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  • A pilot study assessing the spiritual, emotional, physical/environmental, and physiological needs of mechanically ventilated surgical intensive care unit patients via eye tracking devices, head nodding, and communication boards

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A pilot study assessing the spiritual, emotional, physical/environmental, and physiological needs of mechanically ventilated surgical intensive care unit patients via eye tracking devices, head nodding, and communication boards
  1. Erin I Duffy1,
  2. Jonah Garry1,
  3. Lillian Talbot1,
  4. David Pasternak1,
  5. Ashley Flinn1,
  6. Casey Minardi2,
  7. Michele Dookram2,
  8. Kathleen Grant2,
  9. Debbie Fitzgerald1,
  10. Jerry Rubano1,
  11. James Vosswinkel1,
  12. Randeep S Jawa1
  1. 1 Division of Trauma, Emergency Surgery, and Surgical Critical Care, Stony Brook University School of Medicine, Stony Brook, New York, USA
  2. 2 Department of Inpatient Occupational Therapy, Stony Brook University Hospital, Stony Brook, New York, USA
  1. Correspondence to Dr Randeep S Jawa, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Stony Brook University School of Medicine, Stony Brook, New York 11794, USA; randeep.jawa{at}stonybrookmedicine.edu

Abstract

Background Mechanically ventilated patients in the intensive care unit (ICU) are unable to communicate verbally. We sought to evaluate their needs via a communication board (CB) and a novel eye tracking device (ETD) that verbalizes selections made by gazing.

Methods This was a pilot prospective study conducted in a tertiary care surgical ICU. Continuously mechanically ventilated adult surgical ICU patients with a Richmond Agitation-Sedation Scale score of −1 to +1, without cognitive impairment, were eligible. We asked patients four yes-or-no questions to assess basic needs regarding presence of pain, need for endotracheal suction, satisfactory room temperature, and position comfort. Patients were then asked if there was anything else that they wanted to communicate. All responses were confirmed by head nodding.

Results The median accuracy of the CB (100% (IQR 100%–100%)) for basic needs communication (yes/no questions) was comparable with that of the ETD (100% (IQR 68.8%–100%); p=0.14) in the 12 enrolled patients. Notably, 83% of patients desired to communicate additional information, ranging from spiritual (eg, desire for prayer/chaplain), emotional (eg, frustration, desire for comfort), physical/environmental (eg, television), to physiological (eg, thirst/hunger) needs.

Discussion The majority of patients desired to communicate something other than basic needs. Unless specifically assessed via an assistive communication device (eg, CB or ETD), some of these other needs would have been difficult to discern.

Level of evidence IV therapeutic care/management.

  • mechanical ventilation
  • critical care
  • eye tracking device
  • communication
  • assistive and alternative communication (AAC)

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/tsaco-2018-000180

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    Footnotes

    • Presented at This article was presented in part at the 12th Annual Academic Surgical Congress in Las Vegas, Nevada, in February 2017.

    • Contributors Study design: JG, EID, DF, KG, CM, MD, RJ, JV, JR. Study implementation (patient recruitment and testing): EID, JG, DP, LT, AF, KG, CM, MD, DF. Data analysis: JG, EID, RJ, DF, JV. Article preparation: JG, EID, RJ. Critical revision: CM, KG, DF, JV, JR, RJ, EID, AF, LT.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer Tobii Dynavox (Stockholm, Sweden) loaned the eye tracking device for this study. Tobii Dynavox and Vidatak (Acuity Medical, Annapolis, MD) approved the use of included photos. Tobii Dynavox recused itself from study design, data, analysis, and drafting of the article.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The Stony Brook University Human Subjects Committee (IRB) approved this pilot prospective study.

    • Provenance and peer review Not commissioned; externally peer reviewed.