strategies for thirst relief integrative literature review

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Strategies for thirst relief: integrative literature review

Affiliations.

• 1 Universidade Estadual de Londrina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem. Londrina-PR, Brasil.
• 2 Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-Graduação em Enfermagem Fundamental. Ribeirão Preto-SP, Brasil.
• PMID: 27925100
• DOI: 10.1590/0034-7167-2016-0317

Objective:: to analyze the strategies used to relieve the thirst of hospitalized patients.

Method:: an integrative review, for which the databases PubMed, LILACS, CINAHL and the group of references organized by the Group for Study and Research of Thirst were selected for the search of primary studies, with the keywords: thirst, ice, cold, intervention, nursing care, artificial saliva.

Results:: the review sample was composed of ten primary studies. The strategies found were: low temperature using frozen gauze, ice chips, and cold water, menthol associated with cold strategies, chewing gum, acupressure, and the use of a thin straw, substitute saliva, and early fluid ingestion.

Conclusion:: the temperature was presented as a predominant and effective strategy to relieve the thirst for surgical patients in intensive care and hemodialysis treatment.

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Strategies for thirst relief: integrative literature review

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Submission: 07-04-2016 Approval: 08-17-2016

Objective: to analyze the strategies used to relieve the thirst of hospitalized patients. Method: an integrative review, for which the databases PubMed, LILACS, CINAHL and the group of references organized by the Group for Study and Research of Thirst were selected for the search of primary studies, with the keywords: thirst, ice, cold, intervention, nursing care, artificial saliva. Results: the review sample was composed of ten primary studies. The strategies found were: low temperature using frozen gauze, ice chips, and cold water, menthol associated with cold strategies, chewing gum, acupressure, and the use of a thin straw, substitute saliva, and early fluid ingestion. Conclusion: the temperature was presented as a predominant and effective strategy to relieve the thirst for surgical patients in intensive care and hemodialysis treatment.

Descriptors: Thirst; Ice; Nursing Care; Low Temperature; Artificial Saliva.

Objetivo: analisar as estratégias utilizadas para minorar a sede do paciente hospitalizado. Método: revisäo integrativa, para a qual as bases de dados PubMed, LILACS, CINAHL e o conjunto de referencias organizadas pelo Grupo de Estudo e Pesquisa da Sede foram selecionadas para a busca dos estudos primários, com os descritores: thirst, ice, cold, intervention, nursingcare, artif icialsaliva. Resultados: a amostra da revisäo foi composta de 10 estudos primários. As estratégias encontradas foram: baixa temperatura utilizando gaze congelada, lascas de gelo e água fria, mentol associado a estratégias frias, goma de mascar, acupressäo, uso de canudo fino, substituto salivar e ingestäo precoce de líquidos. Conclusâo: a temperatura apresentou-se como estratégia predominante e efetiva para minorar a sede de pacientes cirúrgicos, em cuidado intensivo e em tratamentos de hemodiálise.

Descritores: Sede; Gelo; Cuidados de Enfermagem; Temperatura Baixa; Saliva Artificial.

Objetivo: analizar las estrategias utilizadas para saciar la sed del paciente hospitalizado. Método: revisión integrativa, sobre estudios primarios seleccionados de las bases de datos PubMed, LILACS, CINAHL y del conjunto de referencias elaboradas por el Grupo de Estudio e Investigación de la Sed, con los descriptores: thirst, ice, cold, intervention, nursing care, artificial saliva. Resultados: la muestra de la revisión se compuso de 10 estudios primarios. Las estrategias halladas fueron: baja temperatura utilizando gasa congelada, hielo molido y agua fría, mentol asociado a estrategias frías, goma de mascar, acupresión, uso de sorbete delgado, sustituto salival e ingestión precoz de líquidos. Conclusión: la temperatura se presentó como estrategia predominante y efectiva para saciar la sed en pacientes quirúrgicos, en cuidados intensivos y en tratamientos de hemodiálisis.

Descriptores: Sed; Hielo; Atención de Enfermería; Frío; Saliva Artificial.

INTRODUCTION

Thirst can be defined as a longing or desire to drink water, not necessarily generated by a physiological need, but also triggered by habit, taste, dry mouth or throat, the will to consume fluids that provide a sensation of heating or cooling. Different factors can influence the presence and intensity of the thirst, including, age, comorbidity, nutrition and anxiety0®.

According to its etiology, thirst can be osmotic or hypovolemic(1). Osmotic thirst derives from a slight increase of 1% to 2% in plasma osmolarity, which is able to stimulate the release of the antidiuretic hormone(2). When the compensatory mechanism provided by the osmotic changes are not effective, thirst is activated, prompting the body to seek water(1). In turn, hypovolemic thirst is associated with the need for hydric ingestion to restore plasma volume, and its regulatory mechanism depends both on the reninangiotensin-aldosterone system and the adrenergic action(1).

Once thirst is present, the organism can be satiated in a pre- or post absorptive way(3). In the pre-absorptive way, the pressure and temperature receptors in the oropharynx monitor the impact of hydric ingestion even before the body absorbs the fluids, acting to regulate this act and interrupt the drinking(4). In other words, the parts of the brain responsible for thirst satiety are activated without the need for a large volume of water. The post absorptive mechanism occurs when fluid is absorbed, balancing the blood osmolarity(3).

The hospitalized patient experiences stress situations and deprivation of fluid ingestion, often for prolonged periods, which cause the symptom of "thirst"(5-6). Patients with chronic kidney disease on dialytic therapy have more intense thirst and xerostomia (dry mouth), and also need to maintain a diet with fluid restrictions to prevent hypertension, acute lung edema and congestive heart failure(7-8).

In intensive care units, patients face conditions that predispose them to develop the symptom "thirst", such as hydroeletrolytic disturbances, dry mouth due to prolonged intubation and use of anticholinergic and opioid medications. In some cases, the difficulty communicating makes it impossible to report thirst, causing discomfort, stress, and irritability (900). The surgical patient is exposed to a confluence of factors that result in thirst, such as preoperative fasting, anxiety, surgical-anesthetic drugs, intubation, intraoperative bleeding, and prolonged oxygen therapy(1104). In the case of a child, perioperative thirst is a particularly stressful symptom and pain generator03.

Thirst is, therefore, a symptom that is present in clinical practice, but frequently undervalued, often unnoticed by the health team, although always recorded in the reports of individuals who experience it01O2°5).

The use of strategies that act in the pre-absorptive satiety are a viable alternative for patients who experience thirst in periods of fluid restriction®. However, with professional experience as a basis, it can be inferred that the lack of knowledge of the health staff about safe and effective strategies perpetuates an inertial attitude in face of hospitalized patients' thirst, thereby prolonging their suffering.

The motivation for the conduct of this integrative review was the need to compile knowledge about available strategies for the management of thirst, producing evidence for the implementation of interventions in clinical practice.

To analyze the strategies used to relieve the thirst of hospitalized patients.

This is an integrative review method that gathers, evaluates and summarizes the results of research on specific themes. The stages followed in development of the study were: developing the research question, sampling or literature search of primary studies, data extraction, assessment of the primary studies included, interpreting the results, presenting the review03.

For the development of the research question of the integrative review, the PICO strategy was used (patient, intervention, comparison, outcomes). The use of this strategy to formulate a research question in literature reviews allows for the identification of keywords, which aids in locating relevant primary studies in the databases03. Thus, the defined research question was: "What are the strategies found in the literature to relieve the thirst of hospitalized patients? The first element of the strategy (P) consists of hospitalized patients; the second (I), the strategies; and the fourth element (O) is relieving thirst. It should be noted that, depending on the review method, it is not necessary to use all the elements of the PICO strategy. In this integrative review, the third element, comparison (C), was not used.

The search for primary studies was performed from September to October of 2015, in the following databases: National Library of Medicine National Institutes of Health (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Latin American and Caribbean Center on Health Sciences Information (LILACS), and the group of references organized by the Group of Study and Research on Thirst (GSRT) in the State University of Londrina, located in the State of Paraná.

The controlled terms selected in the Descriptors of Health Science (DeCS) of the Virtual Health Library (VHL) and MeSH Database were thirst, ice, cold, intervention, nursing care, artificial saliva (in English). The noncontrolled terms (keywords) were cold and intervention (in English). The CINAHL headings used as controlled descriptors were thirst, nursing care, ice, cold and artificial saliva, and the noncontrolled was intervention. The terms were combined in different ways to ensure a wide search. The combinations in all databases were: Thirst AND Artificial saliva; Thirst AND Ice; Thirst AND Cold; Thirst AND Intervention; Thirst AND Nursing care.

The inclusion criteria established by the studies were articles with strategies to alleviate the thirst of hospitalized patients. The traditional reviews of the literature, secondary studies (e.g.: systematic review), reply letters and editorials were excluded from the sample of the integrative review. There were no idiom restrictions due to the lack of scientific production on the subject.

In the first analysis, after reading the title and the abstract of the primary studies (n = 826), the articles that did not indicate any strategy/intervention related to thirst were excluded (n = 815). Among them: secondary articles, physical exercise, thirst physiology, hormonal alterations, emotional aspects, thirst related to other diseases that did not answer the research question, and unrelated themes. In the second analysis, reading the full text (n = 11), one duplicated article was excluded. The analyses were performed independently by two expert reviewers.

For data extraction, an instrument developed by nursing researchers was used, which consists of items related to article identification, methodological characteristics, and evaluation of methodological accuracy(18).

For the analysis of the level of evidence, we used the definition of the type of study according to the authors of the included studies. Concepts of nursing researchers who advocate a specific hierarchy of evidence for different clinical questions were applied(16). In the healthcare sciences, clinical questions towards treatment/intervention are measured by means of the strength of evidence. This is classified into seven levels: level 1 (stronger) - evidence from systematic review or metaanalysis of randomized controlled trials; level 2 - evidence derived from well-designed randomized controlled trials; level 3 - evidence from well-designed non-random ized clinical trials; level 4 - evidence from cohort studies and well-designed case-control studies; level 5 - evidence from systematic reviews of descriptive and qualitative studies; level 6 -: evidence from a single descriptive or qualitative study; and level 7 (weaker) - evidence from expert opinion.

The analyses of the highlighted results were performed descriptively, a summary of each study included in the integrative review was presented, and comparisons of the included studies were made highlighting differences, and similarities.

The sample of the integrative review consisted of ten primary studies. The years with the greatest number of publications (two studies each year) were 2010, 2014 and 2015. Regarding idiom, six were published in English, three in Korean and one in Portuguese. One study in Portuguese was performed in Brazil, evidencing the lack of articles published on this subject in the country. In nine articles, nurses were the authors, and one was developed by physicians.

One article shows the results of two studies. Regarding the methods adopted by the studies, five (45.5%)(7'10'19'21) were randomized clinical trials (level of evidence 2); five (45.45%)(11'22_25) were quasiexperimental studies (level of evidence 3); and one (9,10%)(21) was a cross-sectional observational study (level of evidence 4)(16).

The included investigations were predominantly performed with: surgical patients in the postoperative period (60%)(11'19'20'22' 24), chronic renal failure patients on dialysis in three studies (30%) (7'21'25), and patients in intensive care in one study (10%)(10).

Box 1 shows the main information extracted from primary studies included in the review.

In the analysis of the results of the primary studies there is evidence of strategies to reduce thirst intensity and relieve the discomfort associated with research with levels of evidence 2 and 3, mainly interventions using low temperatures, menthol, strategies to stimulate the chewing effort (chewing gum and fine straw to fluid ingestion), salivary substitute, and early introduction of fluids.

In six studies, the authors evaluated strategies using low temperatures in different forms and vehicles, comparing them to usual methods of each context00"11-19'22-24*. The results of the action of cold were significant not only when compared to no action to relieve thirst(10), but also in comparison with the commonly used strategies, such as water at room temperature(11).

Sensory physiology has discovered that every sense depends on the activation of the Transient Receptor Potential (TRP) and the cold feeling is stimulated specifically by the activation of the Transient Receptor Potential Melastatin 8 (TRPM8), which is also stimulated by menthol(1,3). Refreshing the oral cavity with cold can be considered pleasant, related with the pleasure produced by pre-absorptive satiety(3,26).

These differences in the effectiveness of cold and room temperature is justified by the presence of baroreceptors and thermoreceptors in the sensory nerves in the oral mucosa, providing the perception of touch sensations, hot and cold temperatures(2-3). The thermal perceptions occur particularly by means of the TRPM8 receptors, located on various cell structures, covering the whole oral cavity, the trigeminal and glossopharyngeal nerve endings.

The importance of this inervention refers to its extension through three neurons that project into the cingulate region in the cerebral cortex, namely the Brodmann region 3-1-2. This region is activated when there is thirst satiety. With the reduction of the oral mucosa temperature by cold strategies, the TRPM8 is activated, and refreshment, satiety, and relief from discomfort without great fluid ingestion occurs(2-3).

The low temperature fluid was efficient in all studies in which this strategy was used. This clinical finding is extremely important because it allows for the adoption of effective strategies, particularly in intubated, chronic renal and perioperative patients. The frozen gauze strategy was also effective to relieve the thirst intensity and improve the oral cavity condition(22-24). On the other hand, based on the accumulated experience by GSRT in the care of thirsty patients, this strategy is not the most comfortable, because the feel of gauze in contact with the tongue is not pleasant.

The strategies such as ice chips and gargling with cold water are practical, low cost and comfortable to be used in postoperative patients who are conscious and have intact protective reflexes. However, no studies have been identified with application of this strategy preoperatively. Therefore, studies with this strategy should be performed, with the possibility of reducing the discomfort related to thirst in a period in which usually nothing is done to relieve it(11'19'23).

In the only study which used menthol to relieve thirst, a bundle was applied consisting of cold water spray, oral swabs and mentholated lip hydration. This strategy was adopted in intubated patients in intensive care, who were sometimes unconscious and without protective reflexes; still, it proved feasible and easy to apply(10). Thus, it was found that strategies using cold or cold associated with menthol are feasible to be implemented in clinical practice(10). The researchers encourage the performance of the strategies separately, to assess the effectiveness in controlling thirst(10).There were no strategies using menthol alone for the management of thirst, despite the connection of this substance with TRPM8.

In two studies, the authors investigated the strategies on xerostomia (symptoms defined as the subjective sensation of dry mouth). People with xerostomia tend to increase the consumption of liquid food and to facilitate speech(8). The results demonstrated that xerostomia in patients on hemodialysis is directly related to thirst. Dry mouth as a direct result of fluid restriction has a strong impact on oral health and quality of life. These subjective and unpleasant symptoms can potentially be improved by mechanical stimulation of the salivary glands and chewing or palliative care, such as the use of salivary substitutes(8'21).

Two studies with strategies aimed at salivary stimulation (chewing gum, saliva substitutes and use of thin straws) concluded that the methods are effective(7'21). The chewing gum was sugar-free, sweetened with xylitol and sorbitol, with a minty flavor in order to improve patients adherence(7). However, the authors do not discuss the action of menthol on TRPM8 to decrease thirst. In order to stimulate oral hydration, chewing gum can be a feasible alternative for patients in the preoperative period to keep fasting for prolonged times (the strategy has not been investigated in the literature). Xerostomia is subjectively perceived by individuals, and both chewing gum and saliva substitute (Xialine TM) enabled patients do use this strategy to the extent of, and in proportion to, their individual needs(7).

Acupressure is a Chinese massage technique that stimulates the human body points. In this therapy, the hands are used to put pressure on body surface points, relieving obstruction and balancing the energy flow. However the only study found which used acupressure had a small sample, the results are encouraging in relation to the increase in salivary flow and decrease the intensity of the thirst(25,27). This technique can be particularly useful for patients in chronic dialysis treatment, as only 74.6% of patients on dialysis follow a fluid restricted diet(8-28). Strategies to increase salivary flow can be used as effective clinical tools to assist in the adherence of the fluid-restricted diet. This can result in decreased dialytic weight gain, reducing the risk of complications and improving the quality of life(7-21).

One of the great myths in preoperative care, particularly after surgery, is that the patient must maintain an absolute fast, often for an indefinite period, ranging from eight to 37 hours, in different institutional realities(11). This excessive fasting increases the production of gastric juice and further lowers the pH, which increases the risk of complications such as aspiration, and significantly worsens the thirst(29). Therefore, strategies such as the early introduction of fluid in the immediate postoperative period are safe and effective, exponentially reducing thirst and oropharyngeal discomfort, increasing patient satisfaction(TM).

Study limitations

In this integrative review, despite the inclusion of primary studies with levels of evidence 2 and 3, there was a lack of studies on standardization strategies, explanation of sample size calculation, and presentation of the power of generalization. The predominance of studies evaluating cold temperatures on the intensity of thirst and its discomforts corroborate recent findings in the field of sensory physiology. Given the small number of studies on strategies to relieve the thirst of hospitalized patients, there is the need for investments in further research on the subject.

Another limitation was the inclusion of three studies found only in the group of references organized by the Group for Study and Research on Thirst, and not located in the selected databases, despite the rationale for the use of the search methodology. However, we chose to include these studies because of the relevance of their results for the elucidation of the research question.

Contributions to health

The relevance of this review is the synthesis of primary studies that demonstrate feasible strategies to relieve the thirst of hospitalized patients, generating evidence to guide feasible paths in clinical practice.

The evaluation of strategies to relieve thirst and its discomforts consisted, above all, in comparison of the primary usual practices adopted in the study sites.

Strategies found in this review can be combined, such as the use of cold and menthol, or salivary stimulation and early introduction of fluids in the immediate postoperative period. Low temperatures and menthol act on specific thermoreceptors which will activate brain areas responsible for thirst satiety. Strategies that focus on salivary stimulation act on areas responsible for mechanical stimulation of salivary gland and mastication. Early ingestion of fluids, in turn, proved effective and safe to reduce thirst and oropharyngeal discomfort, and increase patient satisfaction in the immediate postoperative period.

The implementation of necessary, safe and effective interventions to reduce thirst should be performed by health professionals, based on a careful and individualized assessment of each patient.

The synthesis of knowledge indicated the need to intensify efforts to develop research with methods able to produce strong evidence regarding this issue, especially in Brazilian hospital practice.

How to cite this article:

Garcia AKA, Fonseca LF, Aroni P, Galväo CM. Strategies for thirst relief: integrative literature review. Rev Bras Enferm [Internet]. 2016;69(6):1148-55. DOI: http://dx.doi.org/10.1590/0034-7167-2016-0317

1. Arai S, Stotts N, Puntillo K. Thirst in critically ill patients: from physiology to sensation. Am J Crit Care [Internet]. 2013[cited 2016 May 11];22(4):328-35. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3718499/pdf/nihms487008.pdf

2. Leiper J. Thirst. In: Caballero B, Allen L, Prentice A. Encyclopedia of human nutrition. 2nd ed. University of Aberdeen, UK: Elsevier Academic Press, 2005. p. 278-86.

3. Eccles R, Du-Plessis L, Dommels Y, Wilkinson JE. Cold pleasure: why we like ice drinks, ice-lollies and ice cream. Appetite [Internet]. 2013[cited 2016 Apr 30];71:357-60. Available from: http://www.sciencedirect.com/science/ article/pii/S0195666313003930

4. Obika LFO, Idu FK, George GO, Ajayi OI, Mowoe RS. Chewing gum and a saliva substitute alleviate thirst and xerostomia in patients on haemodialysis. Niger J Physiol Sci [Internet]. 2009[cited 2016 Apr 10];24(1):25-32. Available from: http:// ndt.oxfordjournals.org/content/20/3/578.full.pdf+html

5. Perlas A, Davis L, Khan M, Mitsakakis N, Chan VW. Gastric sonography in the fasted surgical patient: a prospective descriptive study. Anesth Analg [Internet]. 2011[cited 2016 Apr 30]; 113(1 ):93-7. Available from: http://www. ncbi.nlm.nih.gov/pubmed/21596885

6. De Vecchis R, Baldi C, Cioppa C, Giasi A, Fusco A. Effects of limiting fluid intake on clinical and laboratory outcomes in patients with heart failure: results of a meta-analysis of randomized controlled trials. Herz [Internet]. 2016[cited 2016 Apr 30];41(1):63-75. Available from: http://link. springer.com/article/10.1007%2Fs00059-015-4345-9

7. Bots CP, Brand HS, Veerman EC, Korevaar JC, ValentijnBenz M, Bezemer PD, et al. Chewing gum and a saliva substitute alleviate thirst and xerostomia in patients on haemodialysis. Nephrol Dial Transplant [Internet]. 2005[cited 2016 May 10];20(3):578-84. Available from: http://ndt.oxfor djournals.org/content/20/3/578.full.pdf+html

8. Bots CP, Brand HS, Veerman ECI, Valentiyn-Benz M, Van Amerongen BM, Valentiyn RM, et al. Interdialytic weight gain in patients on hemodialysis is associated with dry mouth and thirst. Kidney Int [Internet]. 2004[cited 2016 May 02];66(4):1662-68. Available from: http://www.scien cedirect.com/science/article/pii/S008525381550238X

9. Landström M, Rehn IM, Frisman GH. Perceptions of registered and enrolled nurses on thirst in mechanically ventilated adult patients in intensive care units- a phenomenographic study. Intensive Crit Care Nurs [Internet]. 2009[cited 2016 Apr 12];25(3): 133-9. Available from: http://www.sciencedirect.com/science/article/pii/S0964339709000238

10. Puntillo KA, Arai SR, Cooper BA, Stotts NA, Nelson JE. A randomized clinical trial of an intervention to relieve thirst and dry mouth in intensive care unit patients. Intensive Care Med [Internet]. 2014[cited 2016 May 11];40(9):1295302. Available from: https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4149585/pdf/nihms603963.pdf

11. Aroni P, Nascimento LA, Fonseca LF. Assessment strategies for the management of thirst in the post-anesthetic recovery room. Acta Paul Enferm [Internet]. 2012[cited 2016 May 11];25(4):530-6. Available from: http://www. scielo.br/pdf/ape/v25n4/en_08.pdf

12. Conchon MF, Nascimento LA, Fonseca LF, Aroni P. Perioperative thirst: an analysis from the perspective of the Symptom Management Theory. Rev Escola Enferm USP [Internet]. 2015[cited 2016 May 11 ];49(1 ):120-8. Available from: http://www.scielo.br/pdf/reeusp/v49n1/0080-6 234-reeusp-49-01-0122.pdf

13. Carey SK, Conchin S, Bloomfield-Stone S. A qualitative study into the impact of fasting within a large tertiary hospital in Australia: the patient's perspective. J Clin Nurs [Internet]. 2015[cited 2016 Apr 20];24:1946-54. Available from: http:// onlinelibrary.wiley.com/doi/10.1111/jocn.12847/pdf

14. Nesami MB, Shorofi AS, Jafari A, Khalilian AR, Tabari SZ. The relationship between stressors and anxiety levels after CABG in Sari, Iran. Iran Red Crescent Med J [Internet]. 2016[cited 2016 May 10];18(5):e25407. Available from: http://ircmj.com/?page = article&article_id = 25407

15. Campana MC, Fonseca LF, Lopes DFM, Martins PR. Percepçâo dos cuidadores quanto à sede da criança cirúrgica. Rev Rene [Internet]. 2015[cited 2016 May 11];16(6):799808. Available from: https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4149585/

16. Mendes KDS, Silveira, RCCP, Galvao CM. Revisao integrativa: método de pesquisa para a incorporaçao de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17(4):758-64.

17. Fineout-Overholt E, Stillwell SB. Asking compelling, clinical questions. In: Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing & healthcare: a guide to best practice. Philadelphia: Wolters Kluwer, Lippincot Williams & Wilkins; 2011. p. 25-39.

18. Ursi ES, Galvao CM. Prevençao de lesöes de pele no perioperatório: revisao integrativa da literatura. Rev Latino-Am Enfermagem. 2006;14(1):124-31.

19. Ford C, McCormick D, Teng W, Parkosewich J. Early initiation of oral intake in adult patients after cardiothoracic surgery is safe and reduces thirst: results of a randomized clinical trial. Circulation [Internet]. 2015[cited 2016 May 11];132(18 Suppl 3):A13586. Available from: http://circ. ahajournals.org/content/132/Suppl_3/A13586

20. Yin X, Ye L, Zhao L, Li L, Song J. Early versus delayed postoperative oral hydration after general anesthesia: a prospective randomized trial. Int J Clin Exp Med [Internet]. 2014[cited 2016 May 11];7(10): 3491-96. Available from: https://www. ncbi.nlm.nih.gov/pmc/articles/PMC4238515/.

21. Fan WF, Zhang Q, Luo LH, Niu JY, Gu Y. Study on the clinical significance and related factors on thirst and xerostomia in maintenance hemodialysis patients. Kidney Blood Press Res [Internet]. 2013[cited 2016 Apr 12];37(4-5):464-74. Available from: http://www.karger.com/Article/Pdf/355717

22. Moon YH, Lee YH, Jeong IS. A comparison of effect between wet gauze with cold normal saline and wet gauze with cold water on postoperative thirst, oral cavity condition, and saliva pH. J Korean Acad Fundam Nurs [Internet]. 2015[cited 2016 Apr 12];22(4):398-405. Available from: http://j.kafn.or.kr/upload/pdf/jkafn-22-4-398.pdf

23. Yoon SY, Min HS. The effects of cold water gargling on thirst, oral cavity condition, and sore throat in orthopedics surgery patients. Korean J Rehabil Nurs. 2011;14(2):136-44.

24. Cho EA, Kim KH, Park JY. Effects of frozen gauze with normal saline and ice on thirst and oral condition of laparoscopic cholecystectomy patients: pilot study. J Korean Acad Nurs. 2010;40(5):714-23.

25. Yang LY, Yates P, Chin CC, Kao TK. Effect of acupressure on thirst in hemodialysis patients. Kidney Blood Press Res [Internet]. 2010[cited 2016 Apr 12];33(4):260-5. Available from: http://www.karger.com/Article/Pdf/317933

26. Eccles R. Role of cold receptors and menthol in thirst, the drive to breathe and arousal. Appetite. 2000;34(1):29-35.

27. Maa SH. Application of acupressure in nursing practice. Hu Li Za Zhi [Internet]. 2005 [cited 2016 Apr 10];52(4):5-10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16088775

28. Durose CL, Holdsworth M, Watson V, Przygrodzka F. Knowledge of dietary restrictions and the medical consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance. J Am Diet Assoc [Internet]. 2004[cited 2016 Apr 20];104(1):35-41. Available from: http://www.sciencedirect.com/science/article/ pii/S0002822303014470

29. Francisco SC, Batista ST, Pena GG. Fasting in elective surgical patients: comparison among the time prescribed, performed and recommended on perioperative care protocols. Arq Bras Cir Dig [Internet]. 2015[cited 2016 May 11];28(4):250-4. Available from: http://www.scielo.br/ pdf/abcd/v28n4/0102-6720-abcd-28-04-00250.pdf

Aline Korki Arrabal GarciaI, Ligia Fahl FonsecaI, Patricia AroniII, Cristina Maria Galväo"

I Universidade Estadual de Londrina, Health Sciences Center, Postgraduate Program in Nursing. Londrina, Paraná, Brazil.

II Universidade de Sao Paulo, Ribeirao Preto College of Nursing,

Postgraduate Program in Nursing Fundamentals. Ribeirao Preto, Sao Paulo, Brazil.

CORRESPONDING AUTHOR Aline Korki Arrabal Garcia E-mail: [email protected]

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Prevalence of and risk factors for thirst in the intensive care unit: An observational study

1 Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Fuzhou China

2 The School of Nursing, Fujian Medical University, Fuzhou China

3 Department of Nursing, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou China

4 Intensive Care Unit, Fujian Provincial Hospital, Fuzhou China

Associated Data

Aim and objectives.

This study investigated the incidence of thirst and contributing factors in intensive care unit (ICU) patients by analysing differences in physiologic, psychological, and disease‐ and environment‐related parameters in ICU patients with vs without thirst.

Little is known about the factors that influence thirst, and there are no standardised methods for identifying at‐risk patients in the ICU. Previous studies generalised the risk of thirst in ICU patients because of a lack of data on relevant variables. Here, we examined the factors contributing to thirst based on symptom management theory.

Prospective descriptive design.

Physiologic, psychological, disease‐related and environment‐related data were collected for 301 patients from 4 ICUs (medical, surgical, cardiac and emergency ICUs) of a hospital from 15 December 2017–10 July 2019 through a screening interview, questionnaires and from electronic medical records. The data were analysed with descriptive statistics, the t‐test and chi‐squared test, and by logistic regression. Binary stepwise logistic regression was used to identify thirst‐associated factors. The findings are reported according to the STROBE checklist for cross‐sectional studies.

In total, 210/301 (69.8%) ICU patients experienced thirst. Risk factors were nil per os order (odds ratio [OR] = 4.10, 95% confidence interval [CI]: 1.44–11.69), surgery (OR = 2.96, 95% CI: 1.11–7.93), high glucose (OR = 3.36, 95% CI: 1.01–11.17) and greater disease severity (OR = 1.13, 95% CI: 1.02–1.24).

Thirst is common in ICU patients. Timely detection of patients’ thirst and identification of those at high risk by ICU nurses can ensure the implementation of effective and safe interventions.

Relevance to clinical practice

The results of this study highlight the need to evaluate thirst symptoms in patients with severe disease and develop relief strategies for fasting, perioperative, and hyperglycaemic patients and others who are at high risk of thirst.

What does this paper contribute to the wider global clinical community?

• The incidence of thirst in ICU patients is high in China; to prevent its occurrence, nurses should routinely evaluate patients’ thirst symptoms.
• For patients at high risk of thirst such as those who are fasting or perioperative or hyperglycaemic patients, nurses must recognise thirst symptoms and implement timely and effective interventions.

1. INTRODUCTION

Thirst is a subjective feeling caused by physiologic or behavioural factors such as a lack of sufficient water in the body and the desire to drink (McKinley et al., 2004 ). The act of drinking is driven by the feeling of thirst and is related to an individual’s drinking habits and oral condition. The assessment and description of thirst symptoms can thus be judged by the intensity of the patient’s own perception and degree of distress (Greenleaf, 1992 ). As most critically ill patients are unable to properly communicate with healthcare professionals to report their symptoms, thirst is often overlooked by doctors or nurses during their treatment.

In an investigation of discomfort symptoms in intensive care unit (ICU) patients, 70.8% reported severe thirst (Puntillo et al., 2010 ). In a study of 100 severely ill patients, 70% had moderate‐to‐severe thirst (Nelson et al., 2001 ); and over 80% of critically ill patients undergoing tracheotomy had thirst symptoms (Nelson et al., 2004 ). Additionally, most chronic critically ill patients in the respiratory ICU reported having severe thirst (Nelson et al., 2004 ).

Thirst is one of the main stressors that reduces the comfort of ICU patients (Kjeldsen et al., 2018 ; Nelson et al., 2001 ; Puntillo, Nelson, et al., 2014 ); it can cause significant distress and stress, which can increase oxygen consumption and the metabolic burden of their organs (Kjeldsen et al., 2018 ; Puntillo et al., 2010 ), and may even induce delirium (Sato et al., 2019 ), thus affecting recovery. Despite its prevalence, thirst in ICU patients is poorly understood by healthcare professionals and is often overlooked in patient management (Arai et al., 2013 ). Unrelieved thirst is a form of distress that nurses can and should alleviate as much as possible, and identifying the factors associated with thirst in ICU patients can help nurses to discern those at high risk who would benefit from an intervention (Stotts et al., 2015 ), providing an evidentiary basis for the assessment and management of thirst symptoms.

Thirst is primarily caused by an increase in fluid osmolality and decrease in blood volume (Arai et al., 2013 ). Nonphysiologic factors that trigger thirst include personal habits (Meinders & Meinders, 2010 ), customary behaviours (Engell et al., 1996 ; Sohn et al., 2001 ), pathologic conditions (Agrawal et al., 2008 ; Holst et al., 2003 ; Mistiaen, 2001 ), and oral and eating conditions (Dawes, 2004 ; Thelin et al., 2008 ). These interact with the body's neurologic, hormonal and signalling systems to maintain the balance of body fluids (Grandjean et al., 2000 ).

Symptom management theory (SMT) focusses on three interactive dimensions: the experiencing of symptoms, management strategies for the symptoms and symptom outcome (Linder, 2010 ). There are many factors that affect thirst in ICU patients that are not always considered. The SMT framework allows the analysis of factors influencing thirst from multiple dimensions. A review of the literature based on SMT found that the 4 main factors influencing thirst in ICU patients were physiology, psychology, disease and the environment (Conchon et al., 2015 ).

Physiology . The sensitivity of the thirst centre declines with ageing, which attenuates the sensation of thirst when plasma osmolality or body fluid volume is altered (Farrell et al., 2008 ; Kenney & Chiu, 2001 ). In clinical trials, older people had higher plasma osmolality levels but experienced fewer symptoms of thirst compared to younger subjects (Mack et al., 1994 ; Phillips et al., 1991 ; Rolls & Phillips, 1990 ), while a recent study reported that age was not associated with the onset of thirst in ICU patients (Stotts et al., 2015 ). Drinking habits and thirst tolerance levels vary across individuals; meanwhile, patients’ level of education affects their understanding of and cooperation with treatment. Thus, interindividual differences influence the level of thirst and degree of thirst distress. At present, the relationship between age, sex, and other physiologic factors and thirst in the Chinese population is not known.

Psychology . Psychological factors such as fear, anxiety, insecurity and surgical stress are associated with the development of thirst in perioperative patients. The hospital environment can cause dry mouth and thirst by inducing psychological stress in patients (Conchon et al., 2015 ). To date, no studies have reported an association between thirst and psychosomatic factors such as anxiety, depression and stress in critically ill patients.

Disease . The homeostasis of the body's internal environment is perturbed by disease; consequently, critically ill patients are prone to fluid or electrolyte imbalance (Lee, 2010 ), which can lead to hypovolemic or hyperosmolar thirst (Arai et al., 2013 ). Patients in the ICU are more likely to experience hyponatraemia or hypernatraemia than other patients, with electrolyte levels varying according to their condition (Agrawal et al., 2008 ; Rosner & Ronco, 2010 ). Surgical haemorrhage, shock or chronic renal insufficiency can also lead to excessive fluid loss in critically ill patients, which can elicit thirst if the fluid is not quickly replenished. Pathologic conditions that induce thirst include bleeding (Phillips et al., 1996 ), heart failure (Holst et al., 2003 ), vomiting (Baylis, 1987 ), digestive disorders (Morita et al., 2001 ), renal failure (Martinez‐Vea et al., 1992 ; Yamamoto et al., 1986 ) and endocrine disorders (Thompson & Baylis, 1987 ). Treatments such as fasting and water restriction, transepithelial intubation and the use of anticholinergic drugs also cause thirst (Stotts et al., 2015 ). In mechanically ventilated patients with oral intubation, the inability to close the mouth and swallow often results in a dry mouth. Over 70% of mechanically ventilated patients experience significant thirst (Nelson et al., 2001 , 2004 ); the inability to eat through the mouth, inadequate fluid replacement and the effects of anaesthetic sedative drugs can cause thirst whereas after extubation, patients often experience increased hunger and thirst due to fasting and water restriction. Commonly used medications for ICU patients such as opioids (Spencer et al., 1986 ), antihypertensives (Stotts et al., 2015 ), antidepressants (Jacob & Spinler, 2006 ) and diuretics (Waldréus et al., 2011 ) can also induce dry mouth and thirst.

Environment . Environmental temperature and humidity are factors that can elicit the sensation of thirst. The relative humidity of the ICU ward should be 50%–60%; when the humidity is too low, the air is dry and water evaporates quickly, causing dry mouth and tongue, sore throat and increased thirst. A prolonged stay in a laminar flow ward can lead to water loss and dry skin and oral mucosa in ICU patients, resulting in the development of thirst symptoms. However, there have been no reports on the relationship between environmental factors in the ICU and thirst. Moreover, previous studies did not investigate the contribution of factors such as anxiety or depression or other psychological parameters to thirst in critically ill patients, whereas findings from studies examining temperature and humidity or other environment‐related parameters were limited in terms of their generalisability. Moreover, although there have been studies on the incidence of and factors associated with thirst in the ICU, data for the Chinese population are lacking.

To address this issue, in this study we investigated the correlation between thirst and related factors in ICU patients in China within an SMT framework. Specifically, in addition to physiologic and disease‐related factors, we assessed the contributions of psychological (anxiety and depression) and environmental (temperature and humidity) parameters to thirst in this population, which has not been previously examined.

2.1. Study design and site

This prospective, descriptive study investigated thirst and associated risk factors in ICU patients. The framework of the study is shown in Figure ​ Figure1. 1 . The study was conducted at a 3A tertiary general hospital with 2500 active beds located in southeastern China and established in 1937. It was the first public hospital established in Fujian Province and provides medical services to the whole region. The Department of Critical Care Medicine of the hospital is a diagnosis and treatment centre for critically ill patients that integrates clinical practice, teaching and scientific research. The hospital has 4 adult ICUs (medical [M]ICU, surgical [S]ICU, emergency [E]ICU and cardiac care unit [CCU]) and treats about 1800 critically ill patients each year, with a bed occupancy rate >86%. The hospital mainly treats patients with multiple organ failure; severe infection; cardiovascular, neurologic or endocrine critical illnesses; and high‐risk patients with critical complications during the perioperative period. The MICU (22 beds) admits patients with severe respiratory failure, endocrine crisis and neurocritical illness; the SICU (20 beds) accommodates critically ill patients (excluding those with cardiac illnesses) during the perioperative period; the EICU (20 beds) is open to critically ill patients with severe trauma, various types of poisoning and major disasters; and the CCU (22 beds) admits critically ill patients after major cardiovascular or intracardiac interventional surgery and those with severe arrhythmia.

Framework for the study of thirst in ICU patients based on SMT [Colour figure can be viewed at wileyonlinelibrary.com ]

2.2. Participants

Study participants were recruited by nurses from December 2017–July 2019 from the 4 ICUs (medical, surgical, cardiac and emergency) of the medical centre. The inclusion criteria were as follows: (1) age ≥18 years; (2) length of ICU stay ≥24 h; (3) conscious during the assessment (Richmond Agitation–Sedation Scale [RASS] score −1 to +1); (4) able to communicate verbally and understand the questionnaires; and (5) agreed to participate in the study. The exclusion criteria were as follows: (1) unable to complete the assessment; and (2) transferred out of the ICU during the study.

2.3. Sample size

The sample size was calculated with the following formula:

where N is the number of samples; P is the estimated overall rate; d is the admissible error; and Z α is the statistic representing a certain confidence level. The prevalence of thirst in ICU patients was reported to be 70% (Puntillo et al., 2010 ) based on a sample size of 172 cases ( d  = 0.1P, α  = 0.05, Z α  = 1.96). Assuming a small proportion of missing data and response rate of approximately 80%, the minimum sample size required for this study was 207 cases.

2.4. Procedure and data collection

Data were collected from 15 December 2017–10 July 2019 after the study protocol was approved by the ethics institutional review board at Fujian Provincial Hospital (approval no. K2016‐009‐01). Two research nurses in each of the 4 ICUs were trained to collect data for this study. The purpose of the study was explained by the research nurses to eligible patients, and written consent was obtained from those who agreed to participate.

We sought patients who could self‐report thirst, were alert and oriented, and scored between −1 and +1 on the RASS (i.e. patients who were not sedated or agitated). Participants self‐reported thirst intensity using a 10‐point numeric rating scale (NRS), which has been widely used for this purpose and has face, construct and concurrent validity. To measure thirst intensity, the research nurse asked the patient, “How intense is your thirst on a scale of 0 to 10, where 0 = ‘no thirst at all’ and 10 = ‘worst thirst imaginable’?”. For patients with an NRS score of 3 or higher, another Likert scale (mild, moderate and severe) was further used to assess their thirst level. Both measures were used to assess thirst intensity.

Three methods (assessment, on‐spot record‐keeping and a review of medical records) were used to collect data for the study. Physiologic disease‐related parameters were obtained from the medical records, and psychological data were assessed by the research nurses after patients were discharged and returned to the general ward. Environmental parameters were measured and recorded by the research nurse during the assessment of thirst. Because of the high variability of thirst in the same ICU patient over the course of a day, after the patient had been admitted to the ICU for 24 h, thirst was evaluated at 18:00 when the patient was awake, and data were collected at 08:00 the following day after confirming the results of the previous assessment with the patient. The data collection process is shown in Figure ​ Figure2 2 .

Data collection process [Colour figure can be viewed at wileyonlinelibrary.com ]

2.4.1. Physiology‐related parameters

The research nurse obtained patients’ demographic and physiologic information including age (≤60 or >60 years), sex (male/female), educational level (primary school or less/junior high school/high school/college graduate and above), body temperature (°C), respiratory frequency (breaths per min), systolic blood pressure (SBP; mmHg), diastolic blood pressure (DBP; mmHg), central venous pressure (CVP; normal/low/high) and body mass index (BMI; kg/m 2 ). Demographic information was obtained from the medical records, and physiologic indices were obtained from data recorded by the monitoring system at the time point closest to the thirst assessment.

2.4.2. Psychology‐related parameters

The Chinese version of the Hospital Anxiety and Depression Scale was used to assess patients’ anxiety and depression symptoms during their stay in the ICU after they were discharged and returned to the general ward. The range of scores for each subscale was 0–21, and higher overall scores indicated worse symptoms.

2.4.3. Disease‐related parameters

Disease‐related variables included primary diagnosis at ICU admission (cardiovascular/respiratory/gastrointestinal/neurologic/other), total length of stay in the ICU, whether the patient died in the ICU (yes/no), severity of illness (Acute Physiology and Chronic Health Evaluation II score), oral intake ability (yes/no), nil per os (NPO) order (yes/no), surgery (yes/no), mechanical ventilation (yes/no), inhalation drug therapy (IDT; yes/no), and fluid intake and output volume (positive/negative balance). Medications that could affect fluid balance or thirst were documented including use of opioids (yes/no) and diuretics (yes/no). Biochemical parameters related to osmolality and blood volume that affect thirst including plasma osmolality (mOsm/l), sodium (normal/low/high), potassium (normal/low), ionised calcium (normal/low), glucose (normal/high), partial pressure of carbon dioxide (normal/low/high) and partial pressure of oxygen (normal/low/high) were also recorded.

The above data were obtained by reviewing the medical records; biochemical and blood gas indicators were the values closest to those recorded at the time point of thirst assessment. The lowest value of each index within the first 24 h after admission to the ICU was selected as an index of the severity of illness according to a combination of clinician and investigator criteria.

2.4.4. Environment‐related parameters

Environment‐related parameters of the ICU in which the patient was admitted were recorded. The temperature (°C) and humidity (%) in the area around the participant's bed were measured using a thermohydrometer (Zhengzhou Boyang Instrument and Meter Co, Zhengzhou, China; Model no. WSB‐5‐H1) placed on the patient's bedside table.

2.5. Data analysis

Data were analysed using SPSS v21.0 software for Mac (SPSS Inc). Descriptive statistics are presented as frequency with percentage for categorical variables, as mean with standard deviation for normally distributed continuous variables and as median with interquartile range for skewed continuous variables. Comparisons between the thirst and non‐thirst groups were performed with the t ‐test, Mann–Whitney U ‐test, Fisher’s exact test and chi‐square test. Both univariate and multivariate regression analyses were performed to identify factors associated with thirst in ICU patients, with thirst intensity (0–10 NRS)—dichotomised as thirst (NRS 3–10) vs. non‐thirst (NRS 0–2)—as the dependent variable. Binary stepwise logistic regression analysis was performed to determine whether thirst was a dependent variable, with statistically significant parameters from the univariate analysis as independent variables. Bilateral analyses were performed for all tests, and a p value <.05 was considered statistically significant. There were no missing values, and the data were processed without changing the original information. Results are reported in compliance with STROBE reporting guidelines for cross‐sectional studies (Supplementary File S1 ).

3.1. Prevalence of thirst

The demographic, physiologic, disease‐related, psychology‐related and environment‐related characteristics of the study population are shown in Table ​ Table1. 1 . Thirst was reported by 210/301 patients (69.8%); of these, 65 (30.9%) reported mild thirst, 90 (42.9%) moderate thirst and 55 (26.2%) severe thirst.

Characteristics of ICU patients in the thirst and non‐thirst groups ( N  = 301)

Data are presented as n (%) or mean ± SD.

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; CCU, cardiac care unit; EICU, emergency intensive care unit; HADS, Hospital Anxiety and Depression Scale; ICU, intensive care unit; MICU, medical intensive care unit; PCO 2 , partial pressure of carbon dioxide; PO 2 , partial pressure of oxygen; SICU, surgical intensive care unit.

* p  < .05, ** p  < .01, *** p  < .001.

3.2. Differences between ICU patients with and without thirst

3.2.1. physiology‐related parameters.

In the thirst and non‐thirst ICU groups, 128 (61.0%) and 47 (51.6%) patients, respectively, were older than 60 years of age, and 137 (65.2%) and 65 (71.4%), respectively, were male. Most participants had an education level of primary school or less. No significant differences were observed in age, sex, education level, body temperature, CVP, heart rate, SBP, DBP or BMI between the two groups.

3.2.2. Disease‐related parameters

A total of 105 patients (50.0%) in the thirst group and 41 (45.1%) in the non‐thirst group had a cardiovascular diagnosis, respectively, with no significant difference between groups. The median number of days spent in the ICU was also comparable between the thirst group (6 days, range: 3–11.25 days) and the non‐thirst group (7 days, range: 4–13.5 days) ( p  > .05). The severity of illness, oral intake ability, NPO order, surgery, mechanical ventilation, use of opioids or diuretics, and sodium and glucose levels differed significantly between the two groups.

3.2.3. Psychology‐related parameters

There were no significant differences in anxiety and depression scores between the 2 groups.

3.2.4. Environment‐related parameters

Among patients in the thirst and non‐thirst groups, 41 (19.5%) and 18 (19.8%), respectively, were in the MICU; 20 (9.5%) and 11 (12.1%), respectively, were in the SICU; 38 (18.1%) and 16 (17.6%), respectively, were in the EICU; and 111 (52.9%) and 46 (50.5%), respectively, were in the CCU. There were no significant differences in the proportion of patients in each type of ICU between the two groups. Mean temperature and humidity of the area next to the participants’ bed were 24.60°C and 52.20%, respectively, in the thirst group and 24.73°C and 53.02%, respectively, in the non‐thirst group, with no significant differences between groups for either variable.

3.3. Factors influencing thirst in ICU patients

The relationship between various parameters and thirst in ICU patients was evaluated by univariate analysis, with the occurrence of thirst as the dependent variable. Eleven disease‐related parameters that were statistically significant in the univariate analysis were selected as independent variables for the binary stepwise logistic regression model ( α in  = 0.05, α out  = 0.1) including the severity of illness, oral intake ability, NPO order, surgery, mechanical ventilation, IDT, use of opioids, use of diuretics, sodium level, glucose level and osmolality. The results of the regression analysis showed that NPO order (odds ratio [OR] = 4.10, 95% confidence interval [CI]: 1.44–11.69), surgery (OR = 2.96, 95% CI: 1.11–7.93), high glucose (OR = 3.36, 95% CI: 1.01–11.17) and greater severity of illness (OR = 1.13, 95% CI: 1.02–1.24) were risk factors for the occurrence of thirst in ICU patients (Table ​ (Table2). 2 ). The Cox–Snell R 2 and Nagelkerke's R 2 for the model were 0.21 and 0.30 respectively. The Hosmer–Lemeshow test for the model revealed no differences between the observed and expected values (χ 2  = 8.38, p  = .397).

Factors contributing to thirst in intensive care unit patients

Cox–Snell R 2  = 0.21; Nagelkerke's R 2  = .30; Hosmer–Lemeshow test χ 2  = 8.38, p  = .397.

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; CI, confidence interval; OR, odds ratio.

4. DISCUSSION

In this study, the incidence of thirst in ICU patients was 69.8%, which is similar to that in earlier reports (Puntillo, Arai, et al., 2014 ). A study of cancer patients in the ICU found that over 70% experienced intense thirst (Nelson et al., 2001 ). However, the incidence of thirst in ICU patients was reported as 40.4% by other investigators (Kalfon et al., 2010 ). This discrepancy may be attributable to the different patient populations and factors such as mechanical ventilation, fasting (including its duration) and use of diuretics among others that affect the occurrence of thirst in ICU patients. Nonetheless, all of the abovementioned studies demonstrate the high incidence and degree of thirst in ICU patients, in line with our own findings.

In the univariate analysis, we identified 11 factors that influence the occurrence of thirst in ICU patients including severity of illness, oral intake ability, NPO order, surgery, mechanical ventilation, IDT, use of opioids, use of diuretics, sodium and glucose levels, and osmolality. The results of the logistic stepwise regression analysis showed that after excluding the effects of confounding factors, NPO order, surgery, high glucose level and greater severity of illness were independent risk factors for the occurrence of thirst in ICU patients. In the multivariate stepwise regression analysis, factors such as mechanical ventilation were not included in the regression model. One reason for this is the small sample size for some of the factors; additionally, confounding variables in the multivariate analysis may have masked the effects of these factors. The risk factors for thirst in ICU patients in this study in decreasing order of significance were NPO order, surgery, high glucose and greater severity of illness.

NPO order was previously reported as a risk factor for thirst in ICU patients (Stotts et al., 2015 ). Maslow’s hierarchy of human needs from lowest to highest are physiologic needs, safety, love and belonging, respect and self‐realisation. Water, food and oxygen constitute the most basic physiologic needs for human survival. In ICU patients undergoing fasting due to treatment requirements, the physiologic need for water could not fully satisfied, which may lead to thirst, that the patients experienced powerlessness and frustration because of their inability to satisfy their thirst. They experienced a lack of control and felt that they were left in a state where they had to endure the situation which affects the patient's comfort and increases physical and mental stress (Goodman & Marino, 2021 ; Kjeldsen et al., 2018 ). Thus, ICU nurses must pay close attention to thirst in fasting patients and adopt effective strategies to alleviate this burden.

Postoperative thirst is a common clinical problem experienced by 75%–89.6% of adult patients (Nascimento et al., 2020 ; Pierotti et al., 2018 ) that may be caused by a combination of factors such as preoperative fasting, anxiety, anaesthetic drugs, intubation, intraoperative bleeding and prolonged oxygen therapy (Carey et al., 2015 ; Garcia et al., 2016 ). High glucose was associated with an increased risk of thirst in our patients, which is consistent with other findings (Stotts et al., 2015 ) including in patients with diabetes (Chuang et al., 2005 ).

High glucose increases plasma osmotic pressure, leading to thirst. We found that more severe illness was associated with a higher incidence of thirst in ICU patients, in agreement with previous work (Stotts et al., 2015 ). Physical functioning is reduced in a disease state; this may be accompanied by high blood sugar or sodium, changes in water and electrolyte balance, and dehydration, all of which can elicit thirst. As the disease worsens, the physiologic status of patients receiving treatment in the ICU becomes more complex; if surgery is performed, the patient may be placed on mechanical ventilation and water intake will be restricted or prohibited, thereby increasing the risk of thirst.

Certain medications such as opioids and diuretics have been linked to the occurrence of thirst in ICU patients (Stotts et al., 2015 ; Zhang et al., 2021 ). Diuretics increase osmolality and consequently cause thirst. The target of opioid action is associated with the body's water regulation system, which may affect thirst perception (Sanger & McCarthy, 1981 ; Spencer et al., 1986 ). In the present study, opioids and diuretics were not found to be independent risk factors for thirst.

Among the reported risk factors in this study, thirst is not associated with depression and anxiety symptoms. The reason for this finding in ICU patients may be that thirst is not the only factor that affects the mental health outcomes of ICU patients in terms of anxiety and depression. Empirical analysis of the risk factors reveals that symptoms such as pain and dyspnoea, sociodemographic and socioeconomic variables, personality traits, disease diagnosis, treatments, life support measures, manifold traumatic experiences and memories during the stay in the ICU are all associated with it (Battle et al., 2017 ; Kapfhammer, 2016 ; Nikayin et al., 2016 ; Rabiee et al., 2016 ), and future research is needed to investigate it.

Although our results showed that the main factors affecting thirst are disease‐related as demonstrated in previous work and we did not identify any new risk factors, our study is important because we examined the potential contribution of psychological and environment‐related parameters to the occurrence of thirst in ICU patients. However, there were some limitations to our study. First, physiologic data such as CVP and osmolality were lacking for some patients, which may have affected the accuracy of the analysis. Second, because the study was conducted in ICUs of a single hospital in China, the results may not be generalisable to all ICU patients. Third, one of the inclusion criteria for this study was patients who were awake and able to answer questions, so there was selection bias that may have excluded some patients who were mechanically ventilated. Additionally, it was not possible to objectively measure thirst intensity, which may also have introduced bias. Future studies should investigate the occurrence of thirst and its risk factors in ICU patients in other areas in China for a more representative sample.

5. CONCLUSION

This study examined the risk factors for thirst in ICU patients in China. We found a high prevalence of thirst in ICU patients (up to 69.8%); risk factors included fasting, surgery, high glucose and greater severity of illness. If thirst is not relieved, it can be a distressing experience for the patient. This study confirms the need for nurses to assess the multidimensional factors affecting thirst in ICU patients, use evidence‐based thirst relief strategies to reduce the discomfort and burden of thirst in critically ill patients within the context of necessary ICU care and evaluate the effectiveness of interventions. This is the first study to apply the SMT framework to the identification of risk factors of thirst in an ICU setting. To improve clinical outcomes, especially in patients with severe illness, timely assessment of patients’ thirst by ICU nurses is critical so that effective and safe interventions can be implemented.

6. RELEVANCE TO CLINICAL PRACTICE

The present study has important implications for the clinical management of ICU patients. Our data demonstrate for the first time the high prevalence of thirst in ICU patients in China and its association with the disease‐related parameters. Our findings highlight the need for greater vigilance on the part of healthcare providers to recognise thirst in ICU patients and identify those at high risk (e.g. patients with severe disease or hyperglycaemia or who are fasting, or perioperative patients). The identified risk factors for thirst can guide the development of effective management strategies to improve patient care and clinical outcomes.

AUTHOR CONTRIBUTIONS

RL and HL are joint first authors. All authors meet the criteria for authorship based on Journal of Clinical Nursing guidelines. Study proposal: HL, RL. Data collection: RL, LC, JH. Data analysis: RL and JH. Preparation and approval of the manuscript: All authors.

CONFLICT OF INTEREST

All authors declared no conflicts of interests.

Supporting information

Supplementary Material

ACKNOWLEDGEMENTS

The authors thank the study participants as well as the nurses and doctors from the 4 intensive care units of Fujian Provincial Hospital and those who contributed to the study by recruiting patients.

Lin, R. , Li, H. , Chen, L. , & He, J. (2023). Prevalence of and risk factors for thirst in the intensive care unit: An observational study . Journal of Clinical Nursing , 32 , 465–476. 10.1111/jocn.16257 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

Clinical trial registration number: This study was registered with the Chinese Clinical Trial Registry (ChiCTR‐INR‐16009108).

This study was funded by the Startup Fund for Scientific Research, Fujian Medical University, China (grant no. 2018QH2023), and Fujian Province Health and Family Planning Commission's Youth Research Foundation (grant no. 2014‐1‐8)

• Agrawal, V. , Agarwal, M. , Joshi, S. R. , & Ghosh, A. K. (2008). Hyponatremia and hypernatremia: Disorders of water balance . Journal of the Association of Physicians of India , 56 , 956–964. [ PubMed ] [ Google Scholar ]
• Arai, S. , Stotts, N. , & Puntillo, K. (2013). Thirst in critically ill patients: From physiology to sensation . American Journal of Critical Care , 22 ( 4 ), 328–335. 10.4037/ajcc2013533 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Battle, C. E. , James, K. , Bromfield, T. , & Temblett, P. (2017). Predictors of post‐traumatic stress disorder following critical illness: A mixed methods study . Journal of the Intensive Care Society , 18 ( 4 ), 289–293. 10.1177/1751143717713853 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Baylis, P. H. (1987). Osmoregulation and control of vasopressin secretion in healthy humans . American Journal of Physiology , 253 ( 5 Pt 2 ), R671–678. 10.1152/ajpregu.1987.253.5.R671 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Carey, S. K. , Conchin, S. , & Bloomfield‐Stone, S. (2015). A qualitative study into the impact of fasting within a large tertiary hospital in Australia – The patients’ perspective . Journal of Clinical Nursing , 24 ( 13–14 ), 1946–1954. 10.1111/jocn.12847 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Chuang, S. F. , Sung, J. M. , Kuo, S. C. , Huang, J. J. , & Lee, S. Y. (2005). Oral and dental manifestations in diabetic and nondiabetic uremic patients receiving hemodialysis . Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics , 99 ( 6 ), 689–695. 10.1016/j.tripleo.2004.06.078 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Conchon, M. F. , Nascimento, L. A. , Fonseca, L. F. , & Aroni, P. (2015). Perioperative thirst: An analysis from the perspective of the Symptom Management Theory . Revista da Escola de Enfermagem da USP , 49 ( 1 ), 122–128. 10.1590/s0080-623420150000100016 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dawes, C. (2004). How much saliva is enough for avoidance of xerostomia? Caries Research , 38 ( 3 ), 236–240. 10.1159/000077760 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Engell, D. , Kramer, M. , Malafi, T. , Salomon, M. , & Lesher, L. (1996). Effects of effort and social modeling on drinking in humans . Appetite , 26 ( 2 ), 129–138. 10.1006/appe.1996.0011 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Farrell, M. J. , Zamarripa, F. , Shade, R. , Phillips, P. A. , McKinley, M. , Fox, P. T. , Blair‐West, J. , Denton, D. A. , & Egan, G. F. (2008). Effect of aging on regional cerebral blood flow responses associated with osmotic thirst and its satiation by water drinking: A PET study . Proceedings of the National Academy of Sciences of the United States of America , 105 ( 1 ), 382–387. 10.1073/pnas.0710572105 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Garcia, A. K. , Fonseca, L. F. , Aroni, P. , & Galvão, C. M. (2016). Strategies for thirst relief: Integrative literature review . Revista Brasileira de Enfermagem , 69 ( 6 ), 1215–1222. 10.1590/0034-7167-2016-0317 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Goodman, S. P. J. , & Marino, F. E. (2021). Thirst perception exacerbates objective mental fatigue . Neuropsychologia , 150 , 107686. 10.1016/j.neuropsychologia.2020.107686 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Grandjean, A. C. , Reimers, K. J. , Bannick, K. E. , & Haven, M. C. (2000). The effect of caffeinated, non‐caffeinated, caloric and non‐caloric beverages on hydration . Journal of the American College of Nutrition , 19 ( 5 ), 591–600. 10.1080/07315724.2000.10718956 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Greenleaf, J. E. (1992). Problem: thirst, drinking behavior, and involuntary dehydration . Medicine and Science in Sports and Exercise , 24 ( 6 ), 645–656. 10.1249/00005768-199206000-00007 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Holst, M. , Strömberg, A. , Lindholm, M. , Uden, G. , & Willenheimer, R. (2003). Fluid restriction in heart failure patients: Is it useful? The design of a prospective, randomised study . European Journal of Cardiovascular Nursing , 2 ( 3 ), 237–242. 10.1016/s1474-5151(03)00066-5 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jacob, S. , & Spinler, S. A. (2006). Hyponatremia associated with selective serotonin‐reuptake inhibitors in older adults . Annals of Pharmacotherapy , 40 ( 9 ), 1618–1622. 10.1345/aph.1G293 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kalfon, P. , Mimoz, O. , Auquier, P. , Loundou, A. , Gauzit, R. , Lepape, A. , Laurens, J. , Garrigues, B. , Pottecher, T. , & Mallédant, Y. (2010). Development and validation of a questionnaire for quantitative assessment of perceived discomforts in critically ill patients . Intensive Care Medicine , 36 ( 10 ), 1751–1758. 10.1007/s00134-010-1902-9 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kapfhammer, H. P. (2016). Depressive, anxiety and posttraumatic stress disorders as long‐term sequelae of intensive care treatment . Nervenarzt , 87 ( 3 ), 253–263. 10.1007/s00115-016-0070-8 (Depressive, Angst‐ und posttraumatische Belastungsstörungen als Konsequenzen intensivmedizinischer Behandlung.) [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kenney, W. L. , & Chiu, P. (2001). Influence of age on thirst and fluid intake . Medicine and Science in Sports and Exercise , 33 ( 9 ), 1524–1532. 10.1097/00005768-200109000-00016 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kjeldsen, C. L. , Hansen, M. S. , Jensen, K. , Holm, A. , Haahr, A. , & Dreyer, P. (2018). Patients’ experience of thirst while being conscious and mechanically ventilated in the intensive care unit . Nursing in Critical Care , 23 ( 2 ), 75–81. 10.1111/nicc.12277 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lee, J. W. (2010). Fluid and electrolyte disturbances in critically ill patients . Electrolyte Blood Press , 8 ( 2 ), 72–81. 10.5049/ebp.2010.8.2.72 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Linder, L. (2010). Analysis of the UCSF Symptom Management Theory: Implications for pediatric oncology nursing . Journal of Pediatric Oncology Nursing , 27 ( 6 ), 316–324. 10.1177/1043454210368532 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mack, G. W. , Weseman, C. A. , Langhans, G. W. , Scherzer, H. , Gillen, C. M. , & Nadel, E. R. (1994). Body fluid balance in dehydrated healthy older men: thirst and renal osmoregulation . Journal of Applied Physiology , 76 ( 4 ), 1615–1623. 10.1152/jappl.1994.76.4.1615 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Martinez‐Vea, A. , García, C. , Gaya, J. , Rivera, F. , & Oliver, J. A. (1992). Abnormalities of thirst regulation in patients with chronic renal failure on hemodialysis . American Journal of Nephrology , 12 ( 1–2 ), 73–79. 10.1159/000168421 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• McKinley, M. J. , Cairns, M. J. , Denton, D. A. , Egan, G. , Mathai, M. L. , Uschakov, A. , Wade, J. D. , Weisinger, R. S. , & Oldfield, B. J. (2004). Physiological and pathophysiological influences on thirst . Physiology & Behavior , 81 ( 5 ), 795–803. 10.1016/j.physbeh.2004.04.055 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Meinders, A. J. , & Meinders, A. E. (2010). How much water do we really need to drink? Nederlands Tijdschrift Voor Geneeskunde , 154 , A1757. [ PubMed ] [ Google Scholar ]
• Mistiaen, P. (2001). Thirst, interdialytic weight gain, and thirst‐interventions in hemodialysis patients: A literature review . Nephrology Nursing Journal , 28 ( 6 ), 601–604, 610–603, quiz 614–605. [ PubMed ] [ Google Scholar ]
• Morita, T. , Tei, Y. , Tsunoda, J. , Inoue, S. , & Chihara, S. (2001). Determinants of the sensation of thirst in terminally ill cancer patients . Supportive Care in Cancer , 9 ( 3 ), 177–186. 10.1007/s005200000205 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nascimento, L. A. D. , Garcia, A. K. A. , Conchon, M. F. , Aroni, P. , Pierotti, I. , Martins, P. R. , Nakaya, T. G. , & Fonseca, L. F. (2020). Advances in the management of perioperative patients’ thirst . AORN Journal , 111 ( 2 ), 165–179. 10.1002/aorn.12931 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nelson, J. E. , Meier, D. E. , Litke, A. , Natale, D. A. , Siegel, R. E. , & Morrison, R. S. (2004). The symptom burden of chronic critical illness . Critical Care Medicine , 32 ( 7 ), 1527–1534. 10.1097/01.ccm.0000129485.08835.5a [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nelson, J. E. , Meier, D. E. , Oei, E. J. , Nierman, D. M. , Senzel, R. S. , Manfredi, P. L. , Davis, S. M. , & Morrison, R. S. (2001). Self‐reported symptom experience of critically ill cancer patients receiving intensive care . Critical Care Medicine , 29 ( 2 ), 277–282. 10.1097/00003246-200102000-00010 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nikayin, S. , Rabiee, A. , Hashem, M. D. , Huang, M. , Bienvenu, O. J. , Turnbull, A. E. , & Needham, D. M. (2016). Anxiety symptoms in survivors of critical illness: A systematic review and meta‐analysis . General Hospital Psychiatry , 43 , 23–29. 10.1016/j.genhosppsych.2016.08.005 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Phillips, M. I. , Heininger, F. , & Toffolo, S. (1996). The role of brain angiotensin in thirst and AVP release induced by hemorrhage . Regulatory Peptides , 66 ( 1–2 ), 3–11. 10.1016/0167-0115(96)00088-2 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Phillips, P. A. , Bretherton, M. , Johnston, C. I. , & Gray, L. (1991). Reduced osmotic thirst in healthy elderly men . American Journal of Physiology , 261 ( 1 Pt 2 ), R166–171. 10.1152/ajpregu.1991.261.1.R166 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pierotti, I. , Fracarolli, I. F. L. , Fonseca, L. F. , & Aroni, P. (2018). Evaluation of the intensity and discomfort of perioperative thirst . Escola Anna Nery , 22 ( 3 ), e20170375. 10.1590/2177-9465-ean-2017-0375 [ CrossRef ] [ Google Scholar ]
• Puntillo, K. A. , Arai, S. , Cohen, N. H. , Gropper, M. A. , Neuhaus, J. , Paul, S. M. , & Miaskowski, C. (2010). Symptoms experienced by intensive care unit patients at high risk of dying . Critical Care Medicine , 38 ( 11 ), 2155–2160. 10.1097/CCM.0b013e3181f267ee [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Puntillo, K. , Arai, S. R. , Cooper, B. A. , Stotts, N. A. , & Nelson, J. E. (2014). A randomized clinical trial of an intervention to relieve thirst and dry mouth in intensive care unit patients . Intensive Care Medicine , 40 ( 9 ), 1295–1302. 10.1007/s00134-014-3339-z [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Puntillo, K. , Nelson, J. E. , Weissman, D. , Curtis, R. , Weiss, S. , Frontera, J. , Gabriel, M. , Hays, R. , Lustbader, D. , Mosenthal, A. , Mulkerin, C. , Ray, D. , Bassett, R. , Boss, R. , Brasel, K. , & Campbell, M. (2014). Palliative care in the ICU: Relief of pain, dyspnea, and thirst – A report from the IPAL‐ICU Advisory Board . Intensive Care Medicine , 40 ( 2 ), 235–248. 10.1007/s00134-013-3153-z [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rabiee, A. , Nikayin, S. , Hashem, M. D. , Huang, M. , Dinglas, V. D. , Bienvenu, O. J. , Turnbull, A. E. , & Needham, D. M. (2016). Depressive symptoms after critical illness: A systematic review and meta‐analysis . Critical Care Medicine , 44 ( 9 ), 1744–1753. 10.1097/ccm.0000000000001811 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rolls, B. J. , & Phillips, P. A. (1990). Aging and disturbances of thirst and fluid balance . Nutrition Reviews , 48 ( 3 ), 137–144. 10.1111/j.1753-4887.1990.tb02915.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rosner, M. H. , & Ronco, C. (2010). Dysnatremias in the intensive care unit . Contributions to Nephrology , 165 , 292–298. 10.1159/000313769 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Sanger, D. J. , & McCarthy, P. S. (1981). Increased food and water intake produced in rats by opiate receptor agonists . Psychopharmacology (Berl) , 74 ( 3 ), 217–220. 10.1007/bf00427097 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Sato, K. , Okajima, M. , & Taniguchi, T. (2019). Association of persistent intense thirst with delirium among critically ill patients: A cross‐sectional study . Journal of Pain and Symptom Management , 57 ( 6 ), 1114–1120. 10.1016/j.jpainsymman.2019.02.022 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Sohn, W. , Heller, K. E. , & Burt, B. A. (2001). Fluid consumption related to climate among children in the United States . Journal of Public Health Dentistry , 61 ( 2 ), 99–106. 10.1111/j.1752-7325.2001.tb03373.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Spencer, R. L. , Deupree, D. , Hsiao, S. , Mosberg, H. I. , Hruby, V. , Burks, T. F. , & Porreca, F. (1986). Centrally‐administered opioid selective agonists inhibit drinking in the rat . Pharmacology, Biochemistry and Behavior , 25 ( 1 ), 77–82. 10.1016/0091-3057(86)90233-9 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Stotts, N. A. , Arai, S. R. , Cooper, B. A. , Nelson, J. E. , & Puntillo, K. A. (2015). Predictors of thirst in intensive care unit patients . Journal of Pain and Symptom Management , 49 ( 3 ), 530–538. 10.1016/j.jpainsymman.2014.07.001 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Thelin, W. R. , Brennan, M. T. , Lockhart, P. B. , Singh, M. L. , Fox, P. C. , Papas, A. S. , & Boucher, R. C. (2008). The oral mucosa as a therapeutic target for xerostomia . Oral Diseases , 14 ( 8 ), 683–689. 10.1111/j.1601-0825.2008.01486.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Thompson, C. J. , & Baylis, P. H. (1987). Thirst in diabetes insipidus: Clinical relevance of quantitative assessment . The Quarterly Journal of Medicine , 65 ( 246 ), 853–862. [ PubMed ] [ Google Scholar ]
• Waldréus, N. , Sjöstrand, F. , & Hahn, R. G. (2011). Thirst in the elderly with and without heart failure . Archives of Gerontology and Geriatrics , 53 ( 2 ), 174–178. 10.1016/j.archger.2010.10.003 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Yamamoto, T. , Shimizu, M. , Morioka, M. , Kitano, M. , Wakabayashi, H. , & Aizawa, N. (1986). Role of angiotensin II in the pathogenesis of hyperdipsia in chronic renal failure . JAMA , 256 ( 5 ), 604–608. 10.1001/jama.1986.03380050072023 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Zhang, W. , Gu, Q. , Gu, Y. , Zhao, Y. , & Zhu, L. (2021). Symptom management to alleviate thirst and dry mouth in critically ill patients: A randomised controlled trial . Australian Critical Care . Online ahead of print. 10.1016/j.aucc.2021.04.002 [ PubMed ] [ CrossRef ] [ Google Scholar ]

• DOI: 10.1590/0034-7167-2022-0154
• Corpus ID: 252897762

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