The EyeControl-Med device, an alternative tool for communication in ventilated critically ill patients: A pilot study examining communication capabilities and delirium.

INTRODUCTION: Communication with ventilated patients in the Intensive care unit (ICU) is challenging. This may lead to anxiety and frustration, potentially contributing to the development of delirium. Various technologies, such as eye-tracking devices, have been employed to facilitate communication with varying grades of success. The EyeControl-Med device is a novel technology that delivers audio content and allows patients to interact by eye movements and could potentially allow for better communication in this setting. The aim of this exploratory concept study was to assess communication capabilities and delirium incidence using the EyeControl-Med device in critically ill patients unable to generate speech. MATERIAL AND METHODS: A single-arm pilot study of patients in a mixed ICU. Patients were approached for consent if they were invasively ventilated and/or tracheotomized, hence unable to generate speech, but had no severe cognitive or sensory impairment that could prevent proper usage. Patients underwent at least 3 sessions with the EyeControl-Med device administered by a speech-language pathologist. Communication and consciousness were assessed using the Loewenstein Communication Scale (LCS) tool during the first and last sessions. Delirium was assessed using a computerized CAM-ICU questionnaire. RESULTS: 15 patients were included, 40% of whom were diagnosed with COVID-19. All patients completed three to seven usage sessions. The mean LCS score improved by 19.3 points (p < 0.0001), with each of its five components showing significant improvements as well. The mean number of errors on the CAM-ICU questionnaire decreased from 6.5 to 2.5 (p = 0.0006), indicating a lower incidence of delirium. No adverse effects were observed. CONCLUSION: The EyeControl-Med device may facilitate communication and reduce the manifestations and duration of delirium in ventilated critically ill patients. Controlled studies are required to establish this effect.

Validation of carbon dioxide production (VCO2) as a tool to calculate resting energy expenditure (REE) in mechanically ventilated critically ill patients: a retrospective observational study.

BACKGROUND: Indirect calorimetry (IC) measurement is considered the gold standard for the assessment of resting energy expenditure (REE). It is based on the measurement of oxygen and carbon dioxide consumption (VO2 and VCO2, respectively). However, its use is limited by cost and technical issues. It has been proposed that, in critically ill patients, the analysis of VCO2 obtained from the ventilator alone may be used as an accurate method to assess REE in ventilated patients. This retrospective study aimed to assess the accuracy of VCO2 measurement alone in the determination of REE. METHODS: This was a retrospective study conducted at the general intensive care unit of a single university-affiliated tertiary medical center. Patients included were invasively ventilated and their REE was measured by using IC. The respiratory quotients (RQs) were set at 0.8, 0.85, and 0.89. Data were collected from computerized patient files. REE obtained from the ventilator by using VCO2 (REE-VCO2) alone was compared with REE obtained from IC (REE-IC). RESULTS: Measurements were obtained for 80 patients, and 497 REE-IC measurements were compared with REE-VCO2 obtained at the same time. The mean REE-IC was 2059.5 ± 491.7 kcal/d. The mean REE-RQs corresponding to RQs of 0.80, 0.85, and 0.89 were 1936.8 ± 680.0, 2017.8 ± 708.8, and 2122.1 ± 745.4 kcal/d, respectively. REE-VCO2 derived from an RQ of 0.85 had the lowest mean difference from REE-IC. Whereas accuracy was higher using an RQ of 0.85, agreement (between 85% and 115%) was highest using an RQ of 0.89. CONCLUSIONS: The level of agreement of REE obtained from VCO2 readings with REE obtained from IC was generally low. IC continues to be the recommended method for REE assessment.

Behind the ESPEN Guidelines on parenteral nutrition in the ICU.

Enteral nutrition (EN) is a well established approach to nutritional support in the ICU. Parenteral nutrition (PN) represents an additional safe approach, substituting or complementing EN when its delivery fails completely or partially. This article attempts to summarize the ESPEN guidelines of PN in the ICU based on the available literature, which is often limited due to quality and methodology heterogeneity; the recommendations are therefore largely expressed as expert opinions.