A randomized clinical trial of an intervention to relieve thirst and dry mouth in intensive care unit patients

Abstract

Purpose To test an intervention bundle for thirst intensity, thirst distress, and dry mouth, which are among the most pervasive, intense, distressful, unrecognized, and under-treated symptoms in ICU patients, but for which data-based interventions are lacking. Methods Single-blinded, randomized clinical trial in three ICUs in a tertiary medical center in urban California. 252 cognitively intact patients reporting thirst intensity (TI) and/or thirst distress (TD) scores ≥ 3 on 0–10 numeric rating scales (NRS) were randomized to Intervention or Usual Care groups. A Research Team Nurse (RTN#1) obtained patients’ pre-procedure TI and TD scores and reports of dry mouth. She then administered a thirst bundle to the Intervention group: oral swab wipes, sterile ice cold water sprays, and a lip moisturizer, or observed patients in the Usual Care group. RTN#2, blinded to group assignment, obtained post-procedure TI and TD scores. Up to 6 sessions per patient were conducted across two days. Results Multilevel linear regression determined that the average decreases in TI and TD scores from pre-procedure to post-procedure were significantly greater in the Intervention group (2.3 and 1.8 NRS points, respectively) versus the Usual Care group (0.6 and 0.4 points, respectively) (p < 0.05). The Usual Care group was 1.9 times more likely than the Intervention group to report dry mouth for each additional session on Day 1. Conclusion This simple, inexpensive thirst bundle significantly decreased ICU patients’ thirst and dry mouth and can be considered a practice intervention for patients experiencing thirst. Clinical trial registered with www.clinicalTrials.gov (NCT01015755).

Evaluation of stressors in intensive care units

“…It should be known that some of these factors can be changed or reduced. Puntillo et al (17) reported that some stress factors in the ICU are subjective and can be modified. They stated that thirst, which was ranked 1st among stress factors in the ICU, can be reduced with simple and inexpensive methods such as placing wet gauze on the lips and using cold water sprays.…”

<b>Perspectiva do anestesiologista em relação à sede no pós-operatório imediato/ Anesthesiologist’s perspective regarding thirst in the immediate postoperative period<b>

“…A temperatura fria conferida pelo gelo estimula receptores orofaríngeos, denominados Transient Receptor Potential Melastatin 8 (TRPM8), presentes tanto na pele quanto na cavidade oral. Esses receptores são sensíveis a baixas temperaturas e a substâncias mentoladas e derivadas do eucalipto (13,20) , capazes de produzir uma agradável sensação de prazer e conforto, levando à saciedade com uma ingestão de menor volume em comparação com a água gelada, diminuindo ainda mais os riscos para o paciente (3) . Esses avanços no manejo da sede perioperatória podem significar uma diminuição desse desconforto para o paciente em recuperação anestésica, desde que adotados na prática clínica.…”

“…Dentre as complicações que podem acometer o paciente no POI, a sede apresenta alta prevalência (75%) (2) e interfere de forma prejudicial na recuperação pós-anestésica. Relatos de pacientes indicam que a sede causa grande distresse e, consequentemente, acarreta sentimentos negativos, como ansiedade e irritabilidade, com alusões a sentimentos de desespero e até pensamentos de morte (3) . Ainda que, no POI, a sede tenha alta prevalência e intensidade e represente distresse, paradoxalmente ela permanece subidentificada e submensurada, e as medidas de alívio na prática clínica não estão padronizadas (1,5) .…”

Research in Review: Driving Critical Care Practice Change

“…Puntillo et al 69 completed an RCT of an intervention to decrease thirst intensity and distress.This study used standardized 1 to 10 scales to assess thirst intensity ("How intense is your thirst? "; 0 = no thirst to 10 = worst possible thirst) and thirst distress ("How distressing [or bothersome] is your thirst?…”