Buehler, Philipp K

Hofmaenner, Daniel A

Wendel-Garcia, Pedro David

English

ZORA

Zurich Open Repository andArchiveUniversity of ZurichUniversity LibraryStrickhofstrasse 39CH-8057 Zurichwww.zora.uzh.chYear: 2023Eye-tracking during newborn intubationsBuehler, Philipp K ; Wendel-Garcia, Pedro David ; Hofmaenner, Daniel ADOI: https://doi.org/10.1038/s41390-023-02630-1Posted at the Zurich Open Repository and Archive, University of ZurichZORA URL: https://doi.org/10.5167/uzh-236917Journal ArticlePublished Version  The following work is licensed under a Creative Commons: Attribution 4.0 International (CC BY 4.0) License.Originally published at:Buehler, Philipp K; Wendel-Garcia, Pedro David; Hofmaenner, Daniel A (2023). Eye-tracking during newbornintubations. Pediatric Research, 94(2):418-419.DOI: https://doi.org/10.1038/s41390-023-02630-1COMMENT OPENEye-tracking during newborn intubationsPhilipp K. Buehler1, Pedro David Wendel-Garcia1 and Daniel A. Hofmaenner1✉© The Author(s) 2023Pediatric Research (2023) 94:418–419; https://doi.org/10.1038/s41390-023-02630-1With great interest, we read the recently published article byKessler et al. in the Journal.1 In a well-designed study, the authorspresent some novel insights into the visual behavior of healthcareprofessionals while performing neonatal intubations.1 We wouldlike to highlight some points of interest that are worth discussing.First, eye-tracking research is relatively novel in the field ofintensive care medicine and research has so far often beenrestricted to limited participant numbers. Recently, it has beenused more frequently to assess visual behavior in the critical careenvironment.2 The authors should thus be congratulated forconducting their study in a multi-centric design, adding externalvalidity to their findings. However, the authors conducted theirtrial in a simulated setting.1 This choice of study designunfortunately precludes observation of a lot of the confoundingeffects existent in a real-life scenario, which eye-tracking enablesto crystalize. Actions performed in emergency situations arecommonly associated with more stress and insecurity as well aswith more interactions with other healthcare providers andmonitoring equipment, than simulated cases. The nuances ofeye-tracking really shine out in these more complex environ-ments, as interfering events can actively be identified.Previous research from our own group has demonstrated thateye-tracking is feasible in real-life scenarios in the intensive careunit, including during the investigation of high-risk interventions.For instance, the technology of eye-tracking was successfully usedduring the visual assessment of extubations of real, critically illpatients, where it could uncover clear mismatches in perceivedversus real patient assessment.3 Undoubtedly, real-life intubationsof newborns would thus enhance our understanding of visualawareness of healthcare personnel and add even more general-izability to the author’s findings. Of note, real-life studies incritically ill newborns have been successfully performed.4Second, while the study of Kessler et al. analyzed the number offixations and dwell time on their pre-specified areas of interest(AOIs), the inclusion of the revisit ratio would probably haveprovided further helpful insights into their analysis. The revisitratio can be interpreted as a surrogate of the complexity of aparticular AOI. Moreover, it is known to be indicative of visualpatterns related to checks and controlling, and thus of increasedneurocognitive focus.5 It would have been interesting to elucidatewhether revisits on distinct AOIs would have differed amongparticipants with different experience levels.Third, in order to synthesize faithful information of using eye-tracking, attention has to be paid in order to keep the participantcohorts homogeneous, as the sample size cannot be indefinitelyincreased at the moment due to time constraints in the evaluationof videos. The large heterogeneity in professional positions, age andexperience observed in this trial might thus have restricted theobservation of more nuanced signals in the data.1 Finally, we wouldrecommend to consider the integration of individual stress levels ofparticipants into the analysis. It is plausible that visual behavior canbe significantly affected by physical or emotional stress.With much interest, we are awaiting further eye-tracking trialsassessing high-risk situations in the critical care environment.Undoubtedly, novel insights could be gained that might assist toimprove patient outcomes in the future.REFERENCES1. Kessler, L. et al. Eye-tracking during simulated endotracheal newborn intubation: aprospective, observational multi-center study. Pediatr. Res. https://doi.org/10.1038/s41390-023-02561-x (2023).2. Hofmaenner, D. A. & Buehler, P. K. The impact of eye-tracking on patient safety incritical care. J. Clin. Monit. Comput. 36, 1577–1579 (2022).3. Hofmaenner, D. A. et al. The doctor’s point of view: eye-tracking as an investigativetool in the extubation process in intensive care units. A pilot study. MinervaAnestesiol. 86, 1180–1189 (2020).4. Law, B. H. Y. et al. Analysis of neonatal resuscitation using eye tracking: a pilotstudy. Arch. Dis. Child. Fetal Neonatal Ed. 103, F82–F84 (2018).5. Lohmeyer, Q. et al. Effects of tall man lettering on the visual behaviour of criticalcare nurses while identifying syringe drug labels: a randomised in situ simulation.BMJ Qual. Saf. 32, 26–33 (2023).AUTHOR CONTRIBUTIONSD.A.H. drafted the initial version of this manuscript. All authors read and approvedthe final version of the manuscript.FUNDINGOpen access funding provided by University of Zurich.COMPETING INTERESTSThe authors declare no competing interests.ADDITIONAL INFORMATIONCorrespondence and requests for materials should be addressed to Daniel A.Hofmaenner.Reprints and permission information is available at http://www.nature.com/reprintsPublisher’s note Springer Nature remains neutral with regard to jurisdictional claimsin published maps and institutional affiliations.Received: 14 April 2023 Accepted: 16 April 2023Published online: 28 April 20231Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland. ✉email: danielandrea.hofmaenner@usz.chwww.nature.com/pr1234567890();,:Open Access This article is licensed under a Creative CommonsAttribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in anymedium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the CreativeCommons license, and indicate if changes were made. The images or other third partymaterial in this article are included in the article’s Creative Commons license, unlessindicated otherwise in a credit line to the material. If material is not included in thearticle’s Creative Commons license and your intended use is not permitted by statutoryregulation or exceeds the permitted use, you will need to obtain permission directlyfrom the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.© The Author(s) 2023P.K. Buehler et al.419

Eye-tracking during newborn intubations

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Eye-tracking during newborn intubations

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