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Puntillo, Kathleen; Arai, Shoshana; Cooper, Bruce; Stotts, Nancy; Francisco, San; Nelson, Judith

doi: 10.1097/
Poster: ABSTRACT Only

Introduction: Thirst is one of the most pervasive, intense, unrecognized, and under-treated symptoms in ICU patients. Thirst intensity (TI) is related to the magnitude, or severity, of the thirst sensation. We conducted a single-blinded, randomized clinical trial testing a non-pharmacologic, nurse-delivered intervention for TI.

Hypothesis: We hypothesized that, compared to usual care, this intervention would relieve TI over time.

Methods: Cognitively clear patients from several ICUs (77 beds) who rated TI > 3 on a 0-10 scale were consented and randomized to usual care (“UC”) or intervention (“I”) groups. All patients rated pre TI. “UC” patients were then observed for 15 minutes by Research Nurse (RN) #1. For “I” patients, RN#1 administered over approximately 15 minutes a theoretically-based “thirst bundle:” 3 oral swab wipes and 3-6 sterile ice cold water sprays 3 times in 15 minutes, with a lip moisturizer at the end. After each session, RN#2, blinded to the procedure, obtained the post TI rating. This session was repeated 2 more times on Day 1 and 3 times on Day 2. We performed a multilevel regression analysis to determine if the decrease over time in TI was greater in “I” versus “UC” patients. We used full maximum likelihood, which allows for missing data on the dependent variable.

Results: Sample characteristics: Average ICU day: 5.2 ± 5.8. The 125 “UC” and 127 “I” patients had no significant difference in mean age: (55.4 vs 54), % male: (56% vs 54%), APACHE II score: (20.2 vs 20.) Patients on mechanical ventilation (MV) were similar: (“UC” 4.8%, “I” 7.1%.) On Days 1 (average 5.2 ± 5.8 days after ICU admission) and 2, “I” patients had a significantly greater decrease in TI than did “UC” patients. Day 1: “UC” mean TI scores: pre = 5.5 (SE = 0.2); post = 4.7(0.2); “I” mean TI scores: pre = 5.7(0.2); post = 3.6(0.2). “I” decreased 1.3 points more than “UC” (p = 0.002). Day 2: “UC” mean TI scores: pre = 4.3 (0.4); post = 4.3(0.4). “I” mean TI scores: pre = 5.5(0.4); post = 2.9(0.4). “I” decreased 2.8 points more than “UC” (p<0.0005).

Conclusions: A simple bundle of thirst relief measures significantly decreased ICU patients’ thirst intensity and should be considered as a practice intervention.

University of California San Francisco

University of California San Francisco School of Nursing

University of California San Francisco

University of California

Mount Sinai School of Medicine

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins