Rastreamento do olhar de médicos na tomada de decisão em cuidados intensivos neonatais ao avaliar um painel de um ventilador mecânico
Data
2024-12-12
Autores
Franco, Pâmella Cristina do Prado 
Orientadores
Barros, Marina Carvalho de Moraes
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A ventilação mecânica é um procedimento fundamental para sobrevida de recém-nascidos em cuidados intensivos. Na assistência a esses pacientes, o médico integra dados clínicos e de exames subsidiários, com informações do painel do ventilador para a tomada de decisão quanto ao manejo da ventilação. Não se conhece os focos de atenção visual do médico ao avaliar o painel de um ventilador mecânico para decidir pela alteração ou não dos parâmetros ventilatórios.
Objetivo: Verificar o foco do olhar de médicos ao avaliar o painel de um ventilador mecânico para decidir pela alteração ou não dos parâmetros ventilatórios.
Método: Estudo experimental realizado no Hospital São Paulo, em parceria com o Centro Universitário FEI. Foram incluídos médicos que prestam assistência a neonatos criticamente doentes e excluídos aqueles com deficiência visual profunda ou, após o experimento, os com captação do sinal ocular inferior a 70% do tempo do experimento. Foram elaboradas três situações clínicas, juntamente com três resultados de gasometria arterial, indicando hipoxemia, hipercapnia ou normalidade dos gases sanguíneos. Os casos foram apresentados de forma aleatória, sendo que a cada médico foi apresentado apenas uma situação clínica. A apresentação do caso ocorreu em tela de computador, e a seguir foi mostrado um vídeo do painel do ventilador iX5 (Vyaire Medical, Chicago, Illinois, USA) correspondente à situação clínica apresentada por 30 segundos. Durante a avaliação do vídeo, o olhar do participante foi rastreado por meio do rastreador Tobii modelo TX300 (Tobii Technology AB, Danderyd, Suécia). Ao final, perguntou-se ao médico se ele alteraria algum parâmetro do ventilador, e no caso de resposta afirmativa, qual seria o parâmetro a ser ajustado. No painel do ventilador foram delimitadas as áreas de interesse (AI) para a avaliação do rastreamento visual: parâmetros monitorados, parâmetros ajustados, e curvas e loops. Avaliou-se a ansiedade do participante pelo Beck Anxiety Inventory antes do experimento. Os desfechos do rastreamento visual foram: fixação visual nas AI (sim vs. não), e número e tempo das fixações visuais nas AI. Os desfechos do rastreamento visual foram comparados entre os médicos que avaliaram as três situações clínicas, e entre aqueles que concluíram ou não a especialização em neonatologia ou medicina intensiva pediátrica, por meio da análise de variância multivariada (MANOVA), ajustada por fatores de confusão.
Resultados: Foram estudados 75 médicos (45 com especialização em neonatologia ou medicina intensiva pediátrica e 30 sem essa especialização). Analisou-se o rastreamento visual dos médicos por 10 segundos após o início da apresentação do vídeo do painel do ventilador, sendo que a captação do sinal ocular ocorreu em 95,2±4,7% do tempo. Dos 75 médicos, 75 (100,0%) fixaram o olhar nas curvas e loops, 71 (94,7%) nos parâmetros monitorados e 60 (80,0%) nos parâmetros ajustados. Os médicos realizaram maior número de fixações visuais e fixaram o olhar por mais tempo nas curvas e loops, seguido dos parâmetros monitorados e parâmetros ajustados: - número de fixações: 14,72±7,64; 8,03±5,98; 5,40±5,00, respectivamente; - tempo das fixações: 3,71±2,12s; 2,07±1,61s; 1,21±1,29s, respectivamente. Não houve diferença entre os médicos que avaliaram os três painéis dos ventiladores quanto ao número deles que fixou o olhar nas três AI, bem como quanto ao número e tempo das fixações visuais. Houve diferença na fixação do olhar no painel do ventilador entre os médicos com e sem especialização. Os médicos sem especialização realizaram maior número de fixações e fixaram o olhar por mais tempo nos parâmetros ajustados, comparados aos com especialização.
Conclusão: Médicos, ao avaliarem o painel de um ventilador para decidir pelo ajuste ou não dos parâmetros ventilatórios focam mais o olhar nas curvas e loops, seguidos dos parâmetros monitorados e ajustados, de modo semelhante para as diferentes situações clínicas. A atenção visual de médicos com e sem especialização em neonatologia ou medicina intensiva pediátrica diferiu, sendo que os sem especialização focaram mais o olhar nos parâmetros ajustados. O conhecimento da atenção visual de médicos ao avaliar o painel de um ventilador mecânico, no processo de decisão de ajuste dos parâmetros ventilatórios pode contribuir para o aprimoramento da capacitação médica.
Introduction: Mechanical ventilation is a fundamental procedure for the survival of newborns in intensive care. When assisting these patients, the physician integrates clinical and exams data with information from the ventilator panel to make decisions regarding ventilation management. The focus of the physician's visual attention when evaluating the panel of a mechanical ventilator to decide whether or not to change the ventilatory parameters is unknown. Objective: To verify the focus of the physician's gaze when evaluating the panel of a mechanical ventilator to decide whether or not to change the ventilatory parameters. Method: Experimental study conducted at Hospital São Paulo, in partnership with Centro Universitário FEI. Physicians who provide care to critically ill neonates were included and those with profound visual impairment or, after the experiment, those with ocular signal capture less than 70% of the time of the experiment were excluded. Three clinical situations were created, together with three arterial blood gas results, indicating hypoxemia, hypercapnia, or normal blood gases. The cases were presented randomly, and each physician was presented to only one clinical situation. The case was presented on a computer screen, and then a video of the iX5 ventilator panel (Vyaire Medical, Chicago, Illinois, USA) corresponding to the clinical situation presented was shown for 30 seconds. During the video evaluation, the participant's gaze was tracked using the Tobii model TX300 tracker (Tobii Technology AB, Danderyd, Sweden). At the end, the physician was asked whether or not to change any parameter of the ventilator, and if so, which parameter would be adjusted. The areas of interest (AOI) for the evaluation of visual tracking were delimited on the ventilator panel: monitored parameters, adjusted parameters, and curves and loops. The participant's anxiety was assessed using the Beck Anxiety Inventory before the experiment. The visual tracking outcomes were: visual fixation on the AOI (yes vs. no), and number and duration of visual fixations on the AOI. The visual tracking outcomes were compared between the physicians who evaluated the three clinical situations, and between those who had or had not completed specialization in neonatology or pediatric intensive care medicine, using multivariate analysis of variance (MANOVA), adjusted for confounding factors. Results: Seventy-five physicians were studied (45 with specialization in neonatology or pediatric intensive care medicine and 30 without this specialization). The physicians' visual tracking was analyzed for 10 seconds after the start of the presentation of the ventilator panel video, and the capture of the ocular signal occurred in 95.2±4.7% of the time. Of the 75 physicians, 75 (100.0%) fixed their gaze on the curves and loops, 71 (94.7%) on the monitored parameters and 60 (80.0%) on the adjusted parameters. The physicians performed greater number of visual fixations and fixed their gaze for longer time on the curves and loops, followed by the monitored parameters and adjusted parameters: - number of fixations: 14.72±7.64; 8.03±5.98; 5.40±5.00, respectively; - fixation time: 3.71±2.12sec; 2.07±1.61sec; 1.21±1.29sec, respectively. There was no difference among the physicians who evaluated the three ventilator panels regarding the number of physicians who fixed their gaze on the three AOIs, as well as regarding the number and duration of visual fixations. There was a difference in the fixation of gaze on the ventilator panel between physicians with and without specialization. Physicians without specialization performed a greater number of fixations and fixed their gaze for longer on the adjusted parameters, compared to those with specialization. Conclusion: When evaluating the panel of a ventilator to decide whether or not to adjust the ventilatory parameters, physicians focused their gaze more on the curves and loops, followed by the monitored and adjusted parameters, in a similar manner for the different clinical situations. The visual attention of physicians with and without specialization in neonatology or pediatric intensive care medicine differed, with those without specialization focusing their gaze more on the adjusted parameters. Knowledge of the visual attention of physicians when evaluating the panel of a mechanical ventilator, in the decision-making process of adjusting ventilation parameters, can contribute to improving medical training.
Introduction: Mechanical ventilation is a fundamental procedure for the survival of newborns in intensive care. When assisting these patients, the physician integrates clinical and exams data with information from the ventilator panel to make decisions regarding ventilation management. The focus of the physician's visual attention when evaluating the panel of a mechanical ventilator to decide whether or not to change the ventilatory parameters is unknown. Objective: To verify the focus of the physician's gaze when evaluating the panel of a mechanical ventilator to decide whether or not to change the ventilatory parameters. Method: Experimental study conducted at Hospital São Paulo, in partnership with Centro Universitário FEI. Physicians who provide care to critically ill neonates were included and those with profound visual impairment or, after the experiment, those with ocular signal capture less than 70% of the time of the experiment were excluded. Three clinical situations were created, together with three arterial blood gas results, indicating hypoxemia, hypercapnia, or normal blood gases. The cases were presented randomly, and each physician was presented to only one clinical situation. The case was presented on a computer screen, and then a video of the iX5 ventilator panel (Vyaire Medical, Chicago, Illinois, USA) corresponding to the clinical situation presented was shown for 30 seconds. During the video evaluation, the participant's gaze was tracked using the Tobii model TX300 tracker (Tobii Technology AB, Danderyd, Sweden). At the end, the physician was asked whether or not to change any parameter of the ventilator, and if so, which parameter would be adjusted. The areas of interest (AOI) for the evaluation of visual tracking were delimited on the ventilator panel: monitored parameters, adjusted parameters, and curves and loops. The participant's anxiety was assessed using the Beck Anxiety Inventory before the experiment. The visual tracking outcomes were: visual fixation on the AOI (yes vs. no), and number and duration of visual fixations on the AOI. The visual tracking outcomes were compared between the physicians who evaluated the three clinical situations, and between those who had or had not completed specialization in neonatology or pediatric intensive care medicine, using multivariate analysis of variance (MANOVA), adjusted for confounding factors. Results: Seventy-five physicians were studied (45 with specialization in neonatology or pediatric intensive care medicine and 30 without this specialization). The physicians' visual tracking was analyzed for 10 seconds after the start of the presentation of the ventilator panel video, and the capture of the ocular signal occurred in 95.2±4.7% of the time. Of the 75 physicians, 75 (100.0%) fixed their gaze on the curves and loops, 71 (94.7%) on the monitored parameters and 60 (80.0%) on the adjusted parameters. The physicians performed greater number of visual fixations and fixed their gaze for longer time on the curves and loops, followed by the monitored parameters and adjusted parameters: - number of fixations: 14.72±7.64; 8.03±5.98; 5.40±5.00, respectively; - fixation time: 3.71±2.12sec; 2.07±1.61sec; 1.21±1.29sec, respectively. There was no difference among the physicians who evaluated the three ventilator panels regarding the number of physicians who fixed their gaze on the three AOIs, as well as regarding the number and duration of visual fixations. There was a difference in the fixation of gaze on the ventilator panel between physicians with and without specialization. Physicians without specialization performed a greater number of fixations and fixed their gaze for longer on the adjusted parameters, compared to those with specialization. Conclusion: When evaluating the panel of a ventilator to decide whether or not to adjust the ventilatory parameters, physicians focused their gaze more on the curves and loops, followed by the monitored and adjusted parameters, in a similar manner for the different clinical situations. The visual attention of physicians with and without specialization in neonatology or pediatric intensive care medicine differed, with those without specialization focusing their gaze more on the adjusted parameters. Knowledge of the visual attention of physicians when evaluating the panel of a mechanical ventilator, in the decision-making process of adjusting ventilation parameters, can contribute to improving medical training.
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Citação
FRANCO, Pâmella Cristina do Prado. Rastreamento do olhar de médicos na tomada de decisão em cuidados intensivos neonatais ao avaliar um painel de um ventilador mecânico 2024. 125 f. Dissertação (Mestrado em Pediatria e Ciências Aplicadas à Pediatria) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.