Application of a Comprehensive Sound Environment Management Program to Reduce the Incidence of Delirium in a Pediatric Intensive Care Unit: A Quasi-Experimental Study

Huangjia Song¹Hanjun Huang²Bingxin Wang³Yuru Zhang¹Wen Qian¹Yaqin Hu¹Yaya Xu¹Xiaohua Ge^2*Lili XU^1*

• ¹Department of Pediatric Critical Care Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
• ²Department of Ideological and Humanistic Education, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
• ³Shanghai General Hospital, Shanghai, China

Objective: To evaluate the effectiveness of a sound environment management program in preventing pediatric delirium (PD) in the pediatric intensive care unit (PICU), and to provide evidence for improving the quality of nursing care and reducing PD incidence. Methods: A sound environment management program was implemented and evaluated using a quasi-experimental design. Patients admitted to the PICU of a tertiary general hospital in Shanghai, China, were recruited by convenience sampling. A total of 354 patients were included and divided into three groups: 139 patients admitted from October 2022 to May 2023 served as the control group (Group A); 109 patients admitted from July to November 2023 received sound environment control (Group B); and 106 patients admitted from December 2023 to April 2024 received sound environment control combined with white noise (WN) intervention (Group C). The control group received routine nursing care, while the intervention groups received additional noise control measures or noise control combined with WN masking. Differences among the three groups were compared in terms of PD incidence, subtype distribution, cortisol level changes, and noise parameters. Results: The incidence of PD was 47.5% (66/139) in Group A, 36.7% (40/109) in Group B, and 31.1% (33/106) in Group C (P = 0.027). The proportion of PD days was 30.7% (190/619) in Group A, 23.6% (107/453) in Group B, and 23.1% (100/433) in Group C (P = 0.006). The incidence of hypoactive PD was 18.7%, 11.9%, and 6.6% in Groups A, B, and C, respectively (P = 0.019). The time effect (P < 0.001) and group-by-time interaction effect (P = 0.002) for cortisol levels across PICU days were both statistically significant. Among the 24-hour acoustic parameters, significant differences were observed in maximum sound level (LAmax, P < 0.001) and minimum sound level (LAmin, P < 0.001). Conclusion: Implementation of a comprehensive sound environment management program in the PICU effectively reduced environmental noise and PD incidence while attenuating stress responses in critically ill children. The program demonstrated significant clinical potential in improving nursing quality and promoting both psychological and physiological stability in pediatric patients.