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Abstract
BackgroundDefining the association between excessive noise in intensive care units, sleep disturbance and morbidity, including delirium, is confounded by the difficulty of implementing successful strategies to reduce patient’s exposure to noise. Active noise control devices may prove to be useful adjuncts but there is currently little to quantify their ability to reduce noise in this complex environment.MethodsSound meters were embedded in the auditory meatus of three polystyrene model heads with no headphones (control), with headphones alone and with headphones using active noise control and placed in patient bays in a cardiac ICU. Ten days of recording sound levels at a frequency of 1 Hz were performed, and the noise levels in each group were compared using repeated measures MANOVA and subsequent pairwise testing.ResultsMultivariate testing demonstrated that there is a significant difference in the mean noise exposure levels between the three groups (p < 0.001). Subsequent pairwise testing between the three groups shows that the reduction in noise is greatest with headphones and active noise control. The mean reduction in noise exposure between the control and this group over 24 h is 6.8 (0.66) dB. The use of active noise control was also associated with a reduction in the exposure to high-intensity sound events over the course of the day.ConclusionsThe use of active noise cancellation, as delivered by noise-cancelling headphones, is associated with a significant reduction in noise exposure in our model of noise exposure in a cardiac ICU. This is the first study to look at the potential effectiveness of active noise control in adult patients in an intensive care environment and shows that active noise control is a candidate technology to reduce noise exposure levels the patients experience during stays on intensive care.
Highlights
Defining the association between excessive noise in intensive care units, sleep disturbance and morbidity, including delirium, is confounded by the difficulty of implementing successful strategies to reduce patient’s exposure to noise
Excessive noise in the intensive care unit (ICU) environment is thought to be a significant factor in sleep disturbance and that this in turn can result in increased morbidity [1]
Model validation The noise detected within the model was amplified compared with the sound level meter alone (p < 0.0001, mean difference 1.9 dB 95% CI 1.855–1.937)
Summary
Defining the association between excessive noise in intensive care units, sleep disturbance and morbidity, including delirium, is confounded by the difficulty of implementing successful strategies to reduce patient’s exposure to noise. The World Health Organization (WHO) noise guidelines state noise should not exceed 35 dB during the day with maximum sound level peaks below 40 dB at night in a hospital to ensure a good sleep [8] the clinical benefit of this approach, or even of a more moderate degree of noise reduction, remains largely untested and without a proven method to reduce noise exposure. Apart from this lower limit of noise exposure, it has been claimed that single-noise events above a sound exposure level of 60 dB are associated with an increased frequency of awakenings [9]
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