Manual Interfaces in Medicine and Mechanics—2

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Considering our results and the impact of tasks on dimensions like performance and effort for some devices, manufacturers may primarily focus on interface simplification and rationalization, immediately providing the most important settings and alarms on a first screen, leaving expert settings to a second one. As with other bench tests, the main limitations of our study may concern the inability to extrapolate our results to the real clinical situation.

First, our technical evaluation was performed on a model, which cannot mimic the complexity of all interactions between a patient and a ventilator. The ASL is a simulator and it remains different from patients, mainly because the spontaneous inspiratory profile is not modified by pressurization during the inspiratory phase.

A new global and comprehensive model for ICU ventilator performances evaluation

However, the bench simulates most other situations and combinations that can be encountered in the clinical field. Second, the objective and subjective ergonomics measurements were assessed during standardized conditions that may be considered as different from real-life conditions. In order to be able to use various physiological sensors during the ergonomics evaluation, we chose not to use a high-fidelity environment with a manikin. We do agree with the fact that human behaviour under test may be significantly affected by the context and set-up of the experiment.

However, while we only included experts, it would have been difficult to reach our experimental goals while also trying to run after a more important degree of immersion that may not be necessary with these types of physicians. A simulated condition may never reproduce all the complexities of the interactions between a patient, a clinician and a ventilator, especially if the tester is an experienced clinician [ 39 ]. There are many techniques available for usability evaluation, such as cognitive walk-through, expert reviews, focus groups, Delphi technique, heuristic evaluation or objective timed tasks completion, all of them providing different information [ 38 ].

To the best of our knowledge, our study is the only one to provide a global and complete ergonomics evaluation, taking into account different techniques. Third, we may also consider that the small number of senior ICU physicians that were included in our study does not enable firm conclusions to be drawn.

Considering the design of the ergonomics evaluation, it required a huge amount of dedicated time from the physicians to undergo the different scenarios and various measurements for the experimental team. Moreover, none of them were familiar with the six tested devices, which exacerbated the difficulty in recruitment.

It was therefore unrealistic to use more testers, and such a drawback also tended to be limited by the use of a device that was known to everyone as a comparison and by the fact that we included physicians from five different ICUs. Such a bias was limited within our evaluation by the fact that, in an attempt to assess the ease of use, we only included naive subjects in order to limit the impact of such experience on the evaluation.

Despite significant technological improvements, several ICU ventilators do exhibit low ergonomics performance and a high risk of misusage. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial.

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Barriers in Human Medicine; Biophysics and mechanics at the disease interface

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