A Novel Sonification Strategy for Auditory Display of Heart Rate and Oxygen Saturation Changes in Clinical Settings

Abstract

Objective:

The aim of this study was development of a sonification scheme to convey deviations in heart rate and oxygen saturation from a desired target level.

Background:

Maintaining physiologic parameters, such as oxygen saturation, within desired ranges, is challenging in many clinical situations. High rates of false positive alarms in clinical settings limit the utility of the alarms that trigger when thresholds are exceeded. Auditory displays that consider the semantic connotations of sounds and the processing limitations of human perception and cognition may improve monitoring.

Method:

Across two experiments, clinical practi-tioners were tested on their ability to (a) discriminate pairs of sounds (two-note discrimination task), (b) infer and discern the intended physiological connotation of each acoustic attribute (name-the-variable task), and (c) categorize the amount of change in an implied physiological variable into three levels of change: none, small, and large (change-magnitude task).

Results:

Considerable variation in performance was observed across the set of practitioners, ranging from near-perfect performance on all tasks, even with no prior exposure to the stimuli, to failure to reach a target accuracy criterion of 87.5% after ~80 min of training. On average, performance was well above chance on the name-the-variable and change-magnitude tasks during initial exposure and reached criterion within ~20 min of training on each task.

Conclusion:

The described sonification strategy may effectively communicate information about current heart rate and oxygen saturation status relative to desired target levels.

Application:

The results can be applied to clinical monitoring settings in which a stream of discrete auditory informational items is indicated.

Keywords

patient monitoring vital statistics timbre alarms decision making

Get full access to this article

View all access options for this article.

References

Altuncu

Ozek

Bilgen

Topuzoglu

Kavuncuoglu

(2008). Percentiles of oxygen saturations in healthy term newborns in the first minutes of life. European Journal of Pediatrics, 167, 687–688. doi:10.1007/s00431-007-0540-x

Anderson

C. G.

Benitz

W. E.

Madan

(2002). Retinopathy of prematurity (ROP) and pulse oximetry: A national survey of recent practices. Pediatric Research, 51, 2136.

Ayotte

Peretz

Hyde

(2002). Congenital amusia: A group study of adults afflicted with a music-specific disorder. Brain, 125, 238–251.

Bancalari

Flynn

Goldberg

R. N.

Bawol

Cassady

Schiffman

. . .Sim

(1987). Influence of trans-cutaneous oxygen monitoring on the incidence of retinopathy of prematurity. Pediatrics, 79, 663–669.

Block

F. E.

(2008). “For if the trumpet give an uncertain sound, who shall prepare himself to the battle?” (I Corinthians 14: 8, KJV). Anesthesia and Analgesia, 106, 357–359. doi:10.1213/ane.0b013e3181606927

Blum

J. M.

Tremper

K. K.

(2010). Alarms in the intensive care unit: Too much of a good thing is dangerous. Is it time to add some intelligence to alarms? Critical Care Medicine, 38, 702–703. doi:10.1097/CCM.0b013e3181bfe97f

Chow

L. C.

Wright

K. W.

Sola

Grp

C. O. A. S.

(2003). Can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? Pediatrics, 111, 339–345.

Claure

D’Ugard

Bancalari

(2009). Automated adjustment of inspired oxygen in preterm infants with frequent fluctuations in oxygenation: A pilot clinical trial. Journal of Pediatrics, 155, 640–675. doi:10.1016/j.jpeds.2009.04.057

Daniels

J. P.

Ansermino

J. M.

(2009). Introduction of new monitors into clinical anesthesia. Current Opinion in Anesthesiology, 22, 775–781. doi:10.1097/ACO.0b013e328331d1da

10.

Deulofeut

Critz

Adams-Chapman

Sola

(2006). Avoiding hyperoxia in infants <= 1250 g is associated with improved short- and long-term outcomes. Journal of Perinatology, 26, 700–705. doi:10.1038/sj.jp.7211608

11.

Edworthy

Hellier

(2006). Alarms and human behaviour: Implications for medical alarms. British Journal of Anaesthesia, 97, 12–17. doi:10.1093/bja/ael114

12.

Edworthy

Loxley

Dennis

(1991). Improving auditory warning design: Relationship between warning sound parameters and perceived urgency. Human Factors, 33, 205–231.

13.

Finer

Leone

(2009). Oxygen saturation monitoring for the preterm infant: The evidence basis for current practice. Pediatric Research, 65, 375–380.

14.

Gorges

Markewitz

B. A.

Westenskow

D. R.

(2009). Improving alarm performance in the medical intensive care unit using delays and clinical context. Anesthesia and Analgesia, 108, 1546–1552. doi:10.1213/ane.0b013e31819bdfbb

15.

Guillaume

Pellieux

Chastres

Drake

(2003). Judging the urgency of nonvocal auditory warning signals: Perceptual and cognitive processes. Journal of Experimental Psychology–Applied, 9, 196–212. doi:10.1037/1076-878x.9.3.196

16.

Hagadorn

J. I.

Furey

A. M.

Nghiem

T. H.

Schmid

C. H.

Phelps

D. L.

Pillers

D. A. M.

. . .Grp

A. V. S.

(2006). Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks’ gestation: The AVIOx study. Pediatrics, 118, 1574–1582. doi:10.1542/peds.2005-0413

17.

Henry

M. J.

McAuley

J. D.

(2010). On the prevalence of congenital amusia. Music Perception: An Interdisciplinary Journal, 27, 413–418.

18.

IEC. (2005). International Standard IEC60601-1-8 (2005-08): Medical electrical equipment, Part 1 -8: General requirements for safety–collateral standard: general requirements, tests and guidance for alarm systems in medical electrical equipment and medical electrical systems. Geneva, Switzerland: International Electrotechnical Commission.

19.

Janata

Childs

(2004, July). Marketbuzz: Sonification of real-time financial data. Paper presented at the ICAD 04: Tenth Meeting of the International Conference on Auditory Display, Sydney, Australia.

20.

Janata

Paroo

(2006). Acuity of auditory images in pitch and time. Perception & Psychophysics, 68, 829–844.

21.

Kamlin

C. O. F.

O’Donnell

C. P. F.

Davis

P. G.

Morley

C. J.

(2006). Oxygen saturation in healthy infants immediately after birth. Journal of Pediatrics, 148, 585–589. doi:10.1016/j.jpeds.2005.12.050

22.

Kiefer

Hoeft

(2010). Display of information in the operating room. Current Opinion in Anesthesiology, 23, 772–777. doi:10.1097/ACO.0b013e32834045fd

23.

Lacherez

Seah

E. L.

Sanderson

P. M.

(2007). Overlapping melodic alarms are almost indiscriminable. Human Factors, 49, 637–645. doi:10.1518/001872007x215719

24.

Leung

Y. K.

Smith

Parker

Martin

(1997, November). Learning and retention of auditory warnings. Paper presented at the Third International Conference on Auditory Display (ICAD), Palo Alto, CA.

25.

Long

J. G.

Lucey

J. F.

Philip

A. G. S.

(1980). Noise and hypoxemia in the intensive-care nursery. Pediatrics, 65, 143–145.

26.

Mondor

T. A.

Finley

G. A.

(2003). The perceived urgency of auditory warning alarms used in the hospital operating room is inappropriate. Canadian Journal of Anaesthesia–Journal Canadien D Anesthesie, 50, 221–228.

27.

Navarro Cebrian

Janata

(2010). Influences of multiple memory systems on auditory mental image acuity. Journal of the Acoustical Society of America, 127, 3189–3202. doi:10.1121/1.3372729

28.

Paneth

(2005). The evidence mounts against use of pure oxygen in newborn resuscitation. Journal of Pediatrics, 147, 4–6.

29.

Petocz

Keller

P. E.

Stevens

C. J.

(2008). Auditory warnings, signal-referent relations, and natural indicators: Re-thinking theory and application. Journal of Experimental Psychology–Applied, 14, 165–178. doi:10.1037/1076-898x.14.2.165

30.

Rabi

Yee

Chen

S. Y.

Singhal

(2006). Oxygen saturation trends immediately after birth. Journal of Pediatrics, 148, 590–594. doi:10.1016/j.jpeds.12.017

31.

Sanderson

P. M.

(2006). The multimodal world of medical monitoring displays. Applied Ergonomics, 37, 501–512. doi:10.1016/j.apergo.2006.04.022

32.

Sanderson

P. M.

Liu

Jenkins

S. A.

(2009). Auditory displays in anesthesiology. Current Opinion in Anesthesiology, 22, 788–795. doi:10.1097/ACO.0b013e3283326a2f

33.

Sanderson

P. M.

Wee

Lacherez

(2006). Learnability and discriminability of melodic medical equipment alarms. Anaesthesia, 61, 142–147. doi:10.1111/j.1365-2044.2005.04502.x

34.

Schellenberg

E. G.

Trehub

S. E.

(2003). Good pitch memory is widespread. Psychological Science, 14, 262–266.

35.

Schmid

Goepfert

M. S.

Kuhnt

Eichhorn

Diedrichs

Reichenspurner

. . .Reuter

D. A.

(2011). The wolf is crying in the operating room: Patient monitor and anesthesia workstation alarming patterns during cardiac surgery. Anesthesia and Analgesia, 112, 78–83. doi:10.1213/ANE.0b013e3181fcc504

36.

Siebig

Kuhls

Imhoff

Gather

Scholmerich

Wrede

C. E.

(2010). Intensive care unit alarms: How many do we need? Critical Care Medicine, 38, 451–456. doi:10.1097/CCM.0b013e3181cb0888

37.

Tin

(2004). Optimal oxygen saturation for preterm babies: Do we really know? Biology of the Neonate, 85, 319–325. doi:10.1159/000078173

38.

Tin

Milligan

D. W. A.

Pennefather

Hey

(2001). Pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation. Archives of Disease in Childhood, 84, F106–F110.

39.

Tomic

S. T.

Janata

(2007). Ensemble: A web-based system for psychology survey and experiment management. Behavior Research Methods, 39, 635–650.

40.

Walker

B. N.

(2007). Consistency of magnitude estimations with conceptual data dimensions used for sonification. Applied Cognitive Psychology, 21, 579–599. doi:10.1002/acp.1291

41.

Ward

W. D.

(1999). Absolute pitch. In Deutsch

(Ed.), The psychology of music (2nd ed., pp. 265–298). San Diego, CA: Academic Press.

42.

Watson

M. O.

(2006, June). Scalable earcons: Bridging the gap between intermittent and continuous auditory displays. Paper presented at the 12th International Conference on Auditory Display, London, UK.

43.

Watson

M. O.

Sanderson

P. M.

(2007). Designing for attention with sound: Challenges and extensions to ecological interface design. Human Factors, 49, 331–346.

44.

Wee

A. N.

Sanderson

P. M.

(2008). Are melodic medical equipment alarms easily learned? Anesthesia and Analgesia, 106, 501–508. doi:10.1213/01.ane.0000286148.58823.6c

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.04 MB