# Assessing oral comprehension with an eye tracking based innovative device in critically ill patients and healthy volunteers: a cohort study: authors' response

Hélène Messet-Charrière, Stephan Ehrmann, Laëtitia Bodet-Contentin

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Hélène Messet-Charrière, Stephan Ehrmann, Laëtitia Bodet-Contentin. Assessing oral comprehension with an eye tracking based innovative device in critically ill patients and healthy volunteers: a cohort study: authors' response. Critical Care, 2023, 27 (1), pp.44. 10.1186/s13054-023-04334-8. hal-05099171

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# Assessing oral comprehension with an eye tracking based innovative device in critically ill patients and healthy volunteers: a cohort study: authors' response

Hélène Messet-Charrière<fnref n="1" />, Stephan Ehrmann<fnref n="2" />,<fnref n="3" /> and Laetitia Bodet-Contentin<fnref n="1" />,<fnref n="4" />*

Dear Editors,

We thank Waydhas and colleagues for their interest and careful reading of our work [1, 2]. Addressing the questions raised will enable us to clarify the subject and further confirm the great potential of eye tracking technology for intensive care unit patients.

First, it was suggested that the performance of patients
could be perceived as low, with a correct answer rate
close to a theoretical guessing rate calculated by Way-
dhas. For technical reasons beyond the scope of this let-
ter exchange, the correct answer rate one would expect
by guessing is much lower than this calculation. Thus, the
readers should not consider the numeric value as an indi-
cation that eye tracking would not be suited for critically
ill patients. Actually, it is the opposite, our work validates
the potential use of this technology in this setting.

Concerning gaze fixation time, whereas our group also
performed similar studies on icons fixation for eye track-
ing-based electronic communication [3, 4], the setting
and objectives of the present study (developing a diag-
nostic tool to quantify comprehension) were completely
different.

We share the concern that the questions of the Mon-
treal-Toulouse-86 test have little to do with the situa-
tion lived by patients which represents a bias inherent
to using a test developed for another context. Hopefully,
collaboration of teams with shared interest may enable to
develop eye tracking fit tests specifically adapted to the
intensive care unit setting.

The aim of our study was to assess the feasibility of
an oral comprehension test using eye tracking technol-
ogy with the ultimate goal to improve communication of
the patient with the staff and family members. By early
detection and precise quantification of comprehension
difficulties, we envision to implement corrective measure
and use appropriate personalized tools to communicate
with patients.

We are strong believers of the importance of personal
human interactions for communication in the intensive
care unit and consider machines as a potential help but in
no way a substitute. Waydhas and colleagues can be reas-
sured on this point, and we strongly believe eye tracking
technology has great potential to contribute to improved
human communication leading towards a more human-
ized intensive care unit.

This comment refers to the article available online at https://doi.org/10.1186/s13054-022-04137-3. This reply refers to the comment available online at https://doi.org/10.1186/s13054-022-04280-x.

<footnote>*Correspondence:</footnote>

<footnote>Laetitia Bodet-Contentin
laetitia.bodet@univ-tours.fr</footnote>

<footnote n="1">¹CHRU Tours, Médecine Intensive Réanimation, Tours, France</footnote>

<footnote n="2">²CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSep FCRIN research network, Tours, France</footnote>

<footnote n="3">³INSERM, Centre d'étude des pathologies respiratoires, U1100, Université de Tours, Tours, France</footnote>

<footnote n="4">⁴INSERM, SPHERE, UMR1246, Université de Tours et Nantes, Tours et Nantes, France</footnote>
**Acknowledgements**

Not applicable.

**Authors' contributions**

L.B-C, H.M-C and S.E. wrote the manuscript draft. All authors contributed to the manuscript for important intellectual content and have read and approved the final manuscript.

**Funding**

Not applicable.

**Availability of data and materials**

Not applicable.

**Declarations**

**Ethics approval and consent to participate**

Not applicable.

**Consent for publication**

Not applicable.

**Competing interests**

SE discloses consultancies from Aerogen Ltd, research support from Aerogen Ltd, Fisher & Paykel Healthcare Ltd, travel reimbursements from Aerogen Ltd and Fisher & Paykel Healthcare Ltd. Other authors declare no conflict of interest.

Received: 20 January 2023 Accepted: 24 January 2023

Published online: 01 February 2023

**References**

1. Waydhas C, Gaschler R, Ull C, et al. Letter to the editor: Failing an automated comprehension test while being able to report on needs: eye-tracking in critically ill intubated patients should not be underestimated. Crit Care. 2022;26:400. https://doi.org/10.1186/s13054-022-04280-x.

2. Bodet-Contentin L, Messet-Charrière H, Gissot V, et al. Assessing oral comprehension with an eye tracking based innovative device in critically ill patients and healthy volunteers: a cohort study. Crit Care. 2022;26:288. https://doi.org/10.1186/s13054-022-04137-3.

3. Bodet-Contentin L, Szymokowicz E, Delpierre E, Chartier D, Gadrez P, Muller G, Renault A, Ehrmann S. Eye tracking communication with intubated critically ill patients: a proof-of-concept multicenter pilot study. Minverva Anesthesiol. 2022;88:690-7.

4. Bodet-Contentin L, Gadrez P, Ehrmann S. Eye-tracking and speech-generating technology to improve communication with intubated intensive care unit patients: initial experience. Intensive Care Med. 2018;44:676677.

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