Eye tracking technology to improve communication with intubated critical care patients: a randomized study

Abstract Background: Communication with patients undergoing mechanical ventilation in the intensive care unit represents a challenge. The aims of the study were (1) to describe communication difficulties related to mechanical ventilation as experienced by healthcare professionals and patients, and (2) to compare the use of a conventional low-tech communication board and a high-tech eye tracking technology-based device to improve communication effectiveness of mechanically ventilated patients in intensive care. Methods: This prospective study consisted of a descriptive cross-sectional part describing the communication difficulties in the intensive care unit and an experimental randomized crossover part comparing the use of two technologically opposed augmentative and alternative communication interfaces. A mixed method approach was applied with a quantitative primary method and a qualitative complementary method. The numerical data were analyzed quantitatively using Mann-Whitney (ordinal variables) and chi-square (binary variables) nonparametric tests. The non-numerical data were analyzed qualitatively using thematization and categorization. Results: A total of 101 healthcare professionals and 44 patients participated. Regarding the descriptive part, the communication difficulty analysis confirmed that mechanical ventilation constitutes a major problem in patient-caregiver communication. Regarding the quantitative experimental part, the treatment effects on transmitted messages quantity (2 median messages per exchange for the board versus 4 median messages per exchange for the eye tracking, p < 0.0001), success rate (80% for the board versus 100% for the eye tracking, p < 0.05) and patient satisfaction (68% negative satisfaction level for the board versus 100% positive satisfaction level for eye tracking, p < 0.0001) were significant. Regarding the qualitative experimental part, the communication content covered 8 themes for the board compared to 9 themes for the eye tracking and the use difficulties included 4 categories for the board as well as for the eye tracking. Conclusion: The eye tracking device may further improve communication effectiveness of mechanically ventilated patients compared to the conventional communication board, both quantitatively and qualitatively. Trial registration: Communication Strategies for Mechanically Ventilated Patients in Intensive Care Units, NCT05651984. Retrospectively registered on December 02, 2022 (https://clinicaltrials.gov/ct2/show/NCT05651984?term=NCT05651984&draw=2&rank=1).