SummaryOur study examined the effectiveness of pulse oximetry sonification enhanced with acoustic tremolo and brightness to help listeners differentiate clinically relevant oxygen saturation ranges. In a series of trials lasting 30 s each, 76 undergraduate participants identified final oxygen saturation range (Target: 100% to 97%; Low: 96% to 90%; Critical: 89% and below), and detected threshold transitions into and out of the target range using conventional sonification (n = 38) or enhanced sonification (n = 38). Median (IQR [range]) accuracy for range identification with the conventional sonification was 80 (70-85 [45-95])%, whereas with the enhanced sonification it was 100 (99-100 [80-100])%; p < 0.001. Accuracy for detecting threshold transitions with the conventional sonification was 60 (50-75 [30-95])%, but with the enhanced sonification it was 100 (95-100 [75-100]%; p < 0.001. Participants can identify clinically meaningful oxygen saturation ranges and detect threshold transitions more accurately with enhanced sonification than with conventional sonification. IntroductionUsing the variable pitch auditory signal of a pulse oximeter, a clinician can detect changes in a patient's heart rate and oxygen saturation level (SpO 2 ) while performing other visually demanding tasks, or when the visual display of the pulse oximeter is out of the line of sight [1][2][3]. However, clinicians cannot accurately estimate the absolute level of SpO 2 without reference to the pulse oximeter's visual display [4]. With the additional cognitive load of other clinical tasks and increased noise, it becomes even more difficult to estimate SpO 2 levels [5].The auditory signal used by pulse oximeters is termed a 'sonification' -a continuous mapping of numerical values or relationships in patient data into comprehensible auditory dimensions [6][7][8]. The pulse oximetry sonification varies pitch alone to convey information about SpO 2 . The rate of the tones represents heart rate and rhythm, and the pitch of the tones represents SpO 2 . Current pulse oximeter sonifications rely on a clinician's ability to perceive relative pitch to infer changes in SpO 2 direction, and their ability to perceive absolute pitch to infer absolute SpO 2 levels [4,5,12,13]. Commercial pulse oximeters map linear increments of SpO 2 to either fixed or percentage increments in sound frequency (perceived as pitch); the former results in a linear mapping, whereas the latter results in a logarithmic mapping [14,15]. A logarithmic scale creates approximately equal-appearing pitch intervals [4,9,14]. Under test conditions, clinicians can identify absolute SpO 2 levels more accurately when SpO 2 is mapped to a logarithmic scale than to a linear scale [12]. However, remedies to date have generally focused on participants' ability to infer absolute SpO 2 levels (e.g. 98%) rather than clinically relevant ranges (e.g. low).In this study, we enhanced a conventional pulse oximetry sonification [14] by adding tremolo and, in extreme cases, brightness to each tone when ...

Enhanced sonifications are more informative than conventional sonification. The implication is that they might allow anaesthetists to judge better when desaturation decreases below, or returns to, a target range.

BACKGROUND: When engaged in visually demanding tasks, anesthesiologists depend on the auditory display of the pulse oximeter (PO) to provide information about patients’ oxygen saturation (Spo 2). Current auditory displays are not always effective at providing Spo 2 information. In this laboratory study, clinician and nonclinician participants identified Spo 2 parameters using either a standard auditory display or an auditory display enhanced with additional acoustic properties while performing distractor tasks and in the presence of background noise. METHODS: In a counterbalanced crossover design, specialist or trainee anesthesiologists (n = 25) and nonclinician participants (n = 28) identified Spo 2 parameters using standard and enhanced PO auditory displays. Participants performed 2 distractor tasks: (1) arithmetic verification and (2) keyword detection. Simulated background operating room noise played throughout the experiment. Primary outcomes were accuracies to (1) detect transitions to and from an Spo 2 target range and (2) identify Spo 2 range (target, low, or critical). Secondary outcomes included participants’ latency to detect target transitions, accuracy to identify absolute Spo 2 values, accuracy and latency of distractor tasks, and subjective judgments about tasks. RESULTS: Participants were more accurate at detecting target transitions using the enhanced display (87%) than the standard display (57%; odds ratio, 7.3 [95% confidence interval {CI}, 4.4–12.3]; P < .001). Participants were also more accurate at identifying Spo 2 range using the enhanced display (86%) than the standard display (76%; odds ratio, 2.7 [95% CI, 1.6–4.6]; P < .001). Secondary outcome analyses indicated that there were no differences in performance between clinicians and nonclinicians for target transition detection accuracy and latency, Spo 2 range identification accuracy, or absolute Spo 2 value identification. CONCLUSIONS: The enhanced auditory display supports more accurate detection of target transitions and identification of Spo 2 range for both clinicians and nonclinicians. Despite their previous experience using PO auditory displays, clinicians in this laboratory study were no more accurate in any Spo 2 outcomes than nonclinician participants.

The COVID-19 pandemic has imposed substantial burdens on clinicians and there is a need to better understand the impact on mental health and well-being. This scoping review investigates the prevalence of mental health concerns in anaesthetists, risk and protective factors for mental well-being, and anaesthetists' pandemic-related concerns and support. We searched online databases for articles published between January 2020 and May 2022, using search terms related to: anaesthesia; burnout, well-being, mental health or stress; and COVID-19. We identified 20 articles comprising 19 different populations of anaesthetists (n = 8680) from 14 countries. Studies identified the prevalence of the following condition in anaesthetists: burnout (14-59%); stress (50-71%); anxiety (11-74%); depression (12-67%); post-traumatic stress (17-25%); psychological distress (52%); and insomnia (17-61%). Significant risk factors for poorer mental health included: direct COVID-19-related issues (fear of self and family exposure to infection; requirement for quarantine); practitioner health factors (insomnia; comorbidities); psychosocial factors (loneliness; isolation; perceived lack of support at home and work); demographic factors (female gender; non-white ethnicity; LGBTQIA+); and workplace factors (redeployment outside area of clinical practice; increased work effort; personal protective equipment shortages). Protective factors identified included: job satisfaction; perceived organisational justice; older age; and male sex. Anaesthetists' self-reported concerns related to: personal protective equipment; resource allocation; fear of infection; fear of financial loss; increased workload; and effective communication of protocols for patient treatment. Support from family, colleagues and hospital management was identified as an important coping mechanism. Findings from this review may support the design of interventions to enhance anaesthetists' psychological health during pandemic conditions and beyond. Future research should include consistent psychological outcome measures and rigorous experimental design beyond cross-sectional studies.

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