A Spatiotemporal and Multisensory Approach to Designing Wearable Clinical ICU Alarms.

In health care, auditory alarms are an important aspect of an informatics system that monitors patients and alerts clinicians attending to multiple concurrent tasks. However, the volume, design, and pervasiveness of existing Intensive Care Unit (ICU) alarms can make it difficult to quickly distinguish their meaning and importance. In this study, we evaluated the effectiveness of two design approaches not yet explored in a smartwatch-based alarm system designed for ICU use: (1) using audiovisual spatial colocalization and (2) adding haptic (i.e., touch) information. We compared the performance of 30 study participants using ICU smartwatch alarms containing auditory icons in two implementations of the audio modality: colocalized with the visual cue on the smartwatch's low-quality speaker versus delivered from a higher quality speaker located two feet away from participants (like a stationary alarm bay situated near patients in the ICU). Additionally, we compared participant performance using alarms with two sensory modalities (visual and audio) against alarms with three sensory modalities (adding haptic cues). Participants were 10.1% (0.24s) faster at responding to alarms when auditory information was delivered from the smartwatch instead of the higher quality external speaker. Meanwhile, adding haptic information to alarms improved response times to alarms by 12.2% (0.23s) and response times on their primary task by 10.3% (0.08s). Participants rated learnability and ease of use higher for alarms with haptic information. These small but statistically significant improvements demonstrate that audiovisual colocalization and multisensory alarm design can improve user response times.

Improved Patient Monitoring with a Novel Multisensory Smartwatch Application.

The design of medical alarms has been heavily criticized in the past decade. Auditory medical alarms have poor learnability, discernibility, and relevance, leading to poor patient outcomes, and alarm fatigue, and overall poor informatic system design. We developed a novel trimodal patient monitoring smartwatch application for patient monitoring. Participants completed two phases: (1) control and (2) our novel trimodal system while identifying alarms (heart rate, oxygenation, and blood pressure) and completing a cognitively demanding task. Alarms were auditory icons presented as either solo or co-alarms. Participant performance was assessed by accuracy and response time (RT) of alarm identification. Using the novel system, accuracy was significantly improved overall (p < 0.01) and in co-alarm situations (p < 0.01), but not for solo alarms (p = 0.484). RT was also significantly faster (p < 0.01) while using the novel system for all alarm types. Participants reported decreased mental workload using the novel system. This feasibility study shows that our novel alarm system performs better than current standards. Improvements in accuracy, RT and perceived mental workload indicate the potential of this system to have a positive impact on medical informatic systems and clinical monitoring, for both the patient and the clinician.

Midterm Outcomes of Endovascular Versus Open Surgical Repair of Intact Descending Thoracic Aneurysms in Patients with Connective Tissue Disorders.

BACKGROUND: Data on the efficacy of endovascular thoracic endovascular aneurysm repair (TEVAR) versus open surgical repair for chronic aortic pathology in patients with connective tissue disorders are limited. In particular, few studies have examined outcomes of TEVAR versus open repair for intact descending thoracic aortic aneurysms (DTAA) in this subset of patients beyond index hospitalization. Therefore, we investigate 5-year outcomes of TEVAR and open surgical repair of intact DTAAs in patients with known connective tissue disorders. METHODS: Using the TriNetX Data Network, a global federated database of over 75 million patients, we conducted a retrospective cohort study of patients with connective tissue disorders and intact DTAAs, treated initially with either TEVAR or open surgery. Eligible patients were 1:1 propensity score-matched for several preoperative co-variates including demographics, surgical history, and comorbidities. We calculated and compared 5-year cumulative incidence and hazards of death, re-intervention, aortic dissection, renal failure, stroke, intracranial hemorrhage, paraplegia, and limb ischemia using the Kaplan-Meier method and Cox proportional hazards models. RESULTS: We identified 55 patients treated with TEVAR and 200 treated with open surgery. After matching, we compared 46 patients in each cohort. After matching, only incidence of re-intervention via endovascular approach was significantly higher among patients in the TEVAR cohort (27.1% vs. 4.8%, P = 0.009). Rates and hazards of other outcomes were higher in the TEVAR group, however, differences were not statistically significant. CONCLUSIONS: Patients treated with TEVAR had numerically higher rates of adverse outcomes compared to open surgical patients, however only the difference in re-intervention rate was statistically significant. Given the evolving landscape of endovascular intervention, greater-powered studies are needed to determine the safety and efficacy of TEVAR for intact DTAAs in a select subset of connective tissue disorder patients.

Delirium Variability is Influenced by the Sound Environment (DEVISE Study): How Changes in the Intensive Care Unit soundscape affect delirium incidence.

Quantitative data on the sensory environment of intensive care unit (ICU) patients and its potential link to increased risk of delirium is limited. We examined whether higher average sound and light levels in ICU environments are associated with delirium incidence. Over 111 million sound and light measurements from 143 patient stays in the surgical and trauma ICUs were collected using Quietyme® (Neshkoro, Wisconsin) sensors from May to July 2018 and analyzed. Sensory data were grouped into time of day, then normalized against their ICU environments, with Confusion Assessment Method (CAM-ICU) scores measured each shift. We then performed logistic regression analysis, adjusting for possible confounding variables. Lower morning sound averages (8 am-12 pm) (OR = 0.835, 95% OR CI = [0.746, 0.934], p = 0.002) and higher daytime sound averages (12 pm-6 pm) (OR = 1.157, 95% OR CI = [1.036, 1.292], p = 0.011) were associated with an increased odds of delirium incidence, while nighttime sound averages (10 pm-8 am) (OR = 0.990, 95% OR CI = [0.804, 1.221], p = 0.928) and the ICU light environment did not show statistical significance. Our results suggest an association between the ICU soundscape and the odds of developing delirium. This creates a future paradigm for studies of the ICU soundscape and lightscape.