Abstract
Introduction: Closed-loop ventilation modes are increasingly being used in intensive care units to ensure more automaticity. Little is known about the visual behavior of health professionals using these ventilation modes. The aim of this study was to analyze gaze patterns of intensive care nurses while ventilating a patient in the closed-loop mode with Intellivent adaptive support ventilation® (I-ASV) and to compare inexperienced with experienced nurses.Materials and Methods: Intensive care nurses underwent eye-tracking during daily care of a patient ventilated in the closed-loop ventilation mode. Five specific areas of interest were predefined (ventilator settings, ventilation curves, numeric values, oxygenation Intellivent, ventilation Intellivent). The main independent variable and primary outcome was dwell time. Secondary outcomes were revisits, average fixation time, first fixation and fixation count on areas of interest in a targeted tracking-time of 60 min. Gaze patterns were compared between I-ASV inexperienced (n = 12) and experienced (n = 16) nurses.Results: In total, 28 participants were included. Overall, dwell time was longer for ventilator settings and numeric values compared to the other areas of interest. Similar results could be obtained for the secondary outcomes. Visual fixation of oxygenation Intellivent and ventilation Intellivent was low. However, dwell time, average fixation time and first fixation on oxygenation Intellivent were longer in experienced compared to inexperienced intensive care nurses.Discussion: Gaze patterns of intensive care nurses were mainly focused on numeric values and settings. Areas of interest related to traditional mechanical ventilation retain high significance for intensive care nurses, despite use of closed-loop mode. More visual attention to oxygenation Intellivent and ventilation Intellivent in experienced nurses implies more routine and familiarity with closed-loop modes in this group. The findings imply the need for constant training and education with new tools in critical care, especially for inexperienced professionals.
Highlights
Closed-loop ventilation modes are increasingly being used in intensive care units to ensure more automaticity
The aim of this study was to analyze gaze patterns of intensive care unit (ICU) nurses using eye-tracking while ventilating a patient in the closed-loop mode Intellivent adaptive support ventilation (IASV) R and to compare the patterns of inexperienced with those of experienced ICU nurses
Written informed consent was given by all participating ICU nurses and the patients involved, or the patients’ legal representatives in cases of incapacity of judgement
Summary
Closed-loop ventilation modes are increasingly being used in intensive care units to ensure more automaticity. Unintentional human errors and lack of situation awareness are among the leading causes of adverse events, in the medical setting [1,2,3,4,5,6,7,8,9,10,11,12]. Inadequate information processing with respect to monitoring devices may contribute to individual errors leading to impaired patient outcomes. To date, it is largely unclear how user interfaces and specific program modes of technical devices are cognitively processed by specialized ICU nurses, despite some past research on graphical displays and situation awareness [11, 15]. Based on constant measurements (i.e., peripheral oxygen saturation and end-tidal carbon dioxide) and algorithms, these modes automatically adjust the fraction of inhaled oxygen (FiO2), the positive end-expiratory pressure (PEEP) and minute ventilation [16, 17]
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