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Musical interventions for comfort Care in Critically ill Children: A systematic review
Chanapai Chaiyakulsil1,2, Bhawida Kusolmanomai3, Marut Chantra4
1Division of Pediatric Critical Care, Department of Pediatrics, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Khlong Nueng, Pathumthani, Thailand.
Insights
Musical interventions show promise for reducing pain and increasing comfort in critically ill children. However, current evidence for sedation, analgesia, and pediatric delirium in the pediatric intensive care unit (PICU) is limited and of low quality.
Area of Science:
- Pediatric critical care medicine
- Music therapy research
- Evidence-based practice in pediatrics
Background:
- Limited evidence exists for musical interventions in the pediatric intensive care unit (PICU).
- Systematic review needed to evaluate music's role in sedation, analgesia, and delirium for critically ill children.
Purpose of the Study:
- To systematically review current literature on musical interventions for sedation, analgesia, and delirium in critically ill children.
- To assess the quality of evidence for music's efficacy in pediatric intensive care.
Main Methods:
- Comprehensive literature search across major databases (MEDLINE, PubMed, Google Scholar, EMBASE).
- Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Independent study screening, risk of bias assessment, and GRADE methodology for evidence quality evaluation.
Main Results:
- Seven studies (RCTs, pre-posttest) were analyzed, yielding low overall evidence quality due to bias and heterogeneity.
- Musical intervention demonstrated positive effects on heart rate (5 studies) and comfort (4 studies), and reduced procedural pain (2 studies).
- No significant improvement in delirium scores was noted in a single pilot study.
Conclusions:
- Musical intervention presents a potential non-pharmacologic approach for sedation and analgesia in pediatric intensive care.
- Further rigorous research is essential to confirm efficacy and explore effects on pediatric delirium.
Background:
Evidence supporting the use of musical intervention in the PICU is still limited. This systematic review aims to examine the current literature on musical interventions for sedation, analgesia, and delirium in critically ill children.
Methods:
A literature search was conducted using MEDLINE, PUBMED, Google Scholar, and EMBASE from inception until December 31, 2024, using relevant medical subject headings and specific search terms. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Strategy was followed for article selection. Two reviewers independently screened studies for eligibility. Risk of bias was assessed, and the quality of evidence was evaluated using the GRADE methodology.
Results:
Seven studies were included in the final analysis (1 randomized crossover trial, 3 randomized controlled trials, and 3 pretest-posttest studies). Due to the risk of bias, heterogeneity, and small sample sizes, the overall quality of evidence was rated as low. The review found that musical intervention led to a decline in heart rate in 5 studies, reduced procedural pain in 2 studies, and increased comfort in 4 studies. No improvement in delirium scores was observed in one single-center pilot study.
Conclusions:
Although evidence is limited, musical intervention shows promise as a non-pharmacologic option for sedation and analgesia in critically ill children in the PICU. Further research is needed to explore its effects on pediatric delirium.
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