Physicians' eye-tracking in neonatal intensive care: evaluating a mechanical ventilator panel

Assess physicians' visual attention when evaluating a mechanical ventilator panel to decide whether to adjust ventilatory parameters in a newborn on mechanical ventilation.

Experimental study involving physicians caring for critically ill neonates. Three clinical scenarios related to arterial blood gas abnormalities (hypoxemia, hypercarbia or normal blood gases) were presented on a computer screen, followed by a 30-second video of a ventilator panel while eye-tracker recorded their gaze. Three areas of interest (AOI) were defined: monitored parameters, adjusted parameters, curves and loops. Visual attention was analyzed in the first 10 seconds of the video. Outcomes included visual fixation (Yes/No), number, and duration (seconds) of visual fixations on each AOI. Multivariate analysis of variance was used to compare outcomes among AOI.

Seventy-five physicians participated, with ocular signal capture acquisition in 95±5% of the time. All physicians (100%) fixated their gaze on the curves/loops, 95% on monitored parameters and 80% on adjusted parameters. Visual fixations were more frequent and longer for curves/loops (8.03±5.98; 2.07±1.61sec), followed by monitored (5.40±5.00; 1.21±1.29sec) and by adjusted parameters (14.72±7.64; 3.71±2.12sec). No differences were observed across clinical scenarios. Physicians without specialization in neonatology or pediatric intensive care focused more on adjusted parameters than specialists.

When evaluating a ventilator panel to decide respiratory management, physicians focused more on the curves and loops, regardless of the clinical scenario. Physicians without specialized training in neonatology or pediatric intensive care had greater visual fixation on adjusted parameters of the ventilator panel than specialists.