Sedatives are a double-edged sword in the intensive care unit. Critically ill patients on ventilators often need them to cope with the pain and stress. But the more of these medications a patient takes in the ICU, the more likely they are to suffer memory loss, delusions, and post-traumatic stress disorder after being released.
A new study suggests that reducing patients’ need for sedation can be as simple as helping them listen to music they like. Researchers at Ohio State and Marquette universities and the University of Minnesota randomly assigned ventilated patients to groups allowed to select their own music and listen at will, or that received typical care. The 126 in the music group used one-third less medication, had substantially lower anxiety levels, and left the ICU sooner than patients who received typical care.
BOTTOM LINE: The calming influence of music penetrates even the intensive care unit, enabling patients to use fewer sedatives.
CAUTIONS: The study did not include the most heavily sedated patients, so it’s unclear whether they would benefit from music therapy. Also, patients were followed for an average of only five days.
WHERE TO FIND IT: Journal of the American Medical Association, online May 20.
Doubts raised about aggressive prostate cancer treatment
Once someone knows a tumor is growing inside them, it’s hard to resist the urge to get rid of it immediately and by any means. But a study from the University of California, Los Angeles finds that men over 65 who have multiple other serious health problems when diagnosed with low- to moderate-risk prostate cancer may be better off monitoring their cancer over time than immediately getting rid of the tumor through surgery or radiation.
Over a 14-year period starting in the mid-1990s, the study showed older, sicker men were less likely to benefit from aggressive treatment than younger, healthier men. With each additional health problem — diabetes, lung disease, heart disease — the less likely a man was to reap life-extending benefits of aggressive treatment, especially if he was over 65, according to the study of 3,183 men. Aggressive prostate cancer treatment can lead to erectile dysfunction, urinary incontinence, and bowel problems — side effects that can’t be justified if the treatment doesn’t extend life, the study concluded. Since many prostate cancers are slow-growing in early stages and the disease is often not fatal, men with less dangerous cancers and a life expectancy limited by other conditions are not likely to see enough benefit from aggressive treatment, the study said.
BOTTOM LINE: Aggressive care is not always the best care for prostate cancer, particularly for late-in-life, slow-growing cancers.
CAUTIONS: Predicting life span is impossible, so no individual can know whether he will live long enough for the benefits of aggressive prostate cancer treatment to outweigh the risks.
WHERE TO FIND IT: Annals of Internal Medicine, online May 21.