Introduction

The neurocritical care unit (NCCU) is among the most technologically complex hospital environments. Continuous monitoring, alarms, and high staff activity often elevate ambient noise above the World Health Organization’s recommended limit of 40–45 dB at night. Excessive and sustained noise is not a mere inconvenience it is a physiologic stressor that adversely affects patients and healthcare professionals alike. Neurocritically ill patients are particularly susceptible to the harmful effects of sound exposure. Studies have demonstrated that noise in intensive care units (ICUs) can increase intracranial pressure (ICP), alter autonomic tone, disrupt circadian rhythms, and promote delirium and anxiety^1,3,6. For ventilated patients, excessive alarms and mechanical noise may worsen patient–ventilator asynchrony and contribute to secondary metabolic and hemodynamic instability^3,10. Beyond patient outcomes, ICU personnel exposed to high ambient noise levels report higher stress, cognitive fatigue, and burnout^2,8.

Despite its significance, noise control in neurocritical care remains underemphasized compared with hemodynamic or respiratory optimization. The ABC framework encompassing ambient control, Behavioral interventions, and Clinical device adjustments is proposed as a structured, conceptual model to guide hospitals in mitigating environmental noise. Drawing on existing literature and clinical observation, this framework aims to reduce acoustic stressors, improve patient stability, and enhance staff well-being ^4,5.

ABC Noise Prevention Strategies in Neurocritical Care

Discussion

The ABC framework offers a comprehensive yet pragmatic approach to noise mitigation in the NCCU. By combining architectural improvements, behavioral modification, and technology-based interventions, the model allows for targeted yet synergistic control of environmental sound. One anticipated concern involves the reduction of auditory alarms in favor of visual or vibratory systems. The objective is not to eliminate critical auditory cues but to recalibrate alarm delivery using multimodal signaling that balances safety with sound reduction. Recent studies confirm that visual and tactile alerts, when appropriately prioritized, maintain or even enhance clinician responsiveness while lowering cognitive load and acoustic fatigue^11,13. Clinical evidence supports that noise control directly influences neurophysiologic stability and recovery. Reduced ambient sound has been linked to fewer ICP spikes, improved sleep efficiency, and decreased delirium rates^1,6,9,12. A quiet environment also benefits staff, lowering perceived stress and fatigue while supporting attentiveness and job satisfaction^2,8. These improvements reinforce the premise that acoustic optimization is integral to both patient safety and occupational health.

The ABC model remains, at present, a conceptual framework derived from current evidence and multidisciplinary experience. Future studies should evaluate its implementation through multicenter trials measuring physiological outcomes (ICP stability, delirium incidence, autonomic variability) and human factors (sleep, burnout, satisfaction). Sustained benefit will depend on institutional commitment, education, and periodic feedback echoing findings from sustainable noise reduction programs^5,7.

Conclusion

Noise in the NCCU represents a modifiable risk factor influencing neurologic recovery, circadian balance, and staff well-being. The proposed ABC framework: Ambient, Behavioral, and Clinical interventions provide a structured pathway for healthcare institutions to address this overlooked aspect of patient safety. Through environmental redesign, culture-building, and technological innovation, neurocritical care units can evolve into quieter, safer, and more restorative settings. Future prospective evaluations are warranted to validate the measurable impact of these strategies on both physiologic and psychosocial outcomes.
 

Declarations

Funding: The authors received no financial support for the research, authorship, or publication of this article.

Conflicts of Interest: The authors declare no conflicts of interest related to this work.

Ethical Approval: Not applicable. This study did not involve human participants or animals.

Informed Consent: Not applicable, as no individual patient data are presented.

Author Contributions: All authors contributed substantially to the conception, drafting, and revision of this manuscript. L.R.M.-S., V.C., S.M.P., and T.J. collaboratively developed the concept and framework. V.C. prepared the initial draft. All authors critically revised the work, approved the final version, and agree to be accountable for its content.

Acknowledgments:

The authors thank healthcare professionals and neurocritical care teams worldwide for their dedication to patient safety and well-being, which inspired the development of this framework.