Duffy Erin I, Garry Jonah, Talbot Lillian, Pasternak David, Flinn Ashley, Minardi Casey, Dookram Michele, Grant Kathleen, Fitzgerald Debbie, Rubano Jerry, Vosswinkel James, Jawa Randeep S
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Stony Brook University School of Medicine, Stony Brook, New York, USA.
Department of Inpatient Occupational Therapy, Stony Brook University Hospital, Stony Brook, New York, USA.
Trauma Surg Acute Care Open. 2018 Sep 19;3(1):e000180. doi: 10.1136/tsaco-2018-000180. eCollection 2018.
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.
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.
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.
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.
IV therapeutic care/management.
重症监护病房（ICU）中接受机械通气的患者无法进行言语交流。我们试图通过交流板（CB）和一种新型眼动追踪设备（ETD）来评估他们的需求，该眼动追踪设备能将注视做出的选择转化为语音。
这是一项在三级护理外科ICU进行的前瞻性试点研究。符合条件的是持续接受机械通气、里士满躁动 - 镇静量表评分为 -1至 +1且无认知障碍的成年外科ICU患者。我们向患者提出四个是或否的问题，以评估关于疼痛存在、气管内吸痰需求、满意的室温及体位舒适度的基本需求。然后询问患者是否还有其他想交流的内容。所有回答均通过点头确认。
在12名入组患者中，交流板（CB）用于基本需求交流（是/否问题）的中位准确率为100%（四分位间距100% - 100%），与眼动追踪设备（ETD）的准确率（100%（四分位间距68.8% - 100%）；p = 0.14）相当。值得注意的是，83%的患者希望交流额外信息，范围从精神层面（如祈祷/牧师探访的愿望）、情感层面（如沮丧、舒适的愿望）、身体/环境层面（如电视）到生理层面（如口渴/饥饿）的需求。
大多数患者希望交流基本需求之外的内容。除非通过辅助交流设备（如CB或ETD）进行专门评估，否则其中一些其他需求将难以辨别。
IV 治疗护理/管理。
