Journal Article

Efficacy and safety of different methods and doses for thirst management in orotracheally intubated and mechanically ventilated patients with ‘nothing by mouth’: A randomized, controlled three-arm trial

Zhong, Wei, Yuan, You, Luo, Qian, Chen, Fang, Zhao, Yuanyuan, Chen, Junxi, Zhang, Xia, Hu, Rujun

2025

Overview

Patients receiving mechanical ventilation via orotracheal intubation (OTI-MV) in the ICU are often ordered to have nothing by mouth (‘nil per os’, NPO) which can lead to an intensified sensation of thirst. Although the issue of thirst has been acknowledged in clinical practice, there is limited research specifically addressing this population, particularly regarding the methods, frequency, and safe dosages of administration. The study, based on the Symptom Management Theory (SMT), formulates a thirst management strategy. It aims to evaluate the effects of different methods, temperatures, and doses, and the safety of a larger dose of 5 mL. A total of 84 participants were randomly assigned to one of three groups: Group A received a 1.6 mL injection of water at room temperature (20–26 °C), Group B received a 1.6 mL spray of cold water (2–6 °C), and Group C received a 5 mL spray of cold water (2–6 °C). Thirst symptoms were assessed using a total of 12 subjective and objective indicators, including the Thirst Intensity Scale, Thirst Distress Scale, Sleep Quality Scale, Oral Mucous Wetness Scale, Number of Additional Interventions, and Adverse Events. The improvement in thirst was greatest in Group C, followed by Group B, and then Group A. In terms of thirst distress, sleep quality, oral mucous wetness, and the number of additional interventions, the cold water spray had the better effect. There was no statistically significant difference in adverse events among the three groups. The spray method was superior to the injection method, cold water was more effective than room temperature water, and the 5 mL dosage outperformed the 1.6 mL. This dosage is considered safe. Thirst management based on SMT proves to be an effective strategy; the 5 mL cold water spray method is safe and effective, offering empirical support for clinical practice.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Adult / Aged / Clinical medicine / Clinical research / Cold / Cold water spray / Critical incidents / Data collection / Dosage / Effect evaluation / Efficacy / Female / Groups / Humans / Intensive care / Intensive Care Units - organization & administration / Intensive Care Units - statistics & numerical data / Intervention / Intubation / Intubation, Intratracheal - adverse effects / Intubation, Intratracheal - methods / Intubation, Intratracheal - standards / Male / Management / Management theory / Mechanical ventilation / Middle Aged / Mouth / Nothing by mouth / Orotracheal intubation / Patients / Psychological distress / Respiration, Artificial - adverse effects / Respiration, Artificial - methods / Respiration, Artificial - standards / Safety / Sleep / Statistical analysis / Subjectivity / Symptom management / Thirst - drug effects / Thirst - physiology / Thirsty management / Ventilation / Water / Water supply / Water temperature