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Erschienen in: Intensive Care Medicine 9/2014

01.09.2014 | Original

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

verfasst von: Kathleen Puntillo, Shoshana R. Arai, Bruce A. Cooper, Nancy A. Stotts, Judith E. Nelson

Erschienen in: Intensive Care Medicine | Ausgabe 9/2014

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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 undertreated symptoms in ICU patients, but for which data-based interventions are lacking.

Methods

This was a single-blinded randomized clinical trial in three ICUs in a tertiary medical center in urban California. A total of 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 six sessions per patient were conducted across 2 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.
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Literatur
1.
Zurück zum Zitat McKinley MJ, Cairns MJ, Denton DA, Egan G, Mathai ML, Uschakov A, Wade JD, Weisinger RS, Oldfield BJ (2004) Physiological and pathophysiological influences on thirst. Physiol Behav 81:795–803PubMedCrossRef McKinley MJ, Cairns MJ, Denton DA, Egan G, Mathai ML, Uschakov A, Wade JD, Weisinger RS, Oldfield BJ (2004) Physiological and pathophysiological influences on thirst. Physiol Behav 81:795–803PubMedCrossRef
2.
Zurück zum Zitat Greenleaf JE (1992) Problem: thirst, drinking behavior, and involuntary dehydration. Med Sci Sports Exerc 24:645–656PubMedCrossRef Greenleaf JE (1992) Problem: thirst, drinking behavior, and involuntary dehydration. Med Sci Sports Exerc 24:645–656PubMedCrossRef
3.
Zurück zum Zitat Sreenbny LM (1996) Xerostomia: diagnosis, management and clinical complications. In: Edgar WM, O’Mullane DM (eds) Saliva and oral health. British Dental Association, London, pp 43–66 Sreenbny LM (1996) Xerostomia: diagnosis, management and clinical complications. In: Edgar WM, O’Mullane DM (eds) Saliva and oral health. British Dental Association, London, pp 43–66
4.
Zurück zum Zitat So HM, Chan DS (2004) Perception of stressors by patients and nurses of critical care units in Hong Kong. Int J Nurs Stud 41:77–84PubMedCrossRef So HM, Chan DS (2004) Perception of stressors by patients and nurses of critical care units in Hong Kong. Int J Nurs Stud 41:77–84PubMedCrossRef
5.
Zurück zum Zitat Lombardo V, Vinatier I, Baillot ML, Franja V, Bourgeon-Ghittori I, Dray S, Jeune S, Mossadegh C, Reignier J, Souweine B, Roch A (2013) How caregivers view patient comfort and what they do to improve it: a French survey. Ann Intensive Care 3:1–8CrossRef Lombardo V, Vinatier I, Baillot ML, Franja V, Bourgeon-Ghittori I, Dray S, Jeune S, Mossadegh C, Reignier J, Souweine B, Roch A (2013) How caregivers view patient comfort and what they do to improve it: a French survey. Ann Intensive Care 3:1–8CrossRef
6.
Zurück zum Zitat Rose L, Nonoyama M, Rezaie S, Fraser I (2013) Psychological wellbeing, health related quality of life and memories of intensive care and a specialised weaning centre reported by survivors of prolonged mechanical ventilation. Intensive Crit Care Nurs. doi:10.1016/j.iccn.2013.11.002 PubMed Rose L, Nonoyama M, Rezaie S, Fraser I (2013) Psychological wellbeing, health related quality of life and memories of intensive care and a specialised weaning centre reported by survivors of prolonged mechanical ventilation. Intensive Crit Care Nurs. doi:10.​1016/​j.​iccn.​2013.​11.​002 PubMed
7.
Zurück zum Zitat Persenius MW, Hall-Lord ML, Wilde-Larsson B (2009) Grasping the nutritional situation: a grounded theory study of patients’ experiences in intensive care. Nurs Crit Care 14:166–174PubMedCrossRef Persenius MW, Hall-Lord ML, Wilde-Larsson B (2009) Grasping the nutritional situation: a grounded theory study of patients’ experiences in intensive care. Nurs Crit Care 14:166–174PubMedCrossRef
8.
Zurück zum Zitat Nelson JE, Meier DE, Oei EJ, Nierman DM, Senzel RS, Manfredi PL, Davis SM, Morrison RS (2001) Self-reported symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med 29:277–282PubMedCrossRef Nelson JE, Meier DE, Oei EJ, Nierman DM, Senzel RS, Manfredi PL, Davis SM, Morrison RS (2001) Self-reported symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med 29:277–282PubMedCrossRef
9.
Zurück zum Zitat Nelson JE, Meier DE, Litke A, Natale DA, Siegel RE, Morrison RS (2004) The symptom burden of chronic critical illness. Crit Care Med 32:1527–1534PubMedCrossRef Nelson JE, Meier DE, Litke A, Natale DA, Siegel RE, Morrison RS (2004) The symptom burden of chronic critical illness. Crit Care Med 32:1527–1534PubMedCrossRef
10.
Zurück zum Zitat Puntillo KA, Arai S, Cohen NH, Gropper MA, Neuhaus J, Paul SM, Miaskowski C (2010) Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med 38:2155–2160PubMedCentralPubMedCrossRef Puntillo KA, Arai S, Cohen NH, Gropper MA, Neuhaus J, Paul SM, Miaskowski C (2010) Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med 38:2155–2160PubMedCentralPubMedCrossRef
11.
Zurück zum Zitat Nelson JE, Puntillo KA, Pronovost PJ, Walker AS, McAdam JL, Ilaoa D, Penrod J (2010) In their own words: patients and families define high-quality palliative care in the intensive care unit. Crit Care Med 38:808–818PubMedCentralPubMedCrossRef Nelson JE, Puntillo KA, Pronovost PJ, Walker AS, McAdam JL, Ilaoa D, Penrod J (2010) In their own words: patients and families define high-quality palliative care in the intensive care unit. Crit Care Med 38:808–818PubMedCentralPubMedCrossRef
12.
Zurück zum Zitat Prendergast V, Jakobsson U, Renvert S, Hallberg IR (2012) Effects of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients: results of a randomized controlled trial. J Neurosci Nurs 44(3):134–146PubMedCrossRef Prendergast V, Jakobsson U, Renvert S, Hallberg IR (2012) Effects of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients: results of a randomized controlled trial. J Neurosci Nurs 44(3):134–146PubMedCrossRef
13.
Zurück zum Zitat Feider LL, Mitchell P, Bridges E (2010) Oral care practices for orally intubated critically ill adults. Am J Crit Care 9:175–183CrossRef Feider LL, Mitchell P, Bridges E (2010) Oral care practices for orally intubated critically ill adults. Am J Crit Care 9:175–183CrossRef
14.
Zurück zum Zitat Pear S (2007) The role of oral care in the prevention of hospital-acquired pneumonia. Infection Control Today 11(10):1–3 Pear S (2007) The role of oral care in the prevention of hospital-acquired pneumonia. Infection Control Today 11(10):1–3
15.
Zurück zum Zitat Wiley SB (1969) Why glycerol and lemon juice? Am J Nurs 69:342–344PubMed Wiley SB (1969) Why glycerol and lemon juice? Am J Nurs 69:342–344PubMed
16.
Zurück zum Zitat Van Drimmelen J, Rollins HF (1969) Evaluation of a commonly used oral hygiene agent. Nurs Res 8:327–332CrossRef Van Drimmelen J, Rollins HF (1969) Evaluation of a commonly used oral hygiene agent. Nurs Res 8:327–332CrossRef
17.
Zurück zum Zitat Meurman JH, Sorvari R, Pelttari A, Rytomaa I, Franssila S, Kroon L (1996) Hospital mouth-cleaning aids may cause dental erosion. Spec Care Dentist 16:247–250PubMedCrossRef Meurman JH, Sorvari R, Pelttari A, Rytomaa I, Franssila S, Kroon L (1996) Hospital mouth-cleaning aids may cause dental erosion. Spec Care Dentist 16:247–250PubMedCrossRef
18.
Zurück zum Zitat Miller M, Kearney N (2001) Oral care for patients with cancer: a review of the literature. Cancer Nurs 24:241–254PubMedCrossRef Miller M, Kearney N (2001) Oral care for patients with cancer: a review of the literature. Cancer Nurs 24:241–254PubMedCrossRef
19.
Zurück zum Zitat Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R (2011) Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev 12:CD008934 Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R (2011) Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev 12:CD008934
20.
Zurück zum Zitat Porth CM, Erickson M (1992) Physiology of thirst and drinking: implication for nursing practice. Heart Lung 21:273–282PubMed Porth CM, Erickson M (1992) Physiology of thirst and drinking: implication for nursing practice. Heart Lung 21:273–282PubMed
21.
Zurück zum Zitat Eccles R (2000) Role of cold receptors and menthol in thirst, the drive to breathe and arousal. Appetite 34:29–35PubMedCrossRef Eccles R (2000) Role of cold receptors and menthol in thirst, the drive to breathe and arousal. Appetite 34:29–35PubMedCrossRef
22.
Zurück zum Zitat Tomioko T, Inomata K, Nakaoka M, Futakami J, Yamada Y, Watanabe M, Takao S, Yokoyama Y (2006) Support for heart failure patients with thirst induced by fluid restriction: usefulness of a spray with sufficient sialogogic effect. J Kushiro City Gen Hosp 18:29–32 Tomioko T, Inomata K, Nakaoka M, Futakami J, Yamada Y, Watanabe M, Takao S, Yokoyama Y (2006) Support for heart failure patients with thirst induced by fluid restriction: usefulness of a spray with sufficient sialogogic effect. J Kushiro City Gen Hosp 18:29–32
23.
Zurück zum Zitat Phillips PA, Bretherton M, Risvanis J, Casley D, Johnston C, Gray L (1993) Effects of drinking on thirst and vasopressin in dehydrated elderly men. Am J Physiol 264:R877–R881PubMed Phillips PA, Bretherton M, Risvanis J, Casley D, Johnston C, Gray L (1993) Effects of drinking on thirst and vasopressin in dehydrated elderly men. Am J Physiol 264:R877–R881PubMed
24.
Zurück zum Zitat Brunstrom JM (2002) Effects of mouth dryness on drinking behavior and beverage acceptability. Physiol Behav 76:423–429PubMedCrossRef Brunstrom JM (2002) Effects of mouth dryness on drinking behavior and beverage acceptability. Physiol Behav 76:423–429PubMedCrossRef
25.
Zurück zum Zitat Brunstrom JM, Macrae AW (1997) Effects of temperature and volume on measures of mouth dryness, thirst and stomach fullness in males and females. Appetite 29:31–42PubMedCrossRef Brunstrom JM, Macrae AW (1997) Effects of temperature and volume on measures of mouth dryness, thirst and stomach fullness in males and females. Appetite 29:31–42PubMedCrossRef
26.
Zurück zum Zitat Berry AM, Davidson PM (2006) Beyond comfort: oral hygiene as a critical nursing activity in the intensive care unit. Intensive Crit Care Nurs 22:318–328PubMedCrossRef Berry AM, Davidson PM (2006) Beyond comfort: oral hygiene as a critical nursing activity in the intensive care unit. Intensive Crit Care Nurs 22:318–328PubMedCrossRef
27.
Zurück zum Zitat Schafer K, Braun HA, Isenberg C (1986) Effect of menthol on cold receptor activity. Analysis of receptor processes. J Gen Physiol 88:757–776PubMedCrossRef Schafer K, Braun HA, Isenberg C (1986) Effect of menthol on cold receptor activity. Analysis of receptor processes. J Gen Physiol 88:757–776PubMedCrossRef
28.
Zurück zum Zitat Deaux E (1973) Thirst satiation and the temperature of ingested water. Science 181:1166–1167PubMedCrossRef Deaux E (1973) Thirst satiation and the temperature of ingested water. Science 181:1166–1167PubMedCrossRef
29.
Zurück zum Zitat Szlyk PC, Sils IV, Francesconi RP, Hubbard RW, Armstrong LE (1989) Effects of water temperature and flavoring on voluntary dehydration in men. Physiol Behav 45:639–647PubMedCrossRef Szlyk PC, Sils IV, Francesconi RP, Hubbard RW, Armstrong LE (1989) Effects of water temperature and flavoring on voluntary dehydration in men. Physiol Behav 45:639–647PubMedCrossRef
30.
Zurück zum Zitat Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P (2008) Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 148:295–309PubMedCrossRef Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P (2008) Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 148:295–309PubMedCrossRef
31.
Zurück zum Zitat Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166:1338–1344PubMedCrossRef Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166:1338–1344PubMedCrossRef
32.
Zurück zum Zitat Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126PubMedCrossRef Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126PubMedCrossRef
33.
Zurück zum Zitat Damiano AM, Bergner M, Draper EA, Knaus WA, Wagner DP (1992) Reliability of a measure of severity of illness: acute physiology of chronic health evaluation–II. J Clin Epidemiol 45:93–101PubMedCrossRef Damiano AM, Bergner M, Draper EA, Knaus WA, Wagner DP (1992) Reliability of a measure of severity of illness: acute physiology of chronic health evaluation–II. J Clin Epidemiol 45:93–101PubMedCrossRef
34.
Zurück zum Zitat Hox J (2002) Multilevel analysis: techniques and applications. Lawrence Erlbaum Associates, Mahwah Hox J (2002) Multilevel analysis: techniques and applications. Lawrence Erlbaum Associates, Mahwah
35.
Zurück zum Zitat Singer JD, Willett JB (2003) Applied longitudinal data analysis: modeling change and event occurrence. Oxford University Press, New YorkCrossRef Singer JD, Willett JB (2003) Applied longitudinal data analysis: modeling change and event occurrence. Oxford University Press, New YorkCrossRef
36.
Zurück zum Zitat Todd KH (1996) Clinical versus statistical significance in the assessment of pain relief. Ann Emer Med 27:439–441CrossRef Todd KH (1996) Clinical versus statistical significance in the assessment of pain relief. Ann Emer Med 27:439–441CrossRef
37.
Zurück zum Zitat Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS (1995) When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 61:277–284PubMedCrossRef Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS (1995) When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 61:277–284PubMedCrossRef
38.
Zurück zum Zitat Hammond F (1995) Involving families in care within the intensive care environment: a descriptive survey. Intensive Crit Care Nurs 11:256–264PubMedCrossRef Hammond F (1995) Involving families in care within the intensive care environment: a descriptive survey. Intensive Crit Care Nurs 11:256–264PubMedCrossRef
Metadaten
Titel
A randomized clinical trial of an intervention to relieve thirst and dry mouth in intensive care unit patients
verfasst von
Kathleen Puntillo
Shoshana R. Arai
Bruce A. Cooper
Nancy A. Stotts
Judith E. Nelson
Publikationsdatum
01.09.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 9/2014
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-014-3339-z

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