E. Duffy1, J. Garry1, J. Vosswinkel1, D. Fitzgerald1, K. Grant1, C. Minardi1, M. Dookram1, R. S. Jawa1 1Stony Brook University Medical Center,Stony Brook, NY, USA
Introduction: Mechanically ventilated patients cannot communicate verbally, creating challenges in addressing their needs. They must rely on alternative means for communication: writing, head nodding, communication boards (CB), etc. It has been suggested that this deficit may be addressed with eye-tracking devices (ETD), tablet-like devices that allow screen selection and enunciation of requests through eye gaze tracking. These devices have traditionally been used by patients with neurodegenerative diseases. We hypothesized that ETDs would be useful in mechanically ventilated surgery/trauma intensive care unit (SICU) patients.
Method: A prospective pilot study was conducted in a tertiary care SICU. A convenience sample was recruited over 5 weeks; the study was conducted Monday-Friday. All adult (age > 18) patients expected to continuously receive mechanical ventilation for > 48 hours, with a RASS score ≥-1 to ≤1 were evaluated. Exclusion criteria included TBI patients with GCS <15, stroke, eye injury, non-English speakers, and pregnant women. Patients were asked five basic needs questions (pain, temperature, position, suctioning) with the ETD and the CB, in random order. Patients were also prompted to communicate anything else they wished. Response accuracy was verified with head nod, hand movement, or blinking. An occupational therapist or SICU nurse served as an objective observer. Both the patient and the observer were surveyed at the end of the session regarding their experience.
Results: Of the 95 patients screened, 90 were excluded: mechanically ventilated <48 hours or not ventilated (n=62), TBI with GCS <15 (n=10), cognitive impairment (n=6), RASS score <-1 or >+1 (n=10), and eye impairment (n=2). Of the remaining 5 patients, 2 patients declined participation and 3 patients were enrolled. Accuracy to yes/no questions was equivalent between the ETD and the CB (Both accurate 10/12, 83% responses), but greater with the ETD for free response answers (2/2 responses for ETD and 2/3 responses for CB). Patient preference for communication was split evenly among the three options: ETD (1), CB (1), baseline form of communication (1). The observer preferred baseline communication (2/3 patients), to the CB (1/3 patients), and the ETD (0/3) for basic and complex communication.
Conclusions: Previous studies theorized that a substantial proportion of mechanically ventilated ICU patients can use ETDs. Our study found a limited proportion of eligible patients, likely due to strict inclusion/exclusion criteria. The major criteria limiting participation were short duration of mechanical ventilation and low RASS score. In terms of optimal communication method, too few patients were enrolled to make any definitive conclusions. As such, the protocol has been being modified to include patients for whom mechanical ventilation is expected for >24 hours. Increased coordination with caregivers during sedation vacations will be pursued.