Fran Lowry

January 24, 2011

January 24, 2011 (San Diego, California) — The pediatric intensive care unit (PICU) is a very noisy place, with sound levels often exceeding the recommended safe limit of 80 decibels, according to research presented here at the Society of Critical Care Medicine 40th Critical Care Congress.

"Such excessive noise might be putting young PICU patients at risk for worse outcomes," Bree Kramer, MD, from Women and Children's Hospital in Buffalo, New York, said in a poster presentation.

Dr. Kramer and her team sought to study the noise levels in their PICU because they were concerned that certain areas on the unit at certain times of the day were too loud for their patients.

"We worried that the noise was affecting the sedation and other care that we were giving our patients," she explained to Medscape Medical News. "We think noise can affect their care. Studies from some neonatal intensive care units have shown that noise affects heart rate, blood pressure, and oxygen saturation. There is not a lot of information right now about pediatric intensive care units, but we thought we would find similar results."

The investigators used the NoisePro noise logger to record decibel levels every 60 seconds in a 24-hour period in their PICU. The machine's microphone was placed 1 meter from the child's head.

They also asked the families and the nurses about their perceptions of noise levels at the bedside.

A total of 40 children were enrolled in the study. Their average age was 6 years.

The study found that the average maximum noise level for all patients was 83 decibels (range, 74.1 to 90.2), and the average minimum was 51.8 decibels (range, 42.5 to 61.4).

The average daily bedside noise level for all patients in the study was 63.3 decibels (range, 58 to 68). On average, the noise level was above 70 decibels 3.7% of the time (range, 0.2% to 14.4%).

All patients experienced an average of 115 minutes per day (range, 13 to 393 minutes) of noise above 100 decibels. The average peak was 134.7 decibels (range, 113.5 to 145.1).

The researchers found that nurses and families considered monitors to be the main source of noise. Noise from the adjacent bed was also felt to be a significant source of noise.

With these data, Dr. Kramer said she plans to study whether new measures, such as noise-canceling headphones or changes in certain aspects of patient care, will improve noise levels in the PICU.

"Loud noises are associated with a need for greater sedation. If we can reduce the noise levels in the PICU, perhaps we will be able to use less sedation. This would be a good thing for patients," she said.

"Right now, most of our patients are experiencing noise above the recommended cutoff point of 80 decibels. I'm sure we are no different than most other intensive care units," Dr. Kramer added. "We need to start being aware of how loud we are in our everyday practice. There are probably very simple changes we could make to help decrease the noise exposure for our patients that will, in the long run, help them get better and recover quicker."

Commenting on this study for Medscape Medical News, Jason M. Kane, MD, from Rush University Medical Center in Chicago, Illinois, who moderated the poster session, said the peaks of high noise shown in this study that occurred throughout the day probably are not good for PICU patients.

"We know from other studies that sleep deprivation actually prolongs ICU stay and delays recovery, so these spikes of noise are problematic and are probably harming our patients," he noted.

The results of the study indicate that there might be opportunities for improvement, Dr. Kane added. "If there are truly areas that are predictably noisy during the day, perhaps those areas can be targeted for a quality improvement initiative."

Dr. Kramer and Dr. Kane have disclosed no relevant financial relationships.

Society of Critical Care Medicine (SCCM) 40th Critical Care Congress: Abstract 566. Presented January 18, 2011.


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