Thirst in Intensive Care Patients: An Unnoticed Problem in Nursing Care

Öz

Thirst is defined as a subjective condition associated with a strong desire to drink. In intensive care patients, thirst is a common and intense symptom with a high incidence. The high prevalence of thirst among critically ill patients has been associated with disease severity, treatments, and medications used. Serum sodium concentration, hyperglycemia, disease severity, and xerostomia are important factors that trigger thirst. In addition, factors such as discontinuation of oral intake, surgical operations, medications, and the use of medical devices that provide respiratory support may also contribute to thirst. Studies have demonstrated that thirst is one of the most prevalent and distressing symptoms in intensive care units. Nevertheless, thirst is not routinely or consistently assessed and effectively managed by intensive care nurses. The limited availability of valid and reliable tools for assessing thirst in critically ill patients restricts nurses’ effectiveness in thirst management. Alleviating thirst is part of humane care and is an important aspect of nursing practice. Effective thirst management strategies are essential to address the thirst experienced by intensive care patients. This review synthesizes the physiology of thirst, incidence, and prevalence in intensive care units based on current research. The tools used to assess thirst and the negative consequences of thirst are described. Risk factors for thirst are discussed in detail, and findings from recent studies on nursing interventions addressing these risk factors are presented. The need for a systematic and multidisciplinary approach to the factors contributing to thirst and for effective thirst management, with nurses taking a leading role in this area, is emphasized.

Anahtar Kelimeler

• Thirst
• Critical Patient
• Intensive Care Nursing
• Intensive Care Unit
• Nursing Care

Destekleyen Kurum

none

Etik Beyan

This study is a literature-based review and does not involve any human or animal subjects. All sources used in the study have been properly cited and referenced.

Yoğun Bakım Hastalarında Susuzluk: Hemşirelik Bakımında Fark Edilemeyen Bir Sorun

Öz

Susuzluk, güçlü bir içme isteğiyle ilişkili öznel bir durum olarak tanımlanır. Yoğun bakım hastalarında susuzluk yaygın ve yoğun bir şekilde gelişen, insidansı yüksek bir semptomdur. Yoğun bakımdaki hastalarda susuzluğun yüksek oranda görülmesi hastalık şiddeti, uygulanan tedavi ve kullanılan ilaçlarla ilişkilendirilmiştir. Serum sodyum konsantrasyonu, hiperglisemi, hastalık şiddeti ve ağız kuruluğu (kserostomi) susuzluğu tetikleyen önemli faktörlerdir. Bununla birlikte oral alımın durdurulması, cerrahi operasyon, kullanılan ilaçlar ve solunum desteği sağlayan tıbbi cihazların kullanımı gibi faktörler de susuzluğu tetiklemektedir. Susuzluğun yoğun bakımdaki hastalarda yaygın ve yoğun semptomlardan biri olduğu çalışmalarla ortaya konulmuştur. Buna rağmen susuzluğun yoğun bakım hemşireleri tarafından rutin veya tutarlı bir şekilde değerlendirilmediği ve etkili şekilde yönetilmediği görülmektedir. Yoğun bakım hastalarında susuzluğun değerlendirilmesi için geçerlik ve güvenirliği sağlanmış araçların sınırlı olması hemşirelerin susuzluk yönetimindeki etkinliğini sınırlandırmaktadır. Susuzluğu gidermek insancıl bakımın bir parçasıdır ve hemşirelik bakımında önemli bir yere sahiptir. Yoğun bakımdaki hastaların yaşadıkları susuzluğun yönetimi için etkili susuzluk yönetimi stratejilerine ihtiyaç vardır. Bu derlemede yoğun bakım ünitesinde yatan hastalarda görülen susuzluğun fizyolojisi, yoğun bakımda görülme sıklığı ve susuzluk prevalansı güncel çalışmalarla incelenmiştir. Susuzluğu değerlendirmek için kullanılan araçlar ve susuzlukla ilişkili olumsuz durumlar açıklanmıştır. Susuzlukla ilişkili risk faktörleri ayrıntılı olarak ele alınmış ve bu risk faktörlerine yönelik hemşirelik müdahalelerini içeren güncel çalışma sonuçlarına yer verilmiştir. Susuzluğa neden olan faktörlerin sistemik ve multidisipliner yaklaşımlar ile ele alınarak susuzluğun etkin bir biçimde yönetilmesi ve bu alanda hemşirelerin öncü olması gerektiği vurgulanmıştır.

Anahtar Kelimeler

• Susuzluk
• Kritik Hasta
• Yoğun Bakım Hemşireliği
• Yoğun Bakım Ünitesi
• Hemşirelik Bakımı

Destekleyen Kurum

yoktur

Etik Beyan

Bu çalışma, literatür taramasına dayalı bir derlemedir ve herhangi bir insan veya hayvan örneği kullanılmamıştır. Kullanılan tüm kaynaklar uygun biçimde atıf verilerek belirtilmiştir.

Kaynakça

1. 1. Xie XM, Huang D, Chun S, et al. Factors influencing thirst in ICU patients: A mixed methods systematic review. Intensive Crit Care Nurs. 2025;86:103811.
2. 2. Waldreus N, Hahn RG, Jaarsma T. Thirst in heart failure: A systematic literature review. Eur J Heart Fail. 2013;15(2):141-149.
3. 3. Porth CM, Erickson M. Physiology of thirst and drinking: Implication for nursing practice. Heart Lung. 1992;21(3):273-282.
4. 4. Greenleaf JE. Problem: thirst, drinking behavior, and involuntary dehydration. Med Sci Sports Exerc. 1992;24(6):645-656.
5. 5. Yuan Y, Luo Q, Zhong W, et al. 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. Intensive Crit Care Nurs. 2025;89:104012.
6. 6. Arai S, Stotts N, Puntillo K. Thirst in critically ill patients: From physiology to sensation. Am J Crit Care. 2013;22(4):328-335.
7. 7. Grandjean AC, Reimers KJ, Bannick KE, Haven MC. The effect of caffeinated, non-caffeinated, caloric, and non-caloric beverages on hydration. J Am Coll Nutr. 2000;19(5):591-600.
8. 8. Widmaier EP, Raff H, Strang KT. Vander’s Human Physiology: The Mechanisms of Body Function. 15th ed. New York, NY: McGraw Hill; 2023.

9. 9. McKinley MJ. The physiological regulation of thirst and fluid intake. News Physiol Sci. 2004;19:1-6.
10. 10. Guyton AC, Hall JE. Tıp Fizyolojisi. 13. baskı. Çeviri: Kaya M, Özdemir E, Demirtaş S. İstanbul, Türkiye: Nobel Tıp Kitabevi; 2021.
11. 11. Danziger J, Zeidel ML. Osmotic homeostasis. Clin J Am Soc Nephrol. 2015;10:852-862.
12. 12. Hughes F, Mythen M, Montgomery H. The sensitivity of the human thirst response to changes in plasma osmolality: A systematic review. Perioper Med. 2018;7:1-11.
13. 13. Doi S, Nakanishi N, Kawahara Y, Nakayama S. Impact of oral care on thirst perception and dry mouth assessments in intensive care patients: An observational study. Intensive Crit Care Nurs. 2021;66:103073.
14. 14. Fukunaga T, Ouchi A, Aikawa G, Okamoto S, Uno S, Sakuramoto H. Prevalence, risk factors, and treatment methods of thirst in critically ill patients: A systematic review and meta-analysis. PLoS One. 2025;20(3):e0315500.
15. 15. Han Z, He Y, Lu Z, Shi Y, Qin J, Wang X. Research progress on nursing care of thirst in critically ill patients. Chin J Nurs. 2021;56(5):782-785.
16. 16. Zhang W, Gu Q, Gu Y, Zhao Y, Zhu L. Symptom management to alleviate thirst and dry mouth in critically ill patients: A randomized controlled trial. Aust Crit Care. 2022;35(2):123-129.
17. 17. Holm A, Dreyer P. Intensive care unit patients' experience of being conscious during endotracheal intubation and mechanical ventilation. Nurs Crit Care. 2017;22:81-88.
18. 18. Sato K, Okajima M, Taniguchi T. Association of persistent intense thirst with delirium among critically ill patients: A cross-sectional study. J Pain Symptom Manage. 2019;57(6):1114-1120.
19. 19. Puntillo KA, Arai S, Cohen NH, et al. Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med. 2010;38:2155-2160.
20. 20. Chanques G, Nelson J, Puntillo K. Five patient symptoms that you should evaluate every day. Intensive Care Med. 2015;41(7):1347-1350.
21. 21. Saltnes-Lillegard C, Rustoen T, Beitland S, et al. Self-reported symptoms experienced by intensive care unit patients: A prospective observational multicenter study. Intensive Care Med. 2023;49(11):1370-1382.
22. 22. Flim M, Spronk PE. Thirst relief in ICU patients: The art of flip-thinking. Intensive Crit Care Nurs. 2025;86:103871.
23. 23. Flim M, Rustoen T, Blackwood B, Spronk PE. Thirst in adult patients in the intensive care unit: A scoping review. Intensive Crit Care Nurs. 2025;86:103787.
24. 24. Zhao P, Luo Y, Xiang L, et al. Dynamic change and risk factors of intense thirst in patients admitted to neuro-intensive care unit: An observational study. Nurs Crit Care. 2025;30(3):e13184.
25. 25. Lin R, Li H, Chen L, He J. Prevalence of and risk factors for thirst in the intensive care unit: An observational study. J Clin Nurs. 2023;32(3-4):465-476.
26. 26. Negro A, Villa G, Greco M, et al. Thirst in patients admitted to intensive care units: An observational study. Ir J Med Sci. 2022;191(5):2283-2289.
27. 27. Wu CL, Luo Q, Fu B, Zhang X, Fu XY, Chen F. Investigation and analysis of influence factors of thirst in ICU patients with oral tracheal intubation and ventilator-assisted ventilation. Chin J Respir Crit Care. 2022;21(5):316-321.
28. 28. Li S, Mi J, Tang Y. A qualitative study of nurses’ perception on patients’ thirst in intensive care units. Intensive Crit Care Nurs. 2022;69:103184.
29. 29. Pattison N. Symptom management of thirst for seriously ill and dying patients in critical care. Intensive Crit Care Nurs. 2025;86:103869.
30. 30. Stotts NA, Arai SR, Cooper BA, Nelson JE, Puntillo KA. Predictors of thirst in intensive care unit patients. J Pain Symptom Manage. 2015;49(3):530-538.
31. 31. Buckley MS, LeBlanc JM, Cawley MJ. Electrolyte disturbances associated with commonly prescribed medications in the intensive care unit. Crit Care Med. 2010;38(Suppl 6):S253-S264.
32. 32. Gao Y, Wu J, Xu HF, Li JY, Su CM, Yang YH. Qualitative study on the real experience of thirst in clear-headed ICU patients. J Qiqihar Med Univ. 2020;41(21):2745-2749.
33. 33. Kjeldsen CL, Hansen MS, Jensen K, Holm A, Haahr A, Dreyer P. Patients’ experience of thirst while being conscious and mechanically ventilated in the intensive care unit. Nurs Crit Care. 2018;23(2):75-81.
34. 34. Chanques G, Constantin JM, Sauter M, et al. Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients. Intensive Care Med. 2009;35(6):996-1003.
35. 35. Engstrom A, Nystrom N, Sundelin G, Rattray J. People’s experiences of being mechanically ventilated in an ICU: a qualitative study. Intensive Crit Care Nurs. 2012;29:88.
36. 36. VonStein M, Buchko BL, Millen C, Lampo D, Bell T, Woods AB. Effect of a scheduled nurse intervention on thirst and dry mouth in intensive care patients. Am J Crit Care. 2019;28:41-46.
37. 37. Diao Q, Chen Y, Jiang Q, Yan Y, Hu Q. Evaluation for the application of thirst pain scale in maintenance hemodialysis patients. J Nurses Train. 2019;34(13):1179-1183.
38. 38. Zhang W, Hao Y, Tian T. The reliability and validity of the Chinese version of thirst distress scale with heart failure. Chin J Nurs. 2019;54(6):957-960.
39. 39. Tu W, Yin Z, Ye D, Cao Y. Management of thirst during postoperative tracheal intubation in patients with acute type A aortic coarctation. J Nurses Train. 2020;35(9):824-827.
40. 40. Liao C, Guan Q, Ma X, et al. Construction of an assessment scale for thirst severity in critically ill patients and its reliability and validity. J Clin Nurs. 2025;34:795-804.
41. 41. Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM. Posttraumatic stress disorder in critical illness survivors: A meta-analysis. Crit Care Med. 2015;43(5):1121-1129.
42. 42. Zhu Y, Lv J, Wang X, Yang F, Zhang W. Knowledge, attitude, and practice regarding thirst management in surgical patients among intensive care unit nurses: A cross-sectional study. Nurs Crit Care. 2025;30(3):e13176.
43. 43. Goodman SPJ, Marino FE. Thirst perception exacerbates objective mental fatigue. Neuropsychologia. 2021;150:107686.
44. 44. Zhang X, He C, Wu J, He L, Liu H. Influence of drinking small amount of ice water to relieve thirst in patients with oral tracheal intubation based on safety protocol for thirst management. J Nurs (China). 2020;27(8):47–50.
45. 45. Yang X, Liu R. The effect of ice-cold water spray on improving oropharyngeal discomfort in patients with gastrointestinal tumors undergoing gastrointestinal surgery decompression. J Med Theory Pract. 2021;34:3821–3823.
46. 46. Gonzalez-Muniz R, Bonache MA, Martín-Escura C, Gómez-Monterrey I. Recent progress in TRPM8 modulation: An update. Int J Mol Sci. 2019;20(11):2618.
47. 47. Liu Y, Mikrani R, He Y, et al. TRPM8 channels: A review of distribution and clinical role. Eur J Pharmacol. 2020;882:173312.
48. 48. Tsai HY, Chao A, Hsiao WL. The effectiveness of cold oral stimuli in quenching postoperative thirst: A systematic review and meta-analysis. Intensive Crit Care Nurs. 2023;75:103359.
49. 49. Skoretz SA, Flowers HL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest. 2010;137(3):665–673.
50. 50. Han P, Suarez-Durall P, Mulligan R. Dry mouth: a critical topic for older adult patients. J Prosthodont Res. 2015;59(1):6–19.
51. 51. Lian R, Zhou S, Guo Y, et al. The effect of ice-cold water spray following the model for symptom management on postoperative thirst in patients admitted to intensive care unit: A randomized controlled study. Intensive Crit Care Nurs. 2024;81:103571.
52. 52. Flim M, Hofhuis J, Spronk P, Jaarsma T. Measuring thirst distress of patients in the intensive care unit. Nurs Crit Care. 2022;27(4):576–582.