Evaluation of sound pressure levels in a pediatric intensive care unit

Caroline de Araújo Mendes, Carlos Roberto Lyra da Silva, Luciane Velasque de Souza, Adriana Carla Bridi, Joice Alves Cabral, Luana Borges Dutra, Raphael Neves Barreiros, Andrea dos Santos Garcia, Margarida dos Santos Salú, Natália Barroso


This study objectives were to measure the sound pressure levels found in the pediatric intensive care unit in a federal institution of Rio de Janeiro; to verify differences in noise levels during the morning and afternoon; to confront the sound pressure levels found against acceptable levels according to national and international noise organizations; to count the quantity of alarms triggered by each type of medical care equipment selected (multiparameter monitor, mechanical ventilator and infusion pump); to verify the relevance in the scientific world about pediatric intensive care unit noise through bibliometrics and to address the trinomial care technology - noise - implications on care. It’s an observational, exploratory, quantitative study, organized in three steps: Parameter collection and decibel meter calibration - data were based on the study by Salú, et al (2015) ; Data collection: 40 hours of discontinued observation (8am to 16pm) on different days for a period two months using two decibel meters; Data processing: An Excel spreadsheet was created for the database and data analysis was performed with the help of Microsoft Office Excel 2010 and Program R, organized into graphs and tables. 61% of the alarms corresponded to the mechanical ventilator; Bed E had the lowest standard deviation (SD = 2.945) and the highest median (69.5dBA). Even by removing the E bed from the analysis, there is a significant difference (p <0.001) between sound pressure levels. The median of the afternoon (28.2dBA); and morning (26.1dBA). Mechanical fan and monitor generated higher sounds; the pediatric intensive care unit has considerably exceeded that recommended by national and international noise organizations; afternoon generated higher sounds than morning. Keywords: Noise Meters; Noise; Intensive care; Pediatrics


Noise Meters; Noise; Intensive care; Pediatrics

Full Text:



- Bosch-Alcaraz A, Falcó-Pegueroles A, Jordan I. A literature review of comfort in the paediatric critical care patient. J. of Clinical Nurs [internet]. 2018 [last accessed on 2019 oct. 2]; 27(13-14):2546-2557. Available from: https://doi.org/10.1111/jocn.14345.

- Oliveira F, de Paiva MB, Nascimento MAdeL, Rezende VM, da Silva AS, da Silva CRL. Nível de ruído da unidade de terapia intensiva pediátrica: estudo observacional correlacional. Braz. J. Nurs [internet]. 2013 set. [last accessed on 2018 apr. 12]; 12(2):431-441. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4043.

- Hamze F, Souza CC, Chianca TCM. Influência das intervenções assistências na continuidade do sono de paciente na unidade de terapia intensiva. 2015 [last accessed on 2018 apr. 13]. Available from: http://www.scielo.br/pdf/rlae/v23n5/pt_0104-1169-rlae-23-05-00789.pdf.

- Anvisa (BR). Resolução n 7, 2010 fev. 24: dispõe sobre os requisitos mínimos para Unidades de Terapia Intensiva e dá outras providências. Brasília: Anvisa; 2010.

- Basner M, Babisch W, Davis A, Brink M, Clark C, Janssen S, et al. Auditory and non-auditory effects of noise on health. Lancet. 2014; 383(9925):1325-1332. doi:10.1016/s0140-6736(13)61613-x

- Cardoso SMS, Kozlowski LC, Lacerda AB, Marques JM, Ribas A. Newborn physiological responses to noise in the

neonatal unit. Braz J Otorhinolaryngol. 2015; 81(6):583–588. doi:10.1016/j.bjorl.2014.11.008

- Disher TC, Benoit B, Inglis D, Burgess SA, Ellsmere B, Hewitt BE, et al. Striving for Optimum Noise-Decreasing Strategies in Critical Care: Initial Measurements and Observations. J Perinat Neonat Nurs. 2017; 31(1):58-66.

- Gadeke R, Doring B, Keller F, Vogel A. The noise level in a children’s hospital and the wake-up threshold in infants. Acta Paediatr Scand. 1969; (58):164–170.

- Galindo APG, Caicedo YC, Pereira AMV. Nivel de ruido en la unidad de cuidado intensivo adulto: Medición, estándares internacionales e implicancias sanitarias. Universidad Y Salud. 2015; 17(2):163-169.

- Kudchadkar S, Aljohani O, Punjabi N. Sleep of critically ill children in the pediatric intensive care unit: a systematic review. Sleep Med Rev. 2014; 18(2):103–110. doi:10.1016/j.biotechadv.2011.08.021. [Secreted].

- Smith HAB, Fuchs DC, Pandharipande PP, Barr FE, Ely EW.

Delirium: an emerging frontier in the management of critically ill children. Anesthesiol Clin. 2011; 29(4):729–750. doi:10.1016/j.anclin.2011.09.011.

- Berglund B, Lindvall T, Schwela D. Guidelines for community noise [internet]. 1999. Available from: http://www.moa.gov.cy/moa/environment/environmentnew.nsf/69D658BCCDE2FDB5C2258041002D61F5/$file/Guidelines%20for%20Community%20Noise%20-%20WHO.pdf >

- Who (Int.). Guidelines for community noise: 4 guidelines values [internet]. 1999 [last accessed on 2019 jan. 13]. Available from: http://www.who.int/docstore/peh/noise/Commnoise4.htm.

- American academy of pediatrics joint committee on infant hearing (US). Position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007 [last accessed on 2018 may 3]; 120(4):898-921. Available from: https://pediatrics.aappublications.org/content/120/4/898.

- Kakehashi TY, Pinheiro EM, Pizzarro G, Guilherme A. Noise level in neonatal intensive unit. Acta Paul. Enferm [internet]. 2007 dez. [last accessed on 2018 may 21]; 20(4): 404-409. Available from: http//www.scielo.br/pdf/ape/v20n4/02.pdf.

- United States environmental protection agency (US). Information on levels of environmental noise requisite to protect public health and welfare with an adequate margin of safety [Report]. Washington: Government Printing Office [internet]. 1974 [last accessed on 2018 jul. 12]. Available from: http://www.epa.gov/storet/dbtop.html.

- Macedo ISC, Mateus DC, Costa EMGC, Asprino ACL, Lourenço EA. Noise assessment in intensive care units. Braz. J. Otorhinolaryngol [internet]. 2009 dez. [last accessed on 2018 may 19]; 75(6):844-846, dez. 2009. Available from: http//www.scielo.br/pdf/bjorl/v75n6a12.pdf.

- ABNT (BR). NBR 10152: níveis de ruído para o conforto acústico. Rio de Janeiro: ABNT. 1987.

- Galindo APG, Caicedo Y, Camargo VPAM. Noise level in intensive care units of a public university hospital in Santa Marta (Colombia). Medicina Intensiva [english edition]. 2016; 40(7):403-410.

- Bridi AC, et al. Tempo estímulo-resposta da equipe de saúde aos alarmes de monitorização na terapia intensiva: implicações para a segurança do paciente grave. Rev. Bras. Ter. Intensiva [internet]. 2014 mar. [last accessed on 2019 oct. 6]; 26(1): 28-35. Available from: http://dx.doi.org/10.5935/0103-507X.20140005.

- Santos F, Silva RCL, Ferrão PPDA, Ribeiro AS, Passamani RF. Fadiga de alarmes de equipamentos eletromédicos em terapia intensiva. Rev. Enferm. UFPE [internet]. 2014 mar. [last accessed on 2019 aug. 7]; 8(3):687-694. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/9726.

- Siebig S, Kuhls S, Imhoff M, Langgartner J, Scholmerich J, Gather U, et al. Collection of annotated data in a critical validation study for alarm algorithms in intensive care-a methodologic framework. J. Crit. Care [internet]. 2010 [last accessed on 2019 oct. 6]; 25(1):128-135. Available from: https://doi.org/10.1016/j.jcrc.2008.09.001.

- Kaur H, Rohlik GM, Nemergut ME, Tripathi S. Comparison of staff and family perceptions of causes of noise pollution in the Pediatric Intensive Care Unit and suggested intervention strategies. Noise Health. 2016; 18:78-84.

- Goldstein J, Laliberte A, Keszler M. Ambient Noise Production by High-Frequency Neonatal Ventilators. The Journal of pediatrics. 2019; 204:157-161.

- Uchoa NT, Procianoy RS, Lavinsky L, Sleifer P. Prevalência de perda auditiva em recém-nascidos de muito baixo peso. J. Pediatr. [internet]. 2003 [last accessed on 2018 nov. 15]; 79(2):123-128. Available from: http://dx.doi.org/10.1590/S0021-75572003000200006.

- Grecco GM, Tsunemi MH, Balieiro MMFG, Kakehashi TY, Pinheiro EM. Repercussões do ruído na unidade de terapia intensiva neonatal. Acta Paul. Enferm [internet]. 2013 [last accessed on 2018 jun. 11]; 26(1):1-7. Available from: http://www.scielo.br/pdf/ape/v26n1/02.pdf.

- Bremmer P, Byers JF, Kiehl E. Noise and the premature infant: physiological effects and practice implications. J. ObstetGynecol Neonatal Nurs [internet]. 2003 [last accessed on 2018 jun. 9]; 3(4):447-454. Available from: https://doi.org/10.1177/0884217503255009.

- Krueger C, Wall S, Parker L, Nealis R. Elevated sound levels within a busy NICU. Neonatal Netw [internet]. 2005 [last accessed on 2019 may 2]; 24(6):33-37. Available from: https://connect.springerpub.com/content/sgrnn/24/6/33.

- Darbyshire JL, Muller-trapet M, Cheer J, Fazi FM, Young JD. Mapping sources of noise in an intensive care unit. Anaesthesia. 2019; 74(8):1018-1025.

- Salú MS, Louro TQ, Tonini T, da Silva RCL, de Figueiredo NMA, da Silva CRL. Níveis de pressão sonora em uma unidade de terapia intensiva pediátrica. Rev. Enferm. UFPE [internet]. 2015 fev. [last accessed on 2018 aug. 16]; 9(2): 918-926. Available from: https://pdfs.semanticscholar.org/c8ae/5edf555dd1fbf1dace55a726d266e98c12e4.pdf.

- Williams A, van Drongelen W, Lasky RE. Noise in contemporary neonatal intensive care. J Acoust Soc Am. 2007; 121:2681-2690.

- Lasky RE, Williams AL. Noise and light exposures for extremely low birth weight newborns during their stay in the neonatal intensive care unit. Pediatrics. 2009; 123:540-546.

- Smith SW, Ortmann AJ, Clark WW. Noise in the neonatal intensive care unit: a new approach to examining acoustic events. Noise Health. 2018 [last accessed on 2020 feb 17]; 20:121-130. Available from: http://www.noiseandhealth.org/text.asp?2018/20/95/121/239583..

- Knutson A. Acceptable Noise Levels for Neonates in the Neonatal Intensive Care Unit. Independent Studies and Capstones. 2013[last accessed on 2020 feb 17]. Available from: http://digitalcommons.wustl.edu/pacs_capstones/643.

- Darcy AE, Hancock LE, Ware EJ. A descriptive study of noise in the neonatal intensive care unit: Ambient levels and perceptions of contributing factors. Adv Neonatal Care. 2008; 8:165-75.

- Chawla S, Barach P, Dwaihy M, Kamat D, Shankaran S, Panaitescu B, et al. A targeted noise reduction observational study for reducing

noise in a neonatal intensive unit. Journal of Perinatology. 2017; 37:1060-1064.

- Kol E, Aydın P, Dursun O. The effectiveness of environmental strategies on noise reduction in a pediatric intensive care unit: creation of single-patient. Journal for Specialists in Pediatric Nursing. 2015; 20:210-217. doi:10.1111/jspn.12116.

- Cvach M. Monitor alarm fatigue: an integrative review. Biomed. Instrum. Technol. [internet]. 2012 [last accessed on 2019 oct. 3]; 46(4):268-277. Available from: https://doi.org/10.2345/0899-8205-46.4.268.

- Graham KC, Cvach M. Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms. Am. J. Crit. Care, [internet]. 2010 [last accessed on 2019 oct. 4]; 19(1):28-34. Available from: http://ajcc.aacnjournals.org/content/19/1/28.short.

- Kawai Y, Weatherhead JR, Traube C, Owens TA, Shaw BE, Fraser EJ, et al. Quality improvement initiative to reduce pediatric intensive care unit noise pollution with the use of a pediatric delirium bundle. J Intensive Care Med. 2019; 34(5):383-390.

- Al-Samsam RH, Cullen P. Sleep and adverse environmental factors in sedated mechanically ventilated pediatric intensive care patients. Pediatr Crit Care Med. 2005; 6(5):562-567.

- Carvalho WB, Pedreira ML, de Aguiar MA. Noise level in a pediatric intensive care unit. J Pediatr.: Rio de janeiro. 2005; 81(6):495-498.

- McAndrew NS, Leske J, Guttormson J, Kelber ST, Moore K, Dabrowski S. Quiet time for mechanically ventilated patients in the medical intensive care unit. Intensive Crit Care Nurs. 2016; 35:22-27.

- Elbaz M, Leger D, Sauvet F, et al. Sound level intensity severely disrupts sleep in ventilated ICU patients throughout a 24-h period: a preliminary 24-h study of sleep stages and associated sound levels. Ann Intensive Care. 2017; 7(1):25.

- Graven SN. Sound and the developing infant in the NICU: conclusions and recommendations for care. J Perinatol. 2000; 20(8[2]):S88–S93.

- Bailey E, Timmons S. Noise levels in PICU: An evaluative study. Pediatric Nursing. 2005; 17(10):22-26.

- Cranmer K, Davenport L. Quiet time in a pediatric medical/surgical setting. Journal of PediatricNursing. 2013; 28:400–405.

- Jousselme C, Vialet R, Jouve E, Lagier P, Martin C, Michel F. Efficacy and mode of action of anoise-sensor light alarm to decrease noise in thepediatric intensive care unit: A prospective randomizedstudy. Pediatric Critical Care Medicine. 2011; 12:e69–e72.

- Shaffner DH. What does it take to get some peace and quiet in the pediatric intensive care unit? Pediatric Critical Care Medicine. 2011; 12(2):238-240.

- Richardson A, Allsop M, Coghill E, Turnock C. Earplugs and eye masks: do they improve critical care patients′ sleep? Nurs. Crit. Care. 2007; 12:278-86.

- Johansson L, Bergbom I, Waye KP, Ryherd E, Lindahl B. The sound environment in an ICU patient room: a content analysis of sound levels and patient experiences. Intensive Critical Care Nursing, [internet]. 2012 [last accessed on 2018 sep. 22; (28):269-279. Available from: https://doi.org/10.1016/j.iccn.2012.03.004.

- Viana RAPP, Vargas MAO, Carmagnani MIS, Tanaka LH, da Luz KR, Schmitt PH. Perfil do enfermeiro de terapia intensiva em diferentes regiões do Brasil. Texto contexto-enferm [internet]. 2014 mar. [last accessed on 2018 nov. 9]; 23(1). Available from: http://www.scielo.br/pdf/tce/v23n1/pt_0104-0707-tce-23-01-00151.pdf.

DOI: https://doi.org/10.23954/osj.v5i2.2415


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Open Science Journal (OSJ) is multidisciplinary Open Access journal. We accept scientifically rigorous research, regardless of novelty. OSJ broad scope provides a platform to publish original research in all areas of sciences, including interdisciplinary and replication studies as well as negative results.