The Sound Environment in the PICU: A Scoping Review Describing Sound Levels, Interventions and Patient Impacts

Abstract

Elevated sound levels are associated with increased morbidity in adult and neonatal intensive care; however, their impact in the paediatric intensive care unit (PICU) remains poorly characterised. The aim of this scoping review was to characterise sound exposure in the PICU, including its measurement, sources, and associations with patient outcomes. MEDLINE, Embase, PsycINFO (Ovid), and PubMed were searched up to 5 November 2025 for full-text, peer-reviewed publications within the past 10 years to reflect the contemporary PICU environment. Titles, abstracts, and full texts were independently screened by two authors, and results were reported according to the PRISMA Extension for Scoping Reviews. Thirty-six publications were included. Publications were grouped into five domains: measurement of sound levels; sources of sound; patient impacts; sound reduction interventions including care bundles incorporating sound descriptions; and other. Reported sound levels varied substantially across studies, reflecting heterogeneity in measurement approaches and clinical contexts. Most studies reported sound levels above WHO recommendations, and several reported maximum levels exceeding 80 dBA. Sound sources were broadly categorised as medical equipment, human activity, and environmental factors. Links between elevated sound and clinically meaningful outcomes remain uncertain. Intervention studies were limited, often behaviour-focused, and rarely evaluated patient-centred outcomes or clinical sustainability. Current evidence suggests WHO recommended sound levels are rarely achieved. The sound environment in the PICU is multifaceted, reflecting the interaction of clinical equipment, human activity, and environmental systems. There is a need for interventional research to evaluate whether modification of the PICU sound environment meaningfully improves patient outcomes.