THE BLOG

Communicating With Patients in an Intensive Care Unit

06/26/2010 05:12 am ET | Updated May 25, 2011

For many years I would frequently perform psychiatric consultation or supervise the psychiatric care of patients in the intensive care setting of medical/surgical hospitals. This was quite a challenging task since at times the patient could not talk. They might have their jaw wired closed, or have tubes in their mouth along with injured incapacitated arms or hands which would make writing impossible. The patient could be fully conscious and desperately want to tell the doctors about pain or discomfort. They might have very clear views on various aspects of the contemplated treatment for them including surgery or continued life support. It is understandable that patients may want to inquire about family members or say innumerable other things that were very important to them and were immensely frustrated by their inability to communicate.

Sometimes the ICU staff, especially the nurses, would have time to try to find a means to communicate with the patient and as a psychiatric consultant I tried to learn these techniques and improvise new ones. More often than not, the patient was capable of squeezing your hand, twice for yes and once for no. You would be surprised how much information can be exchanged using this method. Other times, the blink method was used two blinks of the eye mean yes and one blink means no. One can even devise an alphabet system using these two methods. There was a best selling book titled The Diving Bell and the Butterfly, a memoir by Jean Dominique Bauby, who had a massive stroke at the age 42 which left him completely paralyzed except for his left eyelid. He developed a method communicating with the help of his speech therapist by blinking his eye as she read a list of letters to spell out his messages, letter by letter.

Role of Computer Technology

I always believed that computer technology could be brought to the ICU and make a big difference in the ability of patients who suddenly found themselves unable to speak. If a patient could move their fingers to type on a computer board and it could be set up, some messages could be communicated. However, I wanted a much more elaborate system. I knew that some computer programs easily transformed written words into audio. I had also looked at catalogs of equipment used in some program for the handicapped as well as in some rehabilitation units and knew that some programs mixed this with common words being able to be produced with a single keystroke, therefore facilitating communication of frequently used words such as yes, no, pain etc. I knew that especially for children or developmentally disabled individuals or visually impaired larger screen were sometimes used.

Every ICU In the Country Should Have It

I wanted to put this all together and envisioned every ICU in the country would have the ability to wheel into a patients ICU area a small unit with a very large screen. (You need a large display to immediately get the attention of the ICU staff especially when you are surrounded by all sorts of lines , tubes and equipment and there is also a good deal of ambient noise.) There would be the capacity to translate the words into sound. The computer could be activated by pointing or touching words, pictures or letters, Some people might have special finger devices or even a device they could control with their mouth. Future variations might include line of sight devices where you could look at desired letter or object and activate it by blinking ( I don't know if this is invented yet ). I contacted IBM which had it's headquarters near my old hospital and tried interesting them, as well as other computer companies. I tried to point out that if we did a demonstration project and it worked well, I was sure every hospital in the country and maybe in the world would want to buy this product. I thought I could help by mobilizing intensivists and consultants who work in the ICU to advocate for this product to be made available for patient care. I am sorry to say I couldn't get this project off the ground.

Awareness While in a Vegetative State

I had almost forgotten about his idea until I opened up the LA Times the other day and I read about a research report in the New England Journal of Medicine where modern brain technology, more specifically the functional MRI, detected brain activity in five patients who had been thought to be in a persistent vegetative state, indicating awareness, intent in at least one case a wish to communicate. One patient was asked to imagine playing tennis and the region of the brain most closely associated with complex motor planning became highly active and then would become active when prompted by saying "tennis." When the researchers asked the patient to imagine walking through the house where he grew up and then they said the word "navigate," the patient responded with bursts of activity in the region of the brain involved in constructing and navigating a mental map. Using these two newly learned abilities he was then trained to answer yes and no questions. They could then check the accuracy of this response and demonstrate that through this method he was capable of purposeful thought and communication.

Every ICU in The Country Should Have It

This is obviously just preliminary research and the beginning of methods to allow people who were thought to be in a vegetative state or perhaps in the locked in syndrome, to communicate. Science is actually much further along than I ever imagined when I was trying to communicate with patient with extremely limited but some motor slight function in the ICU . But this makes me feel that we need to at least now use existing technology on a grand scale and bring it to every ICU in the country. I hope someone will see this blog with the connections to get the ball rolling. I will be glad to help anyway that I can.