Influence of Music on Cortisol Levels in Mechanically Ventilated Critically Ill Patients: A Systematic Review

ABSTRACT Background Music has been proposed as a simple, non‐invasive intervention to modulate stress responses in patients undergoing invasive mechanical ventilation (IMV). Its potential impact on cortisol levels represents a promising approach to mitigating physiological stress in intensive care. Aim To examine the effectiveness of music interventions in reducing cortisol levels and, consequently, modulating the stress response in mechanically ventilated patients in intensive care units (ICUs). Study Design A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD42023409196). Five electronic databases were searched without date restrictions. Eligible studies were randomised controlled trials (RCTs) assessing music interventions in adult patients receiving IMV, with serum cortisol as the primary outcome. Risk of bias was assessed using the Cochrane RoB 2 tool. Owing to substantial heterogeneity, findings were synthesised narratively. Results Five RCTs ( n = 208) met the inclusion criteria. Three reported significant reductions in cortisol following music interventions, while two found no differences. Variability in music type, intervention duration, sedation status and measurement timing contributed to inconsistent results. Risk of bias was low in two studies, whereas three were rated as raising some concerns. Conclusions Current evidence on the effect of music on cortisol in mechanically ventilated patients is limited and inconsistent. Findings remain contradictory, preventing firm conclusions about efficacy. Future multicentre trials with standardised protocols and rigorous control of confounders are required. Relevance to Clinical Practice This review highlights a major gap in evidence regarding the biological impact of music in IMV patients. Results from five small, heterogeneous RCTs are inconclusive, and some of them are limited by methodological concerns. Thus, current evidence is insufficient to support changes in clinical practice. While music remains a low‐risk intervention of interest, its actual effect on physiological stress has yet to be demonstrated. Large‐scale, high‐quality studies are needed before clinical recommendations can be made. Systematic Review Registration: PROSPERO ID: CRD42023409196.