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Increased sound levels in the cardiac ICU are associated with an increase in heart rate, blood pressure, and sedation

Published online by Cambridge University Press:  10 December 2024

Sherrill D. Caprarola Open the ORCID record for Sherrill D. Caprarola [Opens in a new window] ,
Melissa B. Jones Open the ORCID record for Melissa B. Jones [Opens in a new window] ,
Gregory K. Yurasek ,
Robin V. O’Neill ,
Cara Pleau ,
Meghan Rowan ,
Heather Gordish-Dressman  and
Gil Wernovsky
Sherrill D. Caprarola*
Affiliation:
Department of Pediatrics, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
Melissa B. Jones
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Children’s National Hospital, Washington, DC, USA
Gregory K. Yurasek
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Children’s National Hospital, Washington, DC, USA
Robin V. O’Neill
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Children’s National Hospital, Washington, DC, USA
Cara Pleau
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Children’s National Hospital, Washington, DC, USA
Meghan Rowan
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Children’s National Hospital, Washington, DC, USA
Heather Gordish-Dressman
Affiliation:
Department of Pediatrics, Center for Translational Research, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
Gil Wernovsky
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiac Critical Care, Children’s National Hospital, Washington, DC, USA Department of Pediatrics, Division of Pediatric Cardiology, Children’s National Hospital, Washington, DC, USA
*
Corresponding author: Sherrill D. Caprarola; Email: [email protected]
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Abstract

Background:

Several organizations including the Environmental Protection Agency, World Health Organization and American Academy of Pediatrics recommend that hospital sound levels not exceed 45 decibels. Yet, several studies across multiple age groups have observed higher than recommended levels in the intensive care setting. Elevated sound levels in hospitals have been associated with disturbances in sleep, patient discomfort, delayed recovery, and delirium.

Methods:

We measured sound levels in a pediatric cardiac intensive care unit and collected vital signs data, sedation dosing and delirium scores. During a 5-week study period, sound levels for 68 patients in 22 private and 4 semi-private rooms were monitored.

Results:

Sound levels were consistently above stated recommendations with an average daytime level of 50.6 decibels (maximum, 76.9 decibels) and an average nighttime level of 49.5 decibels (maximum, 69.6 decibels). An increase in average and maximum sound levels increased the probability of sedation administration the following hour (p-value < 0.001 and 0.01, respectively) and was predictive of an increase in heart rate and blood pressure (p-value < 0.001).

Conclusion:

Sound levels in the CICU were consistently higher than recommended. An increase in heart rate, blood pressure and sedation utilization may suggest a stress response to persistent and sudden loud sounds. Given known negative impacts of excessive noise on stress, sleep, and brain development, as well as the similar adverse effects from the related use of sedative medications, reducing excessive and sudden noise may provide an opportunity to improve short- and long-term hemodynamic and neurodevelopmental outcomes in the pediatric cardiac intensive care unit.

Keywords

Soundnoisedecibel levelscardiac intensive careneurodevelopment
Type
Original Article
Information
Cardiology in the Young , Volume 35 , Issue 2 , February 2025 , pp. 344 - 349
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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