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Sources of Sound Exposure in Pediatric Critical Care
Laura Beth Kalvas1, Tondi M Harrison2
1Laura Beth Kalvas is a postdoctoral fellow, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
Insights
Pediatric intensive care unit (PICU) noise primarily comes from media, family, and clinician sounds. Reducing nighttime noise pollution requires collaboration between clinicians and families to improve patient environments.
Area of Science:
- Pediatric critical care medicine
- Environmental health
- Acoustics
Background:
- Pediatric intensive care unit (PICU) noise levels frequently exceed recommended guidelines.
- The specific sources of this noise pollution remain under-investigated.
Purpose of the Study:
- To systematically identify and quantify the sources of sound exposure within the PICU environment.
Main Methods:
- Secondary analysis of 220.7 hours of continuous bedside video and dosimeter data.
- Adaptation of a validated adult ICU sound source coding scheme for pediatric application.
- Comparison of sound source prevalence during high vs. low sound levels, day vs. night shifts, and peak sound events.
Main Results:
- Human sources included family vocalizations (38%), clinician vocalizations (32%), and child nonverbal sounds (29.4%).
- Environmental sources included media sounds (57.7%), general activity (40.7%), and medical equipment (31.3%).
- Media sounds were present in over half of observations; family and child vocalizations dominated peak noise events.
Conclusions:
- Collaboration between clinicians and families is crucial to mitigate nighttime noise pollution in the PICUs.
- Further large-scale research employing this coding scheme is necessary to fully characterize the PICU soundscape.
Background:
Sound levels in the pediatric intensive care unit (PICU) are often above recommended levels, but few researchers have identified the sound sources contributing to high levels.
Objectives:
To identify sources of PICU sound exposure.
Methods:
This was a secondary analysis of continuous bedside video and dosimeter data (n = 220.7 hours). A reliable coding scheme developed to identify sound sources in the adult ICU was modified for pediatrics. Proportions of sound sources were compared between times of high (≥45 dB) and low (<45 dB) sound, during day (7 AM to 6:59 PM) and night (7 PM to 6:59 AM) shifts, and during sound peaks (≥70 dB).
Results:
Overall, family vocalizations (38% of observation time, n = 83.9 hours), clinician vocalizations (32%, n = 70.6 hours), and child nonverbal vocalizations (29.4%, n = 64.9 hours) were the main human sound sources. Media sounds (57.7%, n = 127.3 hours), general activity (40.7%, n = 89.8 hours), and medical equipment (31.3%, n = 69.1 hours) were the main environmental sound sources. Media sounds occurred in more than half of video hours. Child nonverbal (71.6%, n = 10.2 hours) and family vocalizations (63.2%, n = 9 hours) were highly prevalent during sound peaks. General activity (32.1%, n = 33.2 hours), clinician vocalizations (22.5%, n = 23.3 hours), and medical equipment sounds (20.6, n = 21.3 hours) were prevalent during night shifts.
Conclusions:
Clinicians should partner with families to limit nighttime PICU noise pollution. Large-scale studies using this reliable coding scheme are needed to understand the PICU sound environment.
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