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AIM AND OBJECTIVE To investigate the effectiveness of music interventions on physiological and psychological stress response in intensive care unit (ICU) patients. BACKGROUND ICU patients are exposed to several physiological and psychological stressors during their treatments. Music interventions can be implemented to control these negative effects. DESIGN Systematic review and meta-analysis conducted according to PRISMA Guidelines. METHOD This meta-analysis was conducted per PRISMA guidelines. Seven electronic literature databases, reference lists of similar reviews, grey literature and the Clinical Trials Registry were searched for potential studies up to 30 September 2021. Studies were expected to meet PICOS inclusion criteria. Two reviewers independently assessed the risk of bias of the included studies by using the Cochrane Collaboration tool. Overall, meta-analysis and subgroup analyses (comparator group and music session frequency) were performed using RevMan 5.4. Meta-analysis was conducted when data were available; otherwise, a narrative description was provided. RESULTS Twenty-five articles were included in this review. Music intervention was found to provide reductions in anxiety levels concerning psychological stress. However, it was found that music had an effect only on the systolic blood pressure level concerning the physiological stress and had no effect on the diastolic blood pressure, respiration rate or heart rate. In the subgroup analysis performed against the comparator groups, it was found that music decreased the anxiety level compared to the standard care group but was not effective compared to the noise reduction group. It was found that multiple music sessions reduced the anxiety level better than a single music session. CONCLUSIONS Music interventions involving multiple sessions can be used as a nursing intervention to control the anxiety levels of ICU patients. RELEVANCE TO THE CLINICAL PRACTICE Using music to reduce anxiety and stress levels may reduce the pharmacological need (for sedative or antipsychotic medications) and the risk of associated side effects in ICU patients.