Strategies for thirst relief: integrative literature review

an integrative review, for which the databases PubMed, LILACS, CINAHL and the group of references organized by the Group for Study and Research of Thirst were selected for the search of primary studies, with the keywords: thirst, ice, cold, intervention, nursing care, artificial saliva.

Results:

the review sample was composed of ten primary studies. The strategies found were: low temperature using frozen gauze, ice chips, and cold water, menthol associated with cold strategies, chewing gum, acupressure, and the use of a thin straw, substitute saliva, and early fluid ingestion.

Conclusion:

the temperature was presented as a predominant and effective strategy to relieve the thirst for surgical patients in intensive care and hemodialysis treatment.

Descriptors:
Thirst; Ice; Nursing Care; Low Temperature; Artificial Saliva

Year/ country/ database	Kind of study /evidence level (EL)	Objectives/method	Strategy	Main results
2015 USA Another source GSRT	Ford, McCormick, Teng, Parkosewich⁽¹⁹19 Ford C, McCormick D, Teng W, Parkosewich J. Early initiation of oral intake in adult patients after cardiothoracic surgery is safe and reduces thirst: results of a randomized clinical trial. Circulation [Internet]. 2015[ cited 2016 May 11];132(18 Suppl 3):A13586. Available from: http://circ.ahajournals.org/content/132/Suppl_3/A13586 http://circ.ahajournals.org/content/132/... ⁾ Randomized clinic trial (n = 149) NE = 2	To determine the effect of the early liberal regimen of ice chips and water on adverse events and thirst after cardiothoracic surgery. Patients were randomized to the liberal scheme, which offered ice chips one hour post-extubation then water. The usual regimen was 6-hour fast post-extubation.	Compare the liberal regimen to the usual regimen, evaluating thirst and the following events: nausea, vomiting, dysphagia, and aspiration pneumonia.	There was no statistically significant difference between groups with regard to adverse events. However, the liberal regimen was associated with a significant reduction in thirst. In appropriate patients, this strategy can reduce thirst and uncomfortable symptoms.
2015 Korea Another source GSRT	Moon, Lee, Leong⁽²²22 Moon YH, Lee YH, Jeong IS. A comparison of effect between wet gauze with cold normal saline and wet gauze with cold water on postoperative thirst, oral cavity condition, and saliva pH. J Korean Acad Fundam Nurs [Internet]. 2015[ cited 2016 Apr 12];22(4):398-405. Available from: http://j.kafn.or.kr/upload/pdf/jkafn-22-4-398.pdf http://j.kafn.or.kr/upload/pdf/jkafn-22-... ⁾ Quasi-experimental study (n = 56) NE = 3	Compare the effect between wet gauze with cold saline (experimental group) and wet gauze with cold water (control group) on thirst, oral cavity condition and saliva pH of patients in the immediate postoperative period. The groups received the intervention three times with a 15-minute interval.	Comparison of the effect of gauze with cold saline and gauze with cold water.	Thirst, condition of oral cavity and saliva pH in both groups improved with an increasing number of gauze applications. The reduction in thirst intensity was higher in the experimental group (p = 0.009). There was no difference in the oral cavity condition and pH of saliva between the groups.
2014 China PubMed	Yin, Ye, Zhao, Li, Song⁽²⁰20 Yin X, Ye L, Zhao L, Li L, Song J. Early versus delayed postoperative oral hydration after general anesthesia: a prospective randomized trial. Int J Clin Exp Med [Internet]. 2014[ cited 2016 May 11];7(10): 3491-96. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4238515/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾ Randomized clinic trial (n = 983) NE = 2	To determine the safety and tolerability of early oral rehydration compared with delayed oral rehydration after general anesthesia. The control group received water four hours after anesthesia and those in the experimental group received 0.5 mL/Kg of water when recovered from anesthesia.	Comparison between early and late oral hydration. The outcomes evaluated were nausea, vomiting, desire for liquid, thirst, oropharyngeal discomfort and satisfaction.	Early oral rehydration was safe. Patients in the experimental group showed greater satisfaction, less intense thirst and oropharyngeal discomfort (outcomes measured using scales).
2014 EUA PubMed	Puntillo, Arai, Cooper, Stotts, Nelson⁽¹⁰10 Puntillo KA, Arai SR, Cooper BA, Stotts NA, Nelson JE. A randomized clinical trial of an intervention to relieve thirst and dry mouth in intensive care unit patients. Intensive Care Med [Internet]. 2014[ cited 2016 May 11];40(9):1295-302. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4149585/pdf/nihms603963.pdf https://www.ncbi.nlm.nih.gov/pmc/article... ⁾ Randomized clinic trial (n = 252) NE = 2	To test an intervention bundle for thirst intensity, thirst distress, and dry mouth. Participants were admitted to intensive care units. The control group received usual care and the intervention group received the intervention bundle.	Intervention bundle: cold water spray, mentholated lip hydration and oral swabs. Both thirst intensity and discomfort were assessed.	There was a significant decrease in the mean thirst intensity and suffering in the intervention group compared to the usual care group. The usual care group was 1.9 times more likely to report dry mouth for each intervention session.
2013 China PubMed	Fan, Zhang, Luo, Niu, Gu⁽²¹21 Fan WF, Zhang Q, Luo LH, Niu JY, Gu Y. Study on the clinical significance and related factors on thirst and xerostomia in maintenance hemodialysis patients. Kidney Blood Press Res [Internet]. 2013[ cited 2016 Apr 12];37(4 -5):464-74. Available from: http://www.karger.com/Article/Pdf/355717 http://www.karger.com/Article/Pdf/355717... ⁾ Observational study (n = 42) NE = 4 Randomized clinical trial crossover (n = 11) NE = 2	To analyze the clinical significance and related factors of thirst and xerostomia in hemodialysis patients. The patients received chewing gum (six to 10 times a day or as desired) or a thin straw for sucking water in the first two weeks. After two weeks of wash-out, the thin straw was used during the last two weeks.	Comparison between chewing gum and thin straw to drink water in patients on dialysis. DTI= dialysis thirst inventory VAS= visual analogic scale to measure the thirst Xerostomia measured by VAS= visual analogic scale and XI=inventory to measure the xerostomia.	There was a strong positive correlation between the DTI and VAS to measure thirst, and DIT and VAS to measure xerostomia. In the crossover trial, scores of the DTI to measure xerostomia and of VAS to measure thirst and xerostomia and gain of interdialytic weight were significantly reduced by chewing gum. The VAS scores to measure thirst, DTI and gain of interdialytic weight were significantly reduced by the use of thin straw.
2012 Brazil CINAHL	Aroni, Nascimento, Fonseca⁽¹¹11 Aroni P, Nascimento LA, Fonseca LF. Assessment strategies for the management of thirst in the post-anesthetic recovery room. Acta Paul Enferm [Internet]. 2012[ cited 2016 May 11];25(4):530-6. Available from: http://www.scielo.br/pdf/ape/v25n4/en_08.pdf http://www.scielo.br/pdf/ape/v25n4/en_08... ⁾ Quasi-experimental study (n = 90) NE = 3	To assess strategies to alleviate thirst in the immediate postoperative period. Patients with thirst were divided into two groups (intervention group = ice and control group = water). An assessment and intervention were performed every 10 minutes for one hour.	Comparison between the use of ice (2 mL) and water (2 ml) to alleviate patient’s thirst in the immediate postoperative period.	75% of patients reported thirst. The initial mean intensity of thirst was 5.1 (water group) and 6.1 (group ice), and the final intensity was 2.33 and 1.51 respectively. The difference was not statistically significant; it was inferred that the small volume of ice was not allowed the biggest difference between the groups.
2011 Korea Another source GSRT	Yoon, Min⁽²³23 Yoon SY, Min HS. The effects of cold water gargling on thirst, oral cavity condition, and sore throat in orthopedics surgery patients. Korean J Rehabil Nurs. 2011;14(2):136-44.⁾ Study quasi-experimental, pre-test and post-test with group- no equivalent control (n = 52) NE = 3	To identify the effects of gargling with cold water on thirst and the oral cavity condition, and throat pain in patients undergoing orthopedic surgery with general anesthesia, at 0, 2, 4 and 8 hours after surgery.	Comparison between the use of gargling with cold water (intervention group) and wet gauze (control group).	The score of thirst intensity was lower, and the conditions of the oral cavity were better in the experimental group. However, there was no significant difference in the levels of a sore throat among the groups.
2010 Taiwan PubMed	Yang, Yates, Chin, Kao⁽²⁵25 Yang LY, Yates P, Chin CC, Kao TK. Effect of acupressure on thirst in hemodialysis patients. Kidney Blood Press Res [Internet]. 2010[ cited 2016 Apr 12];33(4):260-5. Available from: http://www.karger.com/Article/Pdf/317933 http://www.karger.com/Article/Pdf/317933... ⁾ Quasi-experimental with single group repeated measures (n = 28) NE = 3	To assess the impact of an acupressure program on thirst intensity and salivary flow in patients on hemodialysis. The patients received a placebo for four weeks at predetermined acupoints, three times a week. Then the patients received acupressure for four weeks.	Comparison between acupressure intervention and adhesive intervention to acupressure (placebo) to decrease the intensity of thirst and increase the salivary flow of patients on dialysis.	The acupressure was associated with significant increase in saliva flow rate (p = 0.04). The mean score of thirst intensity was reduced from 4.21 to 2.43.
2010 Korea PubMed	Cho, Kim, Park⁽²⁴24 Cho EA, Kim KH, Park JY. Effects of frozen gauze with normal saline and ice on thirst and oral condition of laparoscopic cholecystectomy patients: pilot study. J Korean Acad Nurs. 2010;40(5):714-23.⁾ Study quasi-experimental, pretest / post-test, no equivalent control group (n = 53) NE = 3	To examine the effects of ice, gauze with frozen saline and humid gauze on thirst and oral condition of patients in the immediate postoperative period, divided into three groups. The intensity level of the thirst and oral conditions were evaluated three times and every 15 minutes.	Comparison between groups with ice, frozen gauze with saline and humid gauze.	There was a statistically significant difference in the thirst intensity level between the groups after the second intervention. The tongue condition, saliva, oral mucosa and gingiva improved in patients receiving gauze with frozen saline solution or ice.
2005 Holland PubMed	Bots, Brand, Veerman, Korevaar, Valentijn-Benz, Bezemer, Valentijn, Vos, Bejesma, Wee, Van Amerongen, Nieuw Amerongen⁽⁷7 Bots CP, Brand HS, Veerman EC, Korevaar JC, Valentijn-Benz M, Bezemer PD, et al. Chewing gum and a saliva substitute alleviate thirst and xerostomia in patients on haemodialysis. Nephrol Dial Transplant [Internet]. 2005[ cited 2016 May 10];20(3):578-84. Available from: http://ndt.oxfordjournals.org/content/20/3/578.full.pdf+html http://ndt.oxfordjournals.org/content/20... ⁾ Randomized clinical trial crossover (n = 65) NE = 2	To investigate the effect of chewing gum or salivary substitute for dry mouth, thirst, and interdialytic weight gain. Chewing gum and saliva substitute were used for two weeks, there was a wash-out period of two weeks and, then, the other scheme was introduced. Xerostomia, thirst and weight gain rates were evaluated at baseline and after each treatment period.	Comparison between groups of chewing gum and saliva substitute.	The chewing gum reduced the Xerostomia Inventory Score from 29.9 to 28.1. Both the chewing gum and the salivary substitute significantly reduced the DTI scores, but no change occurred in dialysis weight gain.

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[1] CORRESPONDING AUTHOR Aline Korki Arrabal Garcia. E-mail: alinekorki@yahoo.com.br