An Israeli-invented medical tech device is being tested to see if it reduces delirium among patients in hospital intensive care units, including those wounded during the current Israel-Hamas war.
Disorientation and a lack of communication experienced by patients while hospitalized in an ICU can leads to delirium — nightmares and hallucinations — especially if they are intubated. The rate can reach as high as 80 percent in such patients.
The Israeli company EyeControl seeks to avoid such delirium. If this type of acute stress can be eliminated or diminished, it would reduce the chances of a patient suffering from post-traumatic stress disorder (PTSD) after leaving the ICU.
The device developed by EyeControl is a specially designed lightweight plastic headset. It was originally conceived as an alternative and augmentative communication tool for locked-in patients, such as those with advanced amyotrophic lateral sclerosis (ALS).
However, now its functionality is being shifted toward improving and hastening the recovery of ICU patients, who it is hoped are only temporarily locked in and will at some point be woken from sedation and taken off a ventilator. To this end, the product is undergoing trials at Beilinson Medical Center in Petah Tikva and Samson Assuta University Hospital in Ashdod. A third trial will soon begin at a major hospital in Boston.
“When we decided to shift the device’s functionality to temporarily locked-in patients, we launched the study here in Israel a year and a half ago with 30 patients at the Assuta ICU and 45 at Beilinson,” said Eye Control product specialist Michal Finkelstein, who coordinates the study at Assuta.
“For the study, some of the patients have to be controls. But when the war started, we at Assuta decided that the right and compassionate thing to do would be to ensure that the war wounded would not end up in the control group and would therefore get the full benefit of the product,” Finkelstein said.
The EyeControl headset has three main parts: an infrared camera that follows the eye, a bone-conduction earphone, and a cloud-based platform that connects to and controls the headset from anywhere via wi-fi. There is also a small control box that can be attached to the patient’s bed with buttons to control power and volume.
When The Times of Israel recently visited the ICU at Assuta, none of the patients were wearing the headsets.
“That’s because you are here during the visiting hour. When the families are here it is important for there to be direct contact and communication between them and the patient,” Finkelstein explained.
“Otherwise, the patients wear the headsets all the time, except when they are being taken for a test or surgery,” she said.
The headsets are on the patients almost all day and night, but the earphone is not always relaying sound. When it does, it plays recordings of the voices of family and friends, favorite music, and orienting statements.
The latter might involve messages a few times a day with the date and time, and a reminder that the patient is in a hospital.
Families and friends send Finkelstein audio messages by phone, WhatsApp, or a special EyeControl app, which she uploads to an individual patient’s area in EyeControl’s platform.
Finkelstein can schedule when and how often every audio clip plays and make adjustments at any time.
“One soldier in the ICU liked heavy metal music, so his girlfriend sent me his Spotify account and I uploaded a playlist of his favorite metal songs to his headset program,” Finkelstein said.
“In this case, the best thing about EyeControl is that the sounds coming out of it are heard only by the patient. Can you imagine if heavy metal was played aloud next to the soldier’s bed, disturbing all the other patients and staff?” she said.
The infrared eye camera is used to track the patient’s eye movements as they are asked to non-verbally respond to questions that are part of EyeControl’s study on delirium. According to Finkelstein, the questions are adapted and translated from the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), the gold standard for assessing inattention and disorganized thinking in ICU patients. The results of this assessment, together with others administered by the hospital staff, indicate a patient’s level of delirium.
Positive responses to the questionnaire can lead to staff being able to reduce sedation levels, and ultimately a shorter hospitalization and a better recovery for the patient.
Stepping away from the ICU for a few minutes, its director, Dr. Ami Mayo, told The Times of Israel that although the results of the study are not yet known, EyeControl was to his mind “a win-win.”
“It gives a distraught family a task and a sense of control. It’s a way for them to communicate with their loved ones, even if it is one-way. And if we see that EyeControl is having positive effects and the patient’s responses are good, then that gives the families strength and hope,” Mayo said.
“From the medical point of view, anything that reduces delirium and ensuing PTSD is welcome,” he said.
Mayo explained that the ICU environment is disturbing. There is constant light and lots of noise. Patients are sedated, but they are not really sleeping. This leads to gaps in their memory, which their brain fills with made-up scary stories and hallucinations.
“EyeControl gives them positive material to remember subconsciously instead,” he said.
Privately held, EyeControl is supported by the Israel Innovation Authority, the European Innovation Council, and various Israeli health tech investors including the Menomadin Foundation impact investment fund.