(Screen 2 - 6:00 PM Saturday) Sounds Levels in a Pediatric Cardiac Intensive Care Unit are Higher than Recommended and May Lead to Increased Patient Stress

Find board locations here.

Abstract:

Introduction: The Environmental Protection Agency (EPA) and the World Health Organization (WHO) recommend that hospital A-weighted sound level in decibels (dB(A)) do not exceed 40-45 during the day and 35 at night. The American Academy of Pediatrics (AAP) also recommends sound levels for infants and neonates be less than 45 dB(A). Elevated sound levels in hospitals have been associated with disturbances in sleep, patient discomfort, delayed recovery, and delirium. We measured noise levels in a dedicated pediatric cardiac intensive care unit (CICU); our hypothesis was that the CICU is louder than current recommendations and is associated with elevations in heart rate and blood pressure, sedation administration and delirium.

Methods: Tekpro data decibel meters were placed in all 26 patient rooms to measure and record dB(A) levels continuously for 24 hours/day with recordings every 5 minutes between January 25, 2021 and March 1, 2021. Vital signs, CAP-D scores and sedation administration were collected via chart review. The dB(A) levels were converted to an hourly mean dB(A) level and analyzed using mixed effects nested regression models to account for the multiple repeated samples for multiple patients on multiple days and in multiple rooms throughout the time course.

Results: During the study period, 64 patients in 26 private and semi-private rooms were monitored with a total of 166,228 individual decibel readings. Sound levels for this cohort were consistently above the WHO, EPA and AAP recommendations with average daytime levels of 50.6 dB(A) and maximum 76.9 dB(A), and average nighttime levels of 49.5 dB(A) and maximum 69.6 dB(A). An increase in average and maximum noise level during the night shift increased the probability of sedation administration the following hour (p-value < 0.001 and 0.010, respectively) and was predictive of an increase heart rate and blood pressure (p-value < 0.001). There was no association between CAP-D scores and the average and maximum noise levels during the preceding 12 hour shift.

Discussion: Consistent with previous studies, the dB(A) levels in the CICU were consistently higher than the WHO, EPA and AAP recommendations. An increase in heart rate, blood pressure and sedation requirement may suggest a stress response to persistent and sudden loud noises. Given the known negative impacts of excessive noise on stress, sleep, healing and brain development, reducing excessive and sudden noise may help decrease patient stress and possibly improve short- and long-term neurodevelopmental outcomes.