1 Effects of patient-initiated music listening on anxiety in mechanically ventilated ICU patients Linda Chlan, PhD, RN Annie Heiderscheit, PhD, MT-BC, FAMI, LMFT Craig Weinert, MD, MPH Debra Skaar, PharmD Mary Fran Tracy, PhD, RN, CCNS, FAAN University of Minnesota Medical Center, Fairview Kay Savik, MS, Biostatistician University of Minnesota CANS 2012
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1 Effects of patient-initiated music listening on anxiety in mechanically ventilated ICU patients Linda Chlan, PhD, RN Annie Heiderscheit, PhD, MT-BC,
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Effects of patient-initiated music listening on anxiety in mechanically ventilated ICU patients
Linda Chlan, PhD, RNAnnie Heiderscheit, PhD, MT-BC, FAMI, LMFT
Craig Weinert, MD, MPH Debra Skaar, PharmD
Mary Fran Tracy, PhD, RN, CCNS, FAANUniversity of Minnesota Medical Center, Fairview
•Approximately 1 million patients receive mechanical ventilatory support yearly in the U.S.
•55,000 adults admitted daily to ICUs in the U.S.
•Commonly used ICU supportive modality
–34% require ventilatory support for > 48 hours; increasing
•ICUs are inherently stressful for patients and family
•Distress from noise, lack of sleep, social isolation, frustration
Patient Responses to Mechanical Ventilatory Support
• Physiological Stress
Stress of critical illness or infection + Delivery of mechanical breaths
– Critical illness or injury
– Lung injury
– Ventilator associated pneumonia
• Psychological stress• Anxiety: state; heightened arousal, tension, inability to
concentrate
• Fear
• Feel miserable
• Inability to speak; cannot convey needs, feelings, etc.
Anxiety Ratings in Mechanically Ventilated
Patients • Previous work limited to cross-sectional ratings
• State Anxiety Inventory (score range 20-80)
• < 5 days 48.6 + 12.0
• 6-21 days 50.2 + 12.5
• 22+ days 54.2 +11.9
• Chronic/long-term 45.8 +14.5
Chlan L. Description of anxiety levels by individual differences and clinical factor in patients receiving mechanical ventilatory support. Heart Lung 2003; 32:275-282.
Patient Symptom Reports
• 10-item checklist of physical and psychological symptoms (pain, tired, short of breath, restless, anxious, sad, hungry, scared, thirsty, confused)
• Presence (yes/no), intensity (mild, moderate, severe), distress (not very distressing, moderate, very distressing)
• 34% mechanically ventilated in two ICUs
• Anxiety, thirsty, tired reported by 50-75% of assessments
• No difference in intensity or distress if MV, except anxiety
• Dyspnea most distressing; inter-related with anxiety
Puntillo KA, Shoshana A, Cohen N, Gropper M. et al. Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med 2010; 38:2155-2160.