{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T07:01:19Z","timestamp":1790060479590,"version":"4.0.1"},"reference-count":12,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Elevated night\u2010time noise in intensive care units (ICUs) may reduce alarm salience, increase cognitive workload and contribute to alarm desensitisation during bedside surveillance. Most evaluations of Quiet ICU interventions have used uncontrolled or quasi\u2010experimental designs, limiting causal inference.<\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n To evaluate whether a structured bed\u2010level Quiet ICU bundle reduced nocturnal acoustic burden in an adult ICU while preserving alarm visibility for clinical surveillance.<\/jats:p>\n <\/jats:sec>\n \n Study Design<\/jats:title>\n This prospective, randomised counterbalanced crossover study was conducted in an adult intensive care unit in Singapore. Eligible bed\u2010episodes were assigned to one of two 4\u2010night sequences: AABB or BBAA, where A represented usual care and B represented Quiet ICU. The Quiet ICU bundle included muting bedside ventilator and monitor alarm audio while maintaining central alarm visibility, alongside alarm\u2010hygiene measures and quieter communication. Acoustic monitoring was performed overnight from 10:00 PM to 6:00 AM. The primary outcome was equivalent continuous sound level (LAeq); secondary outcomes were maximum sound level (Lmax) and time above 80\u2009dBA. Repeated bed\u2010night observations were analysed using linear mixed\u2010effects models.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Sixty\u2010nine monitored bed\u2010episodes contributed 220 analysed nights. Compared with usual care, Quiet ICU reduced LAeq (adjusted mean difference \u22124.56\u2009dBA, 95% CI \u22125.69 to \u22123.43;\n p<\/jats:italic>\n \u2009<\u20090.001), Lmax (\u22127.77\u2009dBA, 95% CI \u22129.47 to \u22126.06;\n p<\/jats:italic>\n \u2009<\u20090.001) and time above 80\u2009dBA (\u22122.43\u2009min, 95% CI \u22123.63 to \u22121.23;\n p<\/jats:italic>\n \u2009<\u20090.001). The LAeq reduction was likely noticeable in practice. Bedside alarm audio was reactivated on 2 of 113 Quiet ICU nights (1.8%). No safety incidents were identified.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A structured bed\u2010level Quiet ICU bundle reduced night\u2010time acoustic burden while preserving central alarm visibility. Effects on alarm response, staff workload and patient outcomes remain uncertain.<\/jats:p>\n <\/jats:sec>\n \n Relevance to Clinical Practice<\/jats:title>\n In ICUs with reliable central monitoring and clear alarm\u2010governance processes, a Quiet ICU bundle may offer a feasible, low\u2010resource strategy to reduce bedside noise.<\/jats:p>\n <\/jats:sec>\n \n Study Registration<\/jats:title>\n \n OSF Registries; DOI:\n 10.17605\/OSF.IO\/AM59F<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/nicc.70633","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T01:29:50Z","timestamp":1786584590000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reducing Night\u2010Time Sound Levels Through Bed\u2010Level Quiet\n ICU<\/scp>\n Bundle: A Randomised Counterbalanced Crossover Study in Adult Intensive Care"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4055-5222","authenticated-orcid":false,"given":"Wei Jun Dan","family":"Ong","sequence":"first","affiliation":[{"name":"College of Health Sciences, Rush University Chicago Illinois USA"},{"name":"Respiratory Therapy Department Ng Teng Fong General Hospital (NUHS) Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0361-6209","authenticated-orcid":false,"given":"Adrian Ujin","family":"Yap","sequence":"additional","affiliation":[{"name":"Clinical Research Unit and Office of the Chairman, Medical Board, Ng Teng Fong General Hospital, National University Health System Singapore Singapore"},{"name":"Duke\u2010NUS Medical School, National Dental Research Institute Singapore, and National Dental Singapore, Singapore Health Services Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woon Hean Keenan","family":"Chong","sequence":"additional","affiliation":[{"name":"Intensive Care Medicine, Ng Teng Fong General Hospital (NUHS) Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5516-7107","authenticated-orcid":false,"given":"Lawrence Ace","family":"Azul","sequence":"additional","affiliation":[{"name":"Respiratory Therapy Department Ng Teng Fong General Hospital (NUHS) Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Leong","sequence":"additional","affiliation":[{"name":"Nursing Administration Ng Teng Fong General Hospital (NUHS) Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7709-0214","authenticated-orcid":false,"given":"Faheem Ahmed","family":"Khan","sequence":"additional","affiliation":[{"name":"Intensive Care Medicine, Ng Teng Fong General Hospital (NUHS) Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40635\u2010020\u201000321\u20103"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2024.103810"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/nop2.1792"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010024\u201012059\u20109"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912\u2010023\u201001611\u20103"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnr.2026.152087"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.14044"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.51893\/2020.4.OA9"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2026.104349"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.13095"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000885"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010025\u201094365\u20108"}],"container-title":["Nursing in Critical 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