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

Kathleen Puntillo| Shoshana R. Arai| Bruce A. Cooper| Nancy A. Stotts| Judith E. Nelson
Original
Volume 40, Issue 9 / September , 2014

Pages 1295 - 1302

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.

Keywords

References

  1. 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 81:795–803
    • View reference on PubMed
    • View reference on publisher's website
  2. Greenleaf JE (1992) Problem: thirst, drinking behavior, and involuntary dehydration. Med Sci Sports Exerc 24:645–656
    • View reference on PubMed
    • View reference on publisher's website
  3. 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. So HM, Chan DS (2004) Perception of stressors by patients and nurses of critical care units in Hong Kong. Int J Nurs Stud 41:77–84
    • View reference on PubMed
    • View reference on publisher's website
  5. 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 3:1–8
    • View reference on publisher's website
  6. 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
    • View reference on PubMed
  7. 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 14:166–174
    • View reference on PubMed
    • View reference on publisher's website
  8. 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 29:277–282
    • View reference on PubMed
    • View reference on publisher's website
  9. Nelson JE, Meier DE, Litke A, Natale DA, Siegel RE, Morrison RS (2004) The symptom burden of chronic critical illness. Crit Care Med 32:1527–1534
    • View reference on PubMed
    • View reference on publisher's website
  10. 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 38:2155–2160
    • View reference on PubMed
    • View reference on publisher's website
  11. 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 38:808–818
    • View reference on PubMed
    • View reference on publisher's website
  12. 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):134–146
    • View reference on PubMed
    • View reference on publisher's website
  13. Feider LL, Mitchell P, Bridges E (2010) Oral care practices for orally intubated critically ill adults. Am J Crit Care 9:175–183
    • View reference on publisher's website
  14. Pear S (2007) The role of oral care in the prevention of hospital-acquired pneumonia. Infection Control Today 11(10):1–3
  15. Wiley SB (1969) Why glycerol and lemon juice? Am J Nurs 69:342–344
    • View reference on PubMed
  16. Van Drimmelen J, Rollins HF (1969) Evaluation of a commonly used oral hygiene agent. Nurs Res 8:327–332
    • View reference on publisher's website
  17. Meurman JH, Sorvari R, Pelttari A, Rytomaa I, Franssila S, Kroon L (1996) Hospital mouth-cleaning aids may cause dental erosion. Spec Care Dentist 16:247–250
    • View reference on PubMed
    • View reference on publisher's website
  18. Miller M, Kearney N (2001) Oral care for patients with cancer: a review of the literature. Cancer Nurs 24:241–254
    • View reference on PubMed
    • View reference on publisher's website
  19. 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. Porth CM, Erickson M (1992) Physiology of thirst and drinking: implication for nursing practice. Heart Lung 21:273–282
    • View reference on PubMed
  21. Eccles R (2000) Role of cold receptors and menthol in thirst, the drive to breathe and arousal. Appetite 34:29–35
    • View reference on PubMed
    • View reference on publisher's website
  22. 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. 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–R881
    • View reference on PubMed
  24. Brunstrom JM (2002) Effects of mouth dryness on drinking behavior and beverage acceptability. Physiol Behav 76:423–429
    • View reference on PubMed
    • View reference on publisher's website
  25. Brunstrom JM, Macrae AW (1997) Effects of temperature and volume on measures of mouth dryness, thirst and stomach fullness in males and females. Appetite 29:31–42
    • View reference on PubMed
    • View reference on publisher's website
  26. Berry AM, Davidson PM (2006) Beyond comfort: oral hygiene as a critical nursing activity in the intensive care unit. Intensive Crit Care Nurs 22:318–328
    • View reference on PubMed
    • View reference on publisher's website
  27. Schafer K, Braun HA, Isenberg C (1986) Effect of menthol on cold receptor activity. Analysis of receptor processes. J Gen Physiol 88:757–776
    • View reference on PubMed
    • View reference on publisher's website
  28. Deaux E (1973) Thirst satiation and the temperature of ingested water. Science 181:1166–1167
    • View reference on PubMed
    • View reference on publisher's website
  29. Szlyk PC, Sils IV, Francesconi RP, Hubbard RW, Armstrong LE (1989) Effects of water temperature and flavoring on voluntary dehydration in men. Physiol Behav 45:639–647
    • View reference on PubMed
    • View reference on publisher's website
  30. 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 148:295–309
    • View reference on PubMed
    • View reference on publisher's website
  31. 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 166:1338–1344
    • View reference on PubMed
    • View reference on publisher's website
  32. Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126
    • View reference on PubMed
    • View reference on publisher's website
  33. 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 45:93–101
    • View reference on PubMed
    • View reference on publisher's website
  34. Hox J (2002) Multilevel analysis: techniques and applications. Lawrence Erlbaum Associates, Mahwah
  35. Singer JD, Willett JB (2003) Applied longitudinal data analysis: modeling change and event occurrence. Oxford University Press, New York
  36. Todd KH (1996) Clinical versus statistical significance in the assessment of pain relief. Ann Emer Med 27:439–441
    • View reference on publisher's website
  37. 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 61:277–284
    • View reference on PubMed
    • View reference on publisher's website
  38. Hammond F (1995) Involving families in care within the intensive care environment: a descriptive survey. Intensive Crit Care Nurs 11:256–264
    • View reference on PubMed
    • View reference on publisher's website

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