Eye-tracking during simulated endotracheal newborn intubation: a prospective, observational multi-center study.
Journal
Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
received:
03
09
2022
accepted:
27
02
2023
revised:
14
02
2023
medline:
31
7
2023
pubmed:
19
3
2023
entrez:
18
3
2023
Statut:
ppublish
Résumé
The aim was to assess health care providers' (HCPs) visual attention (VA) by using eye-tracking glasses during a simulated neonatal intubation. HCPs from three pediatric and neonatal departments (Feldkirch and Vienna, Austria, and Edmonton, Canada) completed a simulated neonatal intubation scenario while wearing eye-tracking glasses (Tobii Pro Glasses 2 30 participants were included. 50% completed the intubation within 30 s (M = 35.40, SD = 16.01). Mostly nasotracheal intubations exceeded the limit. Experience was an important factor in reducing intubation time. VA differed between more and less experienced HCPs as well as between orotracheal and nasotracheal intubations. Participants also focused on different areas of interest (AOIs) depending on the intubator's experience. More experience was associated with a higher situational awareness (SA) and fewer distractions, which, however, did not transfer to significantly better intubation performance. Half of the intubations exceeded the recommended time limit. Differences in intubation duration depending on type of intubation were revealed. VA differed between HCPs with different levels of experience and depended on duration and type of intubation. Simulated neonatal intubation duration differs between orotracheal and nasotracheal intubation. Visual attention during simulated neonatal intubation shows differences depending on intubation duration, intubator experience, type of intubation, and level of distraction. Intubator experience is a vital parameter for reducing intubation duration and improving intubator focus on task-relevant stimuli.
Sections du résumé
BACKGROUND
The aim was to assess health care providers' (HCPs) visual attention (VA) by using eye-tracking glasses during a simulated neonatal intubation.
METHODS
HCPs from three pediatric and neonatal departments (Feldkirch and Vienna, Austria, and Edmonton, Canada) completed a simulated neonatal intubation scenario while wearing eye-tracking glasses (Tobii Pro Glasses 2
RESULTS
30 participants were included. 50% completed the intubation within 30 s (M = 35.40, SD = 16.01). Mostly nasotracheal intubations exceeded the limit. Experience was an important factor in reducing intubation time. VA differed between more and less experienced HCPs as well as between orotracheal and nasotracheal intubations. Participants also focused on different areas of interest (AOIs) depending on the intubator's experience. More experience was associated with a higher situational awareness (SA) and fewer distractions, which, however, did not transfer to significantly better intubation performance.
CONCLUSION
Half of the intubations exceeded the recommended time limit. Differences in intubation duration depending on type of intubation were revealed. VA differed between HCPs with different levels of experience and depended on duration and type of intubation.
IMPACT
Simulated neonatal intubation duration differs between orotracheal and nasotracheal intubation. Visual attention during simulated neonatal intubation shows differences depending on intubation duration, intubator experience, type of intubation, and level of distraction. Intubator experience is a vital parameter for reducing intubation duration and improving intubator focus on task-relevant stimuli.
Identifiants
pubmed: 36932183
doi: 10.1038/s41390-023-02561-x
pii: 10.1038/s41390-023-02561-x
doi:
Types de publication
Observational Study
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
443-449Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2023. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.
Références
Sawyer, T. et al. Improving neonatal intubation safety: a journey of a thousand miles. J. Neonatal Perinat. Med. 10, 125–131 (2017).
doi: 10.3233/NPM-171686
Weiner, G. M., Zaichkin, J., Kattwinkel, J. Textbook of Neonatal Resuscitation 7th edn, (Elk Grove Village, IL: American Academy of Pediatrics, 2016).
Gelbart, B., Hiscock, R. & Barfield, C. Assessment of neonatal resuscitation performance using video recording in a perinatal centre. J. Paediatr. Child Health 46, 378–383 (2010).
doi: 10.1111/j.1440-1754.2010.01747.x
pubmed: 20546105
Root, L. et al. Improving guideline compliance and documentation through auditing neonatal resuscitation. Front Pediatr. 7, 1–7 (2019).
doi: 10.3389/fped.2019.00294
Simma, B. et al. Delivery room management of infants with very low birth weight in 3 european countries—the video apgar study. J. Pediatr. 222, 106–111 (2020).
doi: 10.1016/j.jpeds.2020.03.035
pubmed: 32418815
Foglia, E. E. et al. Neonatal intubation practice and outcomes: an international registry study. Pediatrics 143, 1–10 (2019).
doi: 10.1542/peds.2018-0902
Robinson, M. È. et al. Trainees success rates with intubation to suction meconium at birth. Arch. Dis. Child Fetal Neonatal Ed. 103, F413–F416 (2018).
doi: 10.1136/archdischild-2017-313916
pubmed: 29636384
Leone, T. A., Rich, W. & Finer, N. N. Neonatal intubation: success of pediatric trainees. J. Pediatr. 146, 638–641 (2005).
doi: 10.1016/j.jpeds.2005.01.029
pubmed: 15870667
Belkhatir, K., Scrivens, A., O’Shea, J. E. & Roehr, C. C. Experience and training in endotracheal intubation and laryngeal mask airway use in neonates: results of a national survey. Arch. Dis. Child Fetal Neonatal Ed. 106, 223–224 (2021).
doi: 10.1136/archdischild-2020-319118
pubmed: 32571833
Spence, K., Barr, P. Cochrane Neonatal Group. Nasal versus oral intubation for mechanical ventilation of newborn infants. Cochrane Database Syst Rev. (1999).
Lenclen, R., Narcy, P., Castela, F. & Huard, F. Evaluation of an educational intervention on the standard of neonatal resuscitation: orotracheal versus nasotracheal intubation. Arch. Pediatr. 16, 337–342 (2009).
doi: 10.1016/j.arcped.2008.12.026
pubmed: 19230628
Wagner, M. et al. Eye-tracking during simulation-based neonatal airway management. Pediatr. Res. 87, 518–522 (2019).
doi: 10.1038/s41390-019-0571-9
pubmed: 31499516
Law, B. H. Y. et al. Analysis of neonatal resuscitation using eye tracking: a pilot study. Arch. Dis. Child Fetal Neonatal Ed. 103, F82–F84 (2018).
doi: 10.1136/archdischild-2017-313114
pubmed: 28824007
Wagner, M. et al. Video-based reflection on neonatal interventions during COVID-19 using eye-tracking glasses: an observational study. Arch. Dis. Child Fetal Neonatal Ed. 107, 156–160 (2022).
doi: 10.1136/archdischild-2021-321806
pubmed: 34413092
Wagner, M. et al. Visual attention during pediatric resuscitation with feedback devices: a randomized simulation study. Pediatr. Res. 91, 1762–1768 (2022).
doi: 10.1038/s41390-021-01653-w
pubmed: 34290385
Endsley, M. R. Measurement of situation awareness in dynamic systems. Hum. Factors J. Hum. Factors Erg. Soc. 37, 65–84 (1995).
doi: 10.1518/001872095779049499
Endsley, M. R. Design and evaluation for situation awareness enhancement. Proc. Hum. Factors Soc. 32nd Annu. Meet. 101–197 (1988).
Endsley, M. R. & Hoffman, R. R. The sacagawea principle. IEEE Intell. Syst. 17, 80–85 (2022).
doi: 10.1109/MIS.2002.1134367
Hamid, H. S., Waternson P. E. Using goal directed task analysis to identify situation awareness requirements of advanced paramedics. In: Advances in Human Factors and Ergonomics in Healthcare (ed. Duffy ViG). First Edition. CRC Press (2011).
Law, B. H. Y. & Schmölzer, G. M. Analysis of visual attention and team communications during neonatal endotracheal intubations using eye-tracking: an observational study. Resuscitation 153, 176–182 (2020).
doi: 10.1016/j.resuscitation.2020.06.019
pubmed: 32580005
O’Donnell, C. P. F., Kamlin, C. O. F., Davis, P. G. & Morley, C. J. Endotracheal intubation attempts during neonatal resuscitation: success rates, duration, and adverse effects. Pediatrics 117, e16–e21 (2006).
doi: 10.1542/peds.2005-0901
pubmed: 16396845
Xue, F. S. et al. Hemodynamic responses to tracheal intubation with the GlideScope® videolaryngoscope: a comparison of oral and nasal routes. Acta Anaesthesiol. Taiwan. 46, 8–15 (2008).
doi: 10.1016/S1875-4597(08)60014-4
pubmed: 18390395
Tien, T. et al. Differences in gaze behaviour of expert and junior surgeons performing open inguinal hernia repair. Surg. Endosc. 29, 405–413 (2015).
doi: 10.1007/s00464-014-3683-7
pubmed: 25125094
McNaughten, B. et al. Clinicians’ gaze behaviour in simulated paediatric emergencies. Arch. Dis. Child 103, 1146–1149 (2018).
doi: 10.1136/archdischild-2017-314119
pubmed: 29514811
Kok, E. M. et al. Systematic viewing in radiology: seeing more, missing less? Adv. Heal Sci. Educ. 21, 189–205 (2016).
doi: 10.1007/s10459-015-9624-y
Hogan, M. P., Pace, D. E., Hapgood, J. & Boone, D. C. Use of human patient simulation and the situation awareness global assessment technique in practical trauma skills assessment. J. Trauma 61, 1047–1052 (2006).
doi: 10.1097/01.ta.0000238687.23622.89
pubmed: 17099507