Visual attention on a respiratory function monitor during simulated neonatal resuscitation: an eye-tracking study

Abstract

Objective: A respiratory function monitor (RFM) may improve positive pressure ventilation (PPV) technique, but many providers do not use RFM data appropriately during delivery room resuscitation. We sought to use eye-tracking technology to identify RFM parameters that neonatal providers view most commonly during simulated PPV.

Design: Mixed methods study. Neonatal providers performed RFM-guided PPV on a neonatal manikin while wearing eye-tracking glasses to quantify visual attention on displayed RFM parameters (ie, exhaled tidal volume, flow, leak). Participants subsequently provided qualitative feedback on the eye-tracking glasses.

Setting: Level 3 academic neonatal intensive care unit.

Participants: Twenty neonatal resuscitation providers.

Main outcome measures: Visual attention: overall gaze sample percentage; total gaze duration, visit count and average visit duration for each displayed RFM parameter. Qualitative feedback: willingness to wear eye-tracking glasses during clinical resuscitation.

Results: Twenty providers participated in this study. The mean gaze sample captured wa s 93% (SD 4%). Exhaled tidal volume waveform was the RFM parameter with the highest total gaze duration (median 23%, IQR 13-51%), highest visit count (median 5.17 per 10 s, IQR 2.82-6.16) and longest visit duration (median 0.48 s, IQR 0.38-0.81 s). All participants were willing to wear the glasses during clinical resuscitation.

Conclusion: Wearable eye-tracking technology is feasible to identify gaze fixation on the RFM display and is well accepted by providers. Neonatal providers look at exhaled tidal volume more than any other RFM parameter. Future applications of eye-tracking technology include use during clinical resuscitation.

Keywords: neonatology; respiratory; resuscitation; technology.

Figure 1:

NewLife Box Respiratory Function Monitor Display (reproduced by permission, NewLifeBox^® Neo-RSD). Numeric data displayed on the left side of the screen include: PIP (peak inspiratory pressure), PEEP (positive end expiratory pressure), flow, RR (respiratory rate), Vte (exhaled tidal volume in mL/kg), Vti (inspiratory tidal volume in mL/kg), and mask leak (%). The numerical data are constantly refreshed and represent real-time values of each respiratory parameter at a specific point in time. Waveform data displayed include pressure, flow, exhaled tidal volume, and pulse rate (using streaming pulse oximeter data during clinical resuscitation). The 2 horizontal orange lines in the Vte waveform region indicate 4mL/kg and 8mL/kg.

Figure 2:

Example heat map. Heat maps are a graphical representation of the mapped gaze data, where colors indicate the density of gaze fixations (density increases from green-yellow-orange-red). Here the heat map demonstrates the summary of all gaze points on the respiratory function monitor (RFM) recorded during the simulation. These are mapped onto an exported image of the RFM screen. The highest density of gaze fixations, indicated by the red color of the gaze point clusters, are seen overlying the exhaled tidal volume waveform region.

Figure 3.

Systematic gaze offset. This heat map from a study participant demonstrates a systematic gaze offset. Areas of high gaze density are mapped to the left and downwards of the numeric respiratory parameters located on the left side of the respiratory function monitor (RFM) display. In figure 3A the original borders of the areas of interest (thick black borders) follow the natural rectangular boundaries of the displayed regions on the RFM screen, but these borders intersect the high gaze density regions displayed in the heat maps. In figure 3B the borders of the areas of interest are adjusted to accommodate the offset seen in the heat map.