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A1825 - Effects of Music on Delirium, and Inflammatory Biomarkers in Mechanically Ventilated and Post-Operative Patients: A Systematic Review of the Literature
Author Block: S. H. Khan1, M. Kitsis1, T. Emmett1, S. Wang2, D. Allen3, D. Golovyan4, B. A. Khan5; 1Pulmonary, Indiana Univ School of Medicine, Indianapolis, IN, United States, 2Indiana University, Indianapolis, IN, United States, 3Indiana University School of Medicine, Indianapolis, IN, United States, 4Indiana University School of Medicine, Fishers, IN, United States, 5Indiana Univ School of Medicine, Indianapolis, IN, United States.
Rationale:
Benefits of music listening in reducing pain, anxiety, blood pressure, and heart rate for both hospitalized and non-hospitalized patients have been previously described in the literature. This effect is hypothesized to be secondary to entrainment of the autonomic nervous system, reduction in sympathetic drive, and dampening of the inflammatory state. Music may therefore be beneficial in delirium, in which a hyper-inflammatory state is also implicated.
Objective:
We conducted a systematic review of the literature to describe effects of music on: 1) delirium; 2) inflammatory biomarkers in mechanically ventilated patients; and 3) inflammatory biomarkers in post-operative patients.
Methods:
A comprehensive search of the literature was performed by a medical librarian in Ovid MEDLINE, PubMed, Embase, the Cochrane Library, CINAHL, PsycINFO, Scopus, ClinicalTrials.gov, and Google Scholar. All searches were performed in March 2017, and all databases were searched from inception. Database-specific subject headings and keyword variants for each of the two major concepts - music therapy and delirium - were identified and combined. Results were limited to the adult population and to the English language. Two reviewers independently evaluated studies for eligibility, critically appraised the included studies, and extracted the data. The methodological quality of each trial was assessed using the Jadad Score.
Results:
2,018 references were identified, of which 1,570 records were screened. Fifteen studies were selected for inclusion. Trials were conducted in 10 countries, one was a multi-hospital study. Study sizes ranged from 10 to 205 participants, with mean age range 47 to 73 years. Eight of the studies included participants on mechanical ventilation. The music session was under 60 minutes in six studies. All except 4 trials delivered music via headphones. Music tracks were classical, relaxing, instrumental, and nature sounds. Eleven studies measured cortisol as an inflammatory biomarker, and in 6 studies, there was a significant decrease in cortisol levels. Only one study investigated the benefit of music on delirium, finding no benefit. Slow tempo music (60 to 80 beats per minute) reduced serum cortisol, increased serum oxytocin, while relaxing music decreased salivary amylase post-operatively. Two studies demonstrated no change in salivary cortisol and urinary free cortisol. While IgA, prolactin, norepinephrine, and glucose levels did not change, NK lymphocytes, ACTH, MET-enkephalin, epinephrine, growth hormone, DHEA, interleukin-6 levels significantly increased.
Conclusion:
Music intervention decreased cortisol levels, but the trials were heterogenous in their participant mix. Further research on music effects on inflammatory biomarkers and delirium is needed.