Ask an answerable question (PICO)：
Delirium is an acute cognitive change accompanied by psychosomatic and behavioral characteristics. It may be combined with visual hallucinations, auditory hallucinations, sleep disturbances, and emotional confusion. Patients may suffer from prolonged hospitalization, increased risk of death, and increased nursing costs due to delirium. Conventional delirium prevention interventions, such as a sense of orientation, preventing infection, and day and night light control, cannot effectively prevent delirium events. Studies have found that listening to music could prevent the events of delirium in intensive care units (ICU). In clinical, it is difficult to implement listening music to prevent the occurrence of delirium in ICU adult patients, because of different medical and surgical attributes, disease severity, and other factors, the degree of implementation and effectiveness were inconsistent. Nurses do not want patients to experience delirium. Thus, we ask a clinical question "Can music listening prevent the events of delirium in ICU patients?" We hope to provide clinical treatment guidance under evidence-based review.
The Method and Analysis of Literature Review：
In this review, we followed the first three steps of the evidence-based nursing 5As process: asking, acquire, appraisal and propose a PICO question "Can music intervention prevent the evenets of delirium in ICU patients?" We systematically searched Airity Library, PubMed/MEDLINE, Cochrane Library, CINAHL database under setting the MeSH term and synonyms related to ‘’intensive care unit adult patient’’, ‘’Music’’ and ‘’Delirium’’ in English and Chinese databases. We included 107 papers with search strategies of OR and AND by Boolean logic and restricted to non- experimental research design. After excluding papers with duplicate articles and without explored the effect of reduce intervention for delirium, we included 3 randomized controlled trials for further evaluation.
Critical Appraisal：
In our review, we used the 2020 CASP randomized controlled trial standard checklist as the tool for critical appraisal. All 3 studies examined the effectiveness of music interventions in reducing the incidence of delirium. As the result of critical appraisal of the quality, 1 RCT is moderate risk of bias on the assignment of participants to interventions randomized; 1 RCT is high-risk and 1 RCT is moderate risk of bias on non-blinding and no intention-to-treat analysis; 1 RCT is moderate risk of bias on the benefits of the experimental intervention outweigh the harms and costs; and 3 RCT whether the results be applied to your local population/in your context and the value of interventions was better than other existing interventions are moderate risk, and other bias are low risk. The three studies are level 1c and 1d evidence in JBI 2014 evidence level for evidence-based medicine (2014). Johnson et al. (2018) found that the occurrence rate of delirium did not decrease significantly in both the group that listened to music and did not listen to music. Khan et al. (2020) found that patients who received slow-paced music had lower rates and severity of delirium compared to those who received personalized music or had no intervention. Furthermore, the RCT study by Esfahanian et al. (2022) showed that patients admitted to the intensive care unit within 48 hours post-surgery experienced a significant improvement in delirium occurrence when they listened to relaxing music.
Results, Conclusions and Recommendations：
As the result of 3 studies, listening to music in ICU patients could prevent the events and reduce the severity of delirium, but the type of music is mainly slow-paced or relaxing. The effects of listening to music among preventing the delirium events were mixed, because of the effect of listening to music were affected by the ward environment, such as telephone noise, family visiting, patients’ dislike of music types, and interruption of medication or treatment. The continuous supervision, tracking and adjustment of music types by professionals would also affect the effectiveness of listening to music. Thus, we encourage routine listen to music to reduce the incidence of delirium in ICU is recommended, but the type of music and listening time need to be selected. We suggest that establishing an inter-professional team with neurology, psychiatry, and consensus on music listening interventions to prevent the delirium events in ICU adult patients, improve the quality of critical care and reduce the burden of care for clinical staffs and achieve the integrity of whole-person care.
