p=0.001) with music therapy. Music therapy is effective to improve analgesia in critically ill children exposed to DPHC.