Case Study Review: IMV & Long Term COVID-19 Complications
By Anna Barker, MusicWorx Intern
At the beginning of my internship in January 2021, I couldn’t help but notice the volume of patients in the ICU. With many staff members covered from head to toe in PPE, I stood and thought, “How many other interns are experiencing this?” As I eased into my second month, I began to notice another interesting trend. The palliative care team had a handful of patients who were actively receiving extracorporeal membrane oxygenation (ECMO) and receiving invasive mechanical ventilation (IMV). Multiple patients were diagnosed with a respiratory complication “due to COVID-19.” These patients no longer required isolation, but sustained severe enough complications to warrant staying in the hospital both on ECMO and IMV. In other words, these individuals were some of the worst case scenarios of COVID-19.
I discovered they were not alone. In January 2021, at least 7061 patients in the United States were admitted to the hospital and received IMV due to COVID-19. To put it in perspective, these numbers only represent about 20% of annual U.S. inpatient admissions. Additionally, over 50% of patients hospitalized due to COVID-19 had a co-occurring respiratory illness with pneumonia being the most common. The long-term complications and extended number of days on IMV suggest another side of COVID-19 that nobody deserves to experience. But what if music therapy could provide support for these individuals? With a fire in my heart, I sought out an answer and a case study was born.
Music Therapy & IMV Patients
Did you know practice guidelines instruct clinicians to first intervene with non-pharmacological interventions when managing symptoms such as stress and anxiety with IMV patients (Heiderscheit, A., et al., 2014)? These guidelines encourage non-pharmacological interventions as they do not have the negative side effects of sedative exposure such as delirium and weakness. Yet, I’ve heard time and time again from music therapists about how challenging it is to get a music therapy program into an adult hospital setting, especially in the ICU. Besides funding, I’m sure part of this is due to the sparsity of music therapy research regarding IMV patients.
Fortunately, the existing literature suggests the positive effect of music therapy both with these patients and overall in the ICU. Heiderscheit (n.d.) found music listening can help enhance and promote a healing environment. The patient is able to focus on the music and shift their focus away from the noisy and overstimulating environment of the ICU. As a result, the music fosters a sense of relaxation and calm, providing a sense of comfort when listening to soothing and familiar music. The best part of all of this is that music interventions are a form of non-pharmacological interventions and do not have the intense negative side effects that sedatives and analgesics do. Let’s not forget to add that research has shown patient-directed music interventions can be a cost effective strategy, as they reduce anxiety and sedative exposure in mechanically ventilated patients (Chlan, L.L., et al., 2018).
Case Study Reflection
For privacy reasons, I am omitting session-specific information . However, I can confirm my case study highlighted the positive impact music therapy can have with patients on IMV and located in the ICU. Almost all patients experienced improved vitals (e.g. heart rate, blood pressure, respiratory rate, oxygen intake) by the end of the music therapy session (average length of 33 minutes) and each expressed appreciation for music therapy services. The patients smiled upon seeing me at the beginning of the session and communicated feeling “relaxed” in some way by the end. Additionally, nurses independently expressed seeing improved vitals and thanked me for bringing music therapy to the patient. Some even inquired about participating with their patients in sessions!
I also want to mention how this case study showcases the adaptability music therapists possess in the ICU to assess, evaluate and adjust their approach to best support the needs of their IMV patients in the moment. I listened to and validated the anxieties and frustrations these patients expressed. Even if they could not communicate verbally, I was able to understand their communication through other ways such as through facial expressions, body language, lip reading, writing on a whiteboard, songwriting, lyric discussion, active music making, and receptive music listening. As a result, patients had a voice during a time their voice was taken from them. They had a space to have a say in their treatment plan and feel heard. Listening to music on headphones or on a CD player is a wonderful option for patients as a self-care strategy, but the value of a music therapist should not be under emphasized.
Conclusively, more research needs to be done looking at music therapy within the ICU and with mechanically ventilated patients. Not only can music therapy be cost effective for hospitals, but it also has the potential to impact the patient’s satisfaction with their care and improve their quality of life. Should long-term COVID-19 complications begin emerging in other respiratory diseases such as pneumonia and COPD in 10 years from now, hospitals can proactively prepare by hiring music therapists to provide non-pharmacological options to patients and assist with staff burnout. I am incredibly grateful for this opportunity and for these patients who forever touched my soul with their tenacity.
Heiderscheit, A. (n.d.) Non-pharmacological management of symptoms during mechanical ventilation and chronic obstructive pulmonary disease in critical care: Patient directed music listening.
Breanna Hetland, Ruth Lindquist, Linda L. Chlan (2015). The influence of music during mechanical ventilation and weaning from mechanical ventilation: A review. Heart & Lung, 44 (5), 416-425. https://doi.org/10.1016/j.hrtlng.2015.06.010.
Chlan, L.L.; Heiderscheit, A.; Skaar, D.J.; & Neidecker, M.V. (2018). Economic evaluation of a patient-directed music intervention for ICU patients receiving mechanical ventilatory support. Critical care medicine.
Chlan, L.L.; Weinert, C. R.l Heiderscheit, A.; Tracy, M.F.; Skaar, D.J.; Guttormson, J.L.; & Savik, K (2013). Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical-ventilatory support: a randomized clinical trial. JAMA.
Heiderscheit, A., Breckenridge, S.J., Chlan, L.L., Savik, K. (2014). Music preferences of mechanically ventilated patients. Music & Medicine, 6(2), 1-10
Hodgson, et al. (2012) Long-term quality of life in patients with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation for refractory hypoxaemia. Critical Care, 16, R202, https://doi.org/10.1186/cc11811
King, et al (2020). Outcomes of mechanically ventilated patients with COVID-19 associated respiratory failure. PLOS ONE. 15(11) https://doi.org/10.1371/journal.pone.0242651
SeyedAlinaghi, S., Afsahi, A. M., Mohsseni, Pour, M., Behnezhad, F., Salehi, M. A., Barzegary, A., Mirzapour, P., Mehraeen, E., & Dadras, O. (2021). Late Complications of COVID-19; a Systematic Review of Current Evidence. Archives of academic emergency medicine, 9(1), e14. https://doi.org/10.22037/aaem.v9i1.1058
Tracy, M. F., & Chlan, L. (2011). Nonpharmacological Interventions to Manage Common Symptoms in Patients Receiving Mechanical Ventilation. Critical Care Nurse, 31(3), 19–29.