Puntillo Kathleen, Arai Shoshana R, Cooper Bruce A, Stotts Nancy A, Nelson Judith E
Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA,
Intensive Care Med. 2014 Sep;40(9):1295-302. doi: 10.1007/s00134-014-3339-z. Epub 2014 Jun 4.
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.
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.
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.
This simple, inexpensive thirst bundle significantly decreased ICU patients' thirst and dry mouth and can be considered a practice intervention for patients experiencing thirst.
测试一种针对口渴强度、口渴困扰和口干的综合干预措施，这些症状是重症监护病房（ICU）患者中最普遍、最强烈、最困扰人、未被认识到且治疗不足的症状，但目前缺乏基于数据的干预措施。
这是一项在加利福尼亚州城市一家三级医疗中心的三个ICU进行的单盲随机临床试验。共有252名认知功能完好、在0至10数字评分量表（NRS）上报告口渴强度（TI）和/或口渴困扰（TD）得分≥3的患者被随机分为干预组或常规护理组。一名研究团队护士（RTN#1）获取患者术前的TI和TD得分以及口干报告。然后，她对干预组实施了一套口渴综合干预措施：口腔擦拭巾、无菌冰冷水喷雾和润唇膏，或观察常规护理组的患者。对分组不知情的RTN#2获取术后的TI和TD得分。每位患者在2天内接受多达6次治疗。
多水平线性回归分析确定，干预组从术前到术后TI和TD得分的平均降幅（分别为2.3和1.8个NRS点）显著大于常规护理组（分别为0.6和0.4个点）（p<0.05）。在第1天，常规护理组每次额外治疗时报告口干的可能性是干预组的1.9倍。
这种简单、低成本的口渴综合干预措施显著减轻了ICU患者的口渴和口干症状，可被视为对口渴患者的一种实践干预措施。
