Intensive Care Medicine

, Volume 40, Issue 9, pp 1295-1302

First online:

A randomized clinical trial of an intervention to relieve thirst and dry mouth in intensive care unit patients

  • Kathleen PuntilloAffiliated withDepartment of Physiological Nursing, University of California, San Francisco Email author 
  • , Shoshana R. AraiAffiliated withDepartment of Physiological Nursing, University of California, San Francisco
  • , Bruce A. CooperAffiliated withOffice of Research, Dean’s Office, Department of Community Health Systems, University of California, San Francisco
  • , Nancy A. StottsAffiliated withDepartment of Physiological Nursing, University of California, San Francisco
  • , Judith E. NelsonAffiliated withDivision of Pulmonary, Critical Care, and Sleep Medicine, Hertzberg Palliative Care Institute, Icahn School of Medicine at Mount Sinai

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To test an intervention bundle for thirst intensity, thirst distress, and dry mouth, which are among the most pervasive, intense, distressful, unrecognized, and undertreated symptoms in ICU patients, but for which data-based interventions are lacking.


This was a single-blinded randomized clinical trial in three ICUs in a tertiary medical center in urban California. A total of 252 cognitively intact patients reporting thirst intensity (TI) and/or thirst distress (TD) scores ≥3 on 0–10 numeric rating scales (NRS) were randomized to intervention or usual care groups. A research team nurse (RTN#1) obtained patients’ pre-procedure TI and TD scores and reports of dry mouth. She then administered a thirst bundle to the intervention group: oral swab wipes, sterile ice-cold water sprays, and a lip moisturizer, or observed patients in the usual care group. RTN#2, blinded to group assignment, obtained post-procedure TI and TD scores. Up to six sessions per patient were conducted across 2 days.


Multilevel linear regression determined that the average decreases in TI and TD scores from pre-procedure to post-procedure were significantly greater in the intervention group (2.3 and 1.8 NRS points, respectively) versus the usual care group (0.6 and 0.4 points, respectively) (p < 0.05). The usual care group was 1.9 times more likely than the intervention group to report dry mouth for each additional session on day 1.


This simple, inexpensive thirst bundle significantly decreased ICU patients’ thirst and dry mouth and can be considered a practice intervention for patients experiencing thirst.


Thirst relief Dry mouth ICU Symptom Non-pharmacological Palliation