Elsevier

Surgery

Volume 159, Issue 3, March 2016, Pages 938-944
Surgery

Trauma/Critical Care
A pilot study of eye-tracking devices in intensive care

https://doi.org/10.1016/j.surg.2015.08.012Get rights and content

Background

Eye-tracking devices have been suggested as a means of improving communication and psychosocial status among patients in the intensive care unit (ICU). This study was undertaken to explore the psychosocial impact and communication effects of eye-tracking devices in the ICU.

Methods

A convenience sample of patients in the medical ICU, surgical ICU, and neurosciences critical care unit were enrolled prospectively. Patients participated in 5 guided sessions of 45 minutes each with the eye-tracking computer. After completion of the sessions, the Psychosocial Impact of Assistive Devices Scale (PIADS) was used to evaluate the device from the patient's perspective.

Results

All patients who participated in the study were able to communicate basic needs to nursing staff and family. Delirium as assessed by the Confusion Assessment Method for the Intensive Care Unit was present in 4 patients at recruitment and none after training. The device's overall psychosocial impact ranged from neutral (−0.29) to strongly positive (2.76). Compared with the absence of intervention (0 = no change), patients exposed to eye-tracking computers demonstrated a positive mean overall impact score (PIADS = 1.30; P = .004). This finding was present in mean scores for each PIADS domain: competence = 1.26, adaptability = 1.60, and self-esteem = 1.02 (all P < .01).

Conclusion

There is a population of patients in the ICU whose psychosocial status, delirium, and communication ability may be enhanced by eye-tracking devices. These 3 outcomes are intertwined with ICU patient outcomes and indirectly suggest that eye-tracking devices might improve outcomes. A more in-depth exploration of the population to be targeted, the device's limitations, and the benefits of eye-tracking devices in the ICU is warranted.

Section snippets

Design and patients

This study was a pilot prospective trial conducted in 3 tertiary ICUs noncontinuously over 10 months between June 2013 and May 2014. The study attempted to prospectively enroll all eligible patients during normal working hours (Monday–Friday, 9 am–5 pm). Participants were recruited from the surgical ICU, medical ICU, and neurosciences critical care unit at The Johns Hopkins Hospital, Baltimore, Maryland. The Johns Hopkins Medicine Institutional Review Board approved the study.

Patients in

Results

A total of 12 patients successfully completed the study protocols during 10 months of nonconsecutive enrollment. Patient characteristics are reported in Table I. Data on screening and total patients recruited who failed to finish the study protocol were not collected. Only 1 patient refused to continue participation in the study after receiving training with the device.

At the initial training session, four patients were positive for delirium as assessed by the CAM-ICU (Table II). By the second

Discussion

Despite the many interventions currently used, some patients remain unable to communicate during their intensive care stay. Eye-tracking devices may allow some of these patients to reestablish communication. In our study, we found that all willing and capable patients effectively communicated basic needs using an eye-tracking device. Moreover, the PIADS results indicated that adaptability and “ability to participate” were the most strongly impacted metrics surveyed, indirectly suggesting an

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    Research performed at The Johns Hopkins Hospital.

    Conflicts of Interest: The primary author, Jonah Garry, received a scholarship from Tobii Technologies 6 months before the analysis of study results and the drafting of the manuscript. All devices used in this study were donated to The Johns Hopkins Hospital before the initiation of the project. The authors have no other conflicts of interest to declare.

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