• Daniel A Hofmaenner, Stephanie Klinzing, Giovanna Brandi, Stephan Hess, Quentin Lohmeyer, Katharina Enthofer, Reto A Schuepbach, and Philipp K Buehler.
• Institute of Intensive Care, University Hospital of Zurich, Zurich, Switzerland - danielandrea.hofmaenner@usz.ch.
• Minerva Anestesiol. 2020 Nov 1; 86 (11): 1180-1189.

BackgroundPatient safety is a top priority in healthcare. Little is known about the visual behavior of professionals during high-risk procedures. The aim of this study was to assess feasibility, usability and safety of eye-tracking to analyze gaze patterns during the extubation process in the intensive care unit.MethodsEye-tracking was used in this observational study to analyze the extubation process in 22 participants. Independent variables were average fixation time, dwell time, fixation count, hit ratio and revisit count for eighteen areas of interest. Primary outcome was dwell time for all areas of interest. Secondary outcomes were average fixation time, fixation count and revisits. In subgroup analyses, experienced and non-experienced physicians were compared.ResultsThe most important area of interest was the patient, as analyzed by dwell time. Fixation of other areas of interest varied significantly among participants. Only 54% checked ventilator respiratory rate, despite declaring it as important in questionnaires. Other neglected areas of interest included tidal volume (59%), peak pressure (63.6%), CO2 (63.6%), temperature (18.2%), blood pressure (59%) and heart rate (68%). Experienced physicians gazed more frequently and longer at the patient while spending less time on monitor and ventilator parameters.ConclusionsEye-tracking can demonstrate that there is a mismatch between physicians' subjective evaluations and corresponding objective real-life measurements. Structured and standardized extubation processes should be performed to improve patient safety. In the immediate postextubation phase, long dwell time on the patient shows that clinical observation remains the most important cornerstone beyond monitoring devices.

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