First experiences of communication with mechanically ventilated patients in the intensive care unit using eye-tracking technology

Ull, Christopher; Weckwerth, Christina; Schildhauer, Thomas A.; Hamsen, Uwe; Gaschler, Robert; Waydhas, Christian; Jansen, Oliver

doi:10.1080/17483107.2020.1821106

Cited by 10 publications

(20 citation statements)

References 14 publications

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“…This was also found in our pilot study in 11 intubated and tracheotomized patients using ET devices for AAC 14 . In contrast to previous reports that used predefined sets of picture words by Tobii Dynavox or let the patients interact with the device without providing pre-structured material, we took simple as well as more complex scales and scores to assess feelings and levels of pain in verbally restricted patients for symptom identification 11–14 …”

Section: Discussionmentioning

confidence: 86%

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The use of predefined scales and scores with eye-tracking devices for symptom identification in critically ill nonverbal patients

Ull

Hamsen

Weckwerth

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Eye tracking (ET) may be a novel tool to enable nonverbal communication. We hypothesized that ET could be used successfully by intensive care unit (ICU) patients with artificial airways to express their levels of pain and mood, quality of life, and self-esteem with predefined scales and scores. METHODS:Prospective, monocentric, observational study, including patients with an endotracheal tube or tracheostomy tube and a history of mechanical ventilation for more than 48 hours without delirium, and inadequate nonverbal communication skills. The ICU patients' pain was assessed with a numeric rating scale, their mood was tested with a smiley analog scale. Quality of life and self-esteem were measured with the European quality of life-5 dimensions-5 levels-score and the visual analog self-esteem scale. RESULTS:A total of 75 patients with a mean age of 58.3 years were included. Main diagnoses for ICU admission were major trauma (45.3%), nonabdominal sepsis (22.6%), and acute abdomen (13.3%). Patients showed moderate levels of pain and sadness with a median of 4 (interquartile range, 3-5.5) on the numeric rating scale and a median of 4 (interquartile range, 3-4) on the smiley analog scale.The general health status on the European quality of life-5 dimensions-5 levels-score was rated as poor. Reporting on the visual analog self-esteem scale, most of the included patients felt trapped (90.7%) and not confident (72%), were frustrated (64%) or did not feel understood (56%). However, despite their severe illness, many patients classified themselves as intelligent (30.6%), not mixed up (38.6%), outgoing (38.6%), and optimistic (44%). CONCLUSION:Eye tracking enables symptom identification in critically ill voiceless patients with impaired communication options. The results of our study may provide guidance for improvement measures in the care of voiceless ICU patients. We believe that ET is useful for symptom identification and therefore may be capable of improving patient-medical team interaction and patient satisfaction. (J

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Section: Discussionmentioning

confidence: 86%

“…Prior studies with small sample sizes of ICU patients have shown promising results in the first use of ET. [11][12][13][14] These voiceless patients were able to communicate their basic needs, to answer rating scales and scores, as well as questionnaires with support of ET.…”

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confidence: 99%

The use of predefined scales and scores with eye-tracking devices for symptom identification in critically ill nonverbal patients

Ull

Hamsen

Weckwerth

et al. 2021

J Trauma Acute Care Surg

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“…Also, partial or complete tube cuff deflation with digital occlusion, plugging or capping of the tube, a one-way speaking valve and tracheostomy button were used. In addition, other measures were found in other studies (Flinterud & Andershed, 2015;Morris et al, 2015;Pina et al, 2020;Shiber et al, 2016;Ull et al, 2020). The use of such devices, however, is predicated on the ability of the patient to be able to use them.…”

Section: Discussionmentioning

confidence: 86%

Patterns of communicating care and caring in the intensive care unit

Al-Shamaly¹

2021

Nursing Open

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Aim: To explore the perceptions and experiences of nurses in communicating the care and caring in the intensive care unit (ICU). Design: A focused ethnography.Methods: This study was conducted in an Australian metropolitan hospital, in which data were gathered from multiple sources: participant observations, document reviews, interviews, and participant's additional written information -oversix months (April-September, 2014). The data were analysed thematically. Findings: This study addressed inclusively communicating care and caring to patients, families, nurses and other health professionals in ICU. The findings identified main themes concerning the changing patterns of communicating the care and caring in ICU, various patterns of communication used, enablers and barriers of communicating care and caring, and significant issues in communicating care and caring in ICU. Documentation of patients' psychological and emotional needs, and nurses' caring behaviours are crucial. These findings need further consideration from all stakeholders.

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“…The decision to test this high‐tech AAC stemmed from frequent reports of our ICU nurses describing communication restrictions when interacting with intubated and invasively ventilated patients with acute tetraplegia despite using proven in‐house standard instruments (eg, lip reading, blinking, winking, pen and paper, communication boards) in the daily ICU care routine. Our first experience of nonverbal communication in 11 ICU patients using ET devices showed promising results and we optimized the user‐friendliness of ET to increase the critically ill patients' acceptance 21 . We revised our BN questionnaire and decided to change several BN questions, restricted answers of our survey to “yes” or “no,” used gaze fixation control instead of wink control to select answers on the ET, and reduced the gaze fixation time from 1000 to 600 ms. After these adjustments, we successfully used ET technology in 64 voiceless ICU patients who were unable to use non‐tech and low‐tech AAC to nonverbally communicate their BN.…”

Section: Discussionmentioning

confidence: 99%

“…The development of eye‐tracking (ET) devices may be used similarly to overcome communication barriers and, therefore, as a tool or an adjunct in the ICU may enable communication for this specific patient group. Few studies have revealed that intubated and/or invasively ventilated patients are indeed able to use ET as a communication auxiliary 18–21 . However, only a few ICU patients have been investigated so far, and the evidence is weak.…”

Section: Introductionmentioning

confidence: 99%

Approach to the basic needs in patients on invasive ventilation using eye‐tracking devices for non‐verbal communication

et al. 2021

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Purpose To analyze the feasibility of eye‐tracking (ET) devices as a communicative approach to the basic needs (BN) of intensive care unit (ICU) and invasively ventilated nonverbal patients. Methods Prospective, monocentric, and observational study including all patients without delirium, with an endotracheal tube or tracheostomy tube, with a history of invasive ventilation for more than 48 h, and inadequate nonverbal communication skills. The investigation was performed with commercially available ET devices (Tobii Dynavox I‐15+) to express BN of ICU patients following a standardized 30‐item yes‐or‐no questionnaire. Results A total of 64 patients with a mean age of 58.6 years were included. The main diagnoses for ICU admission were major trauma (43.6%), sepsis (21.8%), and acute abdomen (15.6%). Pain during repositioning (69%), thirst (69%), sleep disorders (66%), fatigue (64%), and anxiety regarding the lifelong need for assistance (64%) were the main problems reported by the patients. However, most of the patients described expectations of health improvement (78%), good family support (66%), and an improvement in quality of life due to the use of ET devices (67%). Conclusion The use of ET in selected ICU patients with impaired communication is feasible, allowing them to express their BN. Apart from knowing the patients' individual BN, the results of our BN questionnaire may provide guidance for improvement measures in the care of patients in the ICU who are unable to speak. We believe that ET is useful for inquiring about and expressing BN and, therefore, may be capable of improving patient‐medical team interactions and patient satisfaction.

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First experiences of communication with mechanically ventilated patients in the intensive care unit using eye-tracking technology

Cited by 10 publications

References 14 publications

The use of predefined scales and scores with eye-tracking devices for symptom identification in critically ill nonverbal patients

The use of predefined scales and scores with eye-tracking devices for symptom identification in critically ill nonverbal patients

Patterns of communicating care and caring in the intensive care unit

Approach to the basic needs in patients on invasive ventilation using eye‐tracking devices for non‐verbal communication

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