Nagamine T. Neurobiological rhythms in critical care: A commentary on intensive care unit music therapy efficacy and mechanism. World J Crit Care Med 2026; 15(1): 116487 [DOI: 10.5492/wjccm.v15.i1.116487]
Corresponding Author of This Article
Takahiko Nagamine, MD, PhD, Professor, Psychiatric Internal Medicine, Sunlight Brain Research Center, 4-13-18 Jiyugaoka, Hofu 7470066, Yamaguchi, Japan. anagamine@yahoo.co.jp
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Emergency Medicine
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Letter to the Editor
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Mar 9, 2026 (publication date) through Mar 3, 2026
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World Journal of Critical Care Medicine
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2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Nagamine T. Neurobiological rhythms in critical care: A commentary on intensive care unit music therapy efficacy and mechanism. World J Crit Care Med 2026; 15(1): 116487 [DOI: 10.5492/wjccm.v15.i1.116487]
World J Crit Care Med. Mar 9, 2026; 15(1): 116487 Published online Mar 9, 2026. doi: 10.5492/wjccm.v15.i1.116487
Neurobiological rhythms in critical care: A commentary on intensive care unit music therapy efficacy and mechanism
Takahiko Nagamine
Takahiko Nagamine, Psychiatric Internal Medicine, Sunlight Brain Research Center, Hofu 7470066, Yamaguchi, Japan
Author contributions: Nagamine T conducted conceptualization, investigation, writing.
Conflict-of-interest statement: All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Corresponding author: Takahiko Nagamine, MD, PhD, Professor, Psychiatric Internal Medicine, Sunlight Brain Research Center, 4-13-18 Jiyugaoka, Hofu 7470066, Yamaguchi, Japan. anagamine@yahoo.co.jp
Received: November 13, 2025 Revised: December 5, 2025 Accepted: January 7, 2026 Published online: March 9, 2026 Processing time: 108 Days and 3.2 Hours
Abstract
This is a commentary on the randomized controlled trial by Mukhtar et al, which reported findings from a single, 30-minute music therapy session administered prior to extubation in mechanically ventilated intensive care unit (ICU) patients. The study found significant acute improvements in psychological distress and physiological stability, alongside an extraordinary, unexpected reduction in ICU length of stay and ICU mortality. These dramatic hard outcomes suggest a mechanism beyond distraction, requiring sustained modulation of the prefrontal cortex-limbic circuit and the substantial upregulation of neuroplasticity markers, specifically brain-derived neurotrophic factor (BDNF). Critically, the molecular changes required for structural reorganization and clinical benefits like reduced mortality necessitate repeated, sustained stimulus, a condition that sharply contrasts with the study's brief protocol. This presents a major mechanistic conundrum. Future research must therefore employ multisession, placebo-controlled, multicenter trials designed to measure objective, sustained neurobiological changes (e.g., serum BDNF, heart rate variability) to definitively link music therapy to reduced morbidity and mortality in critical care.
Core Tip: The single 30-minute music therapy session achieved remarkable results, including reduced patient anxiety, pain, and, crucially, lower intensive care unit (ICU) mortality (7.4% vs 19.1%) and a shorter ICU length of stay (4.97 days vs 5.70 days). To justify these powerful, long-term findings, the intervention must engage fundamental neurobiological pathways. Since structural brain changes and the upregulation of factors like brain-derived neurotrophic factor require sustained effort, the study's brief, one-time protocol and unblinded design introduce a major mechanistic conundrum. Future, rigorous trials with repeated sessions and credible sham controls are essential to prove that music's neurobiological power, and not just a strong attention effect, drives recovery in critically ill patients.
