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Abstract

Introduction: Thirst is a common and distressing symptom for ICU patients, yet under-recognized and undertreated by clinicians. Thirst distress (TD) is the emotional response engendered by this symptom. We conducted a single-blinded, randomized clinical trial testing a non-pharmacologic, nurse-delivered intervention for TD. Hypothesis: We hypothesized that, compared to usual care, this intervention would relieve TD over time. Methods: Cognitively clear patients from several ICUs (77 beds) who rated TI > 3 on 0-10 scale were consented and randomized to usual care (“UC”) or intervention (“I”) groups. All patients rated pre TD. Then “UC” patients were observed for 15 minutes by Research Nurse (RN) #1. For “I” patients, RN#1 administered 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 TD score. This session was repeated 2 more times on Day 1 and 3 times on Day 2. Mean session duration: 15.6 ± 2.7 minutes.We performed a multilevel regression analysis to determine if the decrease over time in TD 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 20.5) 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 TD than did UC patients. Day 1: “UC” mean TD scores: pre = 4.2 (SE = 0.3); post = 3.6 (0.3); “I” mean TD scores: pre = 4.9 (0.3); post = 3.2 (0.3).”I” decreased 1.12 points more than “UC” (p = 0.012). Day 2: “UC” mean TD scores: pre = 3.3 (0.4); post = 3.4(0.4). “I” mean TD scores: pre = 4.5(0.4); post = 2.5(0.4). “I” decreased 2.6 points more than “UC” (p = 0.001). Conclusions: A simple bundle of thirst relief measures significantly decreased ICU patients’ thirst distress and should be considered as a practice intervention.