Music for pain relief during bed bathing of mechanically ventilated patients: A pilot study

Abstract

Background: Pain is a universal issue and is of particular concern in mechanically ventilated patients, as they require intensive nursing care and multiple invasive procedures, while being unable to communicate verbally. The aim of this study was to assess the effect of music on pain experienced by mechanically ventilated patients during morning bed bathing.

Methods: Of the 60 mechanically ventilated patients enrolled in this single-center pilot study between March 2013 and October 2015, the first 30 received no music and the next 30 the music intervention, during the morning bed bath. The Behavioral Pain Scale (BPS) score was determined during and at the end of the bath then 30, 60, and 120 minutes after the bath. BPS score changes over time were assessed and the proportions of bath times spent with a BPS score ≥5 and with the maximal BPS score were determined.

Results: At baseline, no patient had pain (defined as a BPS score <5) and the median BPS score was 3 [IQR, 3;3] in both groups (P = 0.43). After bed bath initiation, 88% of patients experienced pain. The maximum BPS value during the bath was lower in the music group (5 [5;6.7] vs. 7 [5;7]). Proportions of total bath time spent with BPS≥5 and with the maximum BPS were significantly lower in the music group than in the control group (2.0 [0.3;4.0] vs. 10 [4.3;18.0]; P < .0001 and 1.5 [0;3.0] vs. 3.5 [2.0;6.0]; P = .005; respectively). Two hours after the end of the bath, the BPS values had returned to baseline in both groups.

Conclusion: In our population, music significantly decreased pain intensity and duration during the morning bed bath in mechanically ventilated patients. These results warrant further assessment in a large multicenter randomized controlled trial.

Trial registration: ClinicalTrials.gov NCT02883959.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Study flow diagram.

Fig 2. Changes in physiological parameters (systolic, diastolic, and mean arterial blood pressure and heart and respiratory rates) in each study group according to time from the beginning of the bed bath (n = 60).

The shaded area indicates the middle 50% of the data and the lower and upper ends of the box the 25th percentile and 75th percentile, respectively. The solid black horizontal line through each shaded box indicates the median value. The circles above the vertical solid black lines are individual outliers. P values are provided above each pair of values. Gray color indicates the control group and blue color the music intervention group. Panel A. Boxplot of systolic arterial blood pressure (mmHg) in the music and control groups. Panel B. Boxplot of diastolic arterial blood pressure (mmHg) in the music and control groups. Panel C. Boxplot of mean arterial blood pressure (mmHg) in the music and control groups. Panel D. Boxplot of heart rate (beat per min) in the music and control groups. Panel E. Boxplot of respiratory rate (beat per min) in the music and control groups.

Fig 3

Boxplot of proportion of total bath time spent with Behavioral Pain Scale (BPS) score ≥5 (Panel A) and with maximal BPS score (Panel B) in the music and control groups (n = 60). The shaded area indicates the middle 50% of the data and the lower and upper ends of the box the 25th percentile and the 75th percentile, respectively. The solid black horizontal line through each shaded box indicates the median value. The circles above the vertical solid black lines are individual outliers. P values are provided above each pair of values. Panel A. Boxplot of total time spent with Behavioral Pain Scale (BPS) score ≥5 in the music and control groups. Panel B. Boxplot of proportion of total bath time spent with maximal Behavioral Pain Scale (BPS) score in the music and control groups.

Fig 4. Analysis in the matched subsample: Changes in physiological parameters (systolic, diastolic, and mean arterial blood pressure and heart and respiratory rates) in each study group according to time from the beginning of the bed bath (n = 22).

The shaded area indicates the middle 50% of the data and the lower and upper ends of the box the 25th percentile and the 75th percentile, respectively. The solid black horizontal line through each shaded box indicates the median value. The circles above the vertical solid black lines are individual outliers. P values are provided above each pair of values. Gray color indicates the matched control group and blue color the matched music intervention group. Panel A. Boxplot of systolic arterial blood pressure (mmHg) in the matched music and control groups. Panel B. Boxplot of diastolic arterial blood pressure (mmHg) in the matched music and control groups. Panel C. Boxplot of mean arterial blood pressure (mmHg) in the matched music and control groups. Panel D. Boxplot of heart rate (beats per min) in the matched music and control groups. Panel E. Boxplot of respiratory rate (beat per min) in the matched music and control groups.

Fig 5

Boxplot of the proportion of total bath time spent with Behavioral Pain Scale (BPS) score ≥5 (Panel A) and with the maximal Behavioral Pain Scale (BPS) score (Panel B) in the matched music and control groups (n = 22). The shaded area indicates the middle 50% of the data and the lower and upper ends of the box the 25th percentile and the 75th percentile, respectively. The solid black horizontal line through each shaded box indicates the median value. The circles above the vertical solid black lines are individual outliers. P values are provided above each pair of values. Panel A. Boxplot of total time spent with Behavioral Pain Scale (BPS) score ≥5 in the matched music and control groups. Panel B. Boxplot of proportion of total bath time spent with the maximum Behavioral Pain Scale (BPS) score in the matched music and control groups.