To Relieve the Patient's Thirst, Refresh the Mouth First: A Pilot Study Using Mini Mint Ice Cubes in Severely Dehydrated Patients

Effects of cold spray on thirst, frequency of oral care, and pain of general surgery intensive care unit patients

This study aims to investigate the effects of intraoral cold water spray on thirst, frequency of oral care and postoperative period pain at surgical incision site in patients having abdominal surgery. The study was carried out as a randomized controlled trial, registered under Clinical Trial Number: NCT05940818. The study involved 110 participants, divided equally into two groups (n = 55): the experimental group and the control group. Data were collected using patient information form, NRS, Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS) and Visual Analog Scale (VAS). The severity of thirst at 1st, 8th, 16th h of post-operative period (p < 0.01) and the frequency of oral care application at 16th h were statistically significantly decreased in the experimental group when compared to the control group (p < 0.01).There wasn't statistically significant difference between the patients in the experimental and control groups in terms of pain at surgical incision site (p > 0.05). The patient's thirst and need for frequent oral care in the postoperative period were reduced by the application of a cold water spray. In patients undergoing abdominal surgery, the use of cold water spray application may be recommended to reduce thirst and the need for frequency of oral care application.

Origins of thirstiness sensation and current food solutions

The sensation of thirstiness is the desire to drink water. In certain situations, the ingestion of liquid water can be restricted. As a result, thirstiness is not relieved, resulting in an uncomfortable and distressing situation. The present review describes thirstiness and hydration, the food products and beverages that cause thirstiness, and the beverages and food products currently available to quench thirstiness in individuals with restricted access to liquid ingestion. It also discusses how to measure the effectiveness of calming thirstiness. To diminish thirstiness distress, different alternatives to liquids are proposed. Individuals with swallowing disorders are given thickened water, individuals with restricted water ingestion are given ice cubes or ice popsicles of different flavors, and sportspeople are given energy gels. However, current beverage solutions seem not to relieve thirst fully, although some stimuli like iced water, flavors (especially lemon and mint), or acids seem to work better than plain stimuli and could be added to existing products. Therefore, there is still a need to incorporate these strategies into beverage and food formulations and to test their effectiveness.

A Novel Approach to Managing Thirst and Dry Mouth in Palliative Care: A Prospective Randomized Cross-Over Trial

CONTEXT

Thirst and xerostomia are significant and highly distressing symptoms experienced by patients receiving palliative and end-of-life care.

OBJECTIVES

Determine a reduction of thirst intensity and perceptions of dry mouth on a numerical scale following both the experimental intervention (mini mint ice cubes) and control (plain ice chips).

METHODS

Cross-over Randomized Controlled Trial (RCT) to assess the effectiveness of novel intervention in the treatment of dry mouth and the sensation of thirst in palliative care patients.

RESULTS

Patients rated the severity of their symptoms of dry mouth and thirst using a numeric rating scale (NRS). On commencing the study and preintervention, all patients suffered severe dry mouth and thirst (≥5/10). Mint and plain ice cubes produced improvement of symptoms immediately after interventions. Results from dry mouth ratings show, a decrease of 1.6 points for plain ice cubes (P < 0.0001), on average, ratings for mint ice cubes decreased 3.7 (P < 0.0001). For the sensation of thirst, the plain ice cube intervention group rating decreased 1.7 points (P < 0.006), ratings for mint ice cubes decreased 3.4 points (P < 0.0001). The average decrease in dry mouth and thirst intensity scores from preintervention to postintervention were significantly greater for mint ice cubes (P < 0.05) and 86.6% of patients preferred mint ice cubes.

CONCLUSION

This trial found that while usual mouth care and the intervention were both able to reduce the intensity of dry mouth and the sensation of thirst, the mint intervention had a greater response.

Relieving Perception of Thirst and Xerostomia in Patients with Palliative and End-of-life Care Needs: A Rapid Review

CONTEXT

Thirst and dry mouth are interlinked symptoms that frequently cause significant distress for patients with life-limiting conditions.

OBJECTIVES

The objective of this rapid review was to identify and synthesize effective interventions that relieve perceptions of thirst and dry mouth of patients with palliative care and end-of-life care needs.

METHODS

Eligible studies were undertaken in clinical settings, with patients experiencing thirst-related distress and/or dry mouth. This review of peer-reviewed literature was conducted following aspects of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. The main outcomes of interest were: 1) efficacy of thirst and dry mouth interventions for patient, and 2) patient, caregiver, and staff acceptability and satisfaction of the interventions. Scientific journal articles were retrieved through searches in electronic databases of MEDLINE (Ovid), CINAHL (EBSCO), and AgeLine (EBSCO).

RESULTS

Eleven studies were included for analysis and synthesis of the results. Most studies either focused on a dry mouth intervention or reported dry mouth outcomes within a broader thirst intervention (n = 9/11 studies). Standard oral care was the common intervention type (n = 5/11). All but one dry mouth intervention reported statistical improvement in outcomes of interest. All studies that reported on thirst were conducted in an Intensive Care Unit (ICU) setting (n = 4/4). No studies specifically addressed thirst in patients in specialist palliative care settings.

CONCLUSION

Evidence from this review suggests that thirst interventions established within the ICU setting may prove effective for treatment of terminally ill patients receiving specialist palliative care.

Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross-over randomized controlled trial E-CHOISIR (Electronic-CHOIce of a System for Intensive care Relaxation)

Purpose

To assess the impact of different electronic relaxation devices on common stressful patient symptoms experienced in intensive care unit (ICU).

Methods

Sixty critically ill patients were enrolled in four relaxation sessions using a randomized cross-over design: standard relaxation (TV/radio), music therapy (MUSIC-CARE©), and two virtual reality systems using either real motion pictures (DEEPSEN©) or synthetic motion pictures (HEALTHY-MIND©). The goal was to determine which device was the best to reduce overall patient discomfort intensity (0–10 Numeric Rating Scale (NRS); primary endpoint). Secondary endpoints were specific stressful symptoms (pain, anxiety, dyspnea, thirst, and lack of rest feeling) and stress response measured by Analgesia/Nociception Index (ANI). Multivariate mixed-effect analysis was used, taking into account patient characteristics and multiple measurements.

Results

Fifty patients followed the full research protocol, and ten patients did at least one research planned session of relaxation. HEALTHY-MIND© was associated with a significant decrease in overall discomfort, the primary endpoint (median NRS = 4[2–6] vs. 2[0–5]; p = 0.01, mixed-effect model), accompanied by a significant decrease in stress response (increase in ANI, secondary endpoint; p < 0.01). Regarding other secondary endpoints, each of the two virtual reality systems was associated with a decrease in anxiety (p < 0.01), while HEALTHY-MIND© was associated also with a decrease in pain (p = 0.001) and DEEPSEN© with a decrease in lack of rest (p = 0.01). Three incidents (claustrophobia/dyspnea/agitation) were reported among 109 virtual reality sessions. Cybersickness was rare (NRS = 0[0–0]).

Conclusion

Electronic relaxation therapy is a promising, safe, and effective non-pharmacological solution that can be used to improve overall discomfort in alert and non-delirious ICU patients. Its effectiveness depends on technical characteristics (virtual reality using a synthetic imagined world versus a real world or music therapy alone without virtual reality), as well as the type of symptoms.

Electronic relaxation therapies are effective supportive care tools for improving stressful symptoms in ICU patients.

Effectiveness depends on the type of symptom and the characteristics of the devices.

Overall discomfort and adrenergic stress response are more significantly improved by virtual reality using a synthetic imagined world than using a real world or music therapy alone.

[High flow oxygen via nasal cannula: Palliative care and ethical considerations]

High flow oxygen via nasal cannula (HFO₂NC) has become the first-line reference symptomatic treatment for hypoxemic acute respiratory failure. This non-invasive technique can be addressed, as palliative therapeutic care, to frail patients near end-of-life with a do-not-intubate order. A distinction will be made between those with an imminent and inevitable fatal outcome (pallitative end-of-life management) and those with hope for transient clinical remission (meliorative management). This review focuses on the expected physiological benefits and technical benefits/risks incurred by HFO₂NC use in this population. Its main purpose is to highlight the ethical principles governing the palliative management of patients in acute respiratory failure with a do-not-intubate order, and to discuss the various elements to be considered when defining the patient's palliative care plan, in a holistic, individual-centered approach.