The effects of hypnosis and music intervention on comfort and anxiety during weaning from mechanical ventilation: A pilot study

Objective

To compare the efficacy of hypnosis or music intervention in alleviating distressing symptoms in critically ill patients facing extended or challenging liberation from mechanical ventilation (MV).

Study design

Single-center, prospective interventional trial.

Methods

Critically ill patients experiencing extended or challenging MV weaning were assigned to either a hypnosis group or a music intervention group where participants chose calming music from a provided list for a 30-min session. Inclusion criteria encompassed periods during pressure support ventilation, spontaneous breathing trials with tracheostomy or immediately after MV weaning. Hemodynamic, respiratory and electroencephalogram (EEG) parameters were collected before, during and after the intervention. Cortisol blood levels were also assessed. The primary outcome was the patient comfort and anxiety levels assessed using a Visual Analog Scale (VAS).

Results

Twenty-nine patients out of 75 eligible patients were enrolled in the study (15 in the hypnosis group and 14 in the music intervention group). The comfort level increased from 4 [2–6] to 8 [7–9] (p < 0.01) and from 5 [4–6] to 7 [5–8] (p < 0.01) for the hypnosis and music intervention groups, respectively (both p < 0.01). The anxiety level decreased from 5 [5–7] to 3 [2–5] (p < 0.01) and from 6 [5–8] to 4 [3–6] (p < 0.01) for the hypnosis and music intervention groups, respectively (both p < 0.01). No differences were observed between the study groups. Respiratory rate decreased after hypnosis from 28 [25–37] to 24 [23–35] (p < 0.01), but was unchanged with music intervention. Heart rate showed a significant decline from baseline values after both interventions, but reverted to initial values subsequently. Mean arterial pressure exhibited an elevation from 94 (86–110) to 99 (80–108) mmHg after hypnosis (p = 0.01), while a reduction from 87 (75–101) to 82 (74–88) mmHg after music intervention (p = 0.01). Cortisol concentrations significantly decreased from 249 [175–291] to 207 [145–242] μg/L after music intervention (p = 0.02), but was unchanged after hypnosis (both p = 0.04). Both interventions led to a significant decrease in slow delta power and an increase in theta and alpha power on EEG, indicative of a hypnosis-like state.

Conclusions

In this pilot study, a single session of either hypnosis or music intervention was demonstrated to effectively reduce anxiety and enhance comfort, in critically ill patients facing extended or challenging MV weaning.