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Ali SA, Mohammed TA, Mohammed MA, Mahgoub AA. Development and Validation of Eyes Care Bundle for Mechanically Ventilated Patients. Crit Care Nurs Q 2024; 47:202-217. [PMID: 38860950 DOI: 10.1097/cnq.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Lack of proper eye care (EC) for mechanically ventilated patients can lead to serious ocular complications. Objective of this study is to develop and validate eyes care bundle for mechanically ventilated patients. A Delphi design study was conducted between March and May 2021. The Content Validity Index (CVI) was used to calculate the degree of agreement among the experts to analyze the bundle. Content validity was determined by 5 experts using a 4-point Likert scale. They evaluated the items in terms of the following: 1 = "irrelevant," 2 = "somewhat relevant if the phrasing is profoundly adjusted," 3 = "relevant with some adjustment," and 4 = "very relevant." The CVI was applied, and the accepted value was ≥0.50. The validation of EC bundle was conducted through 3 rounds after developed it based on the evaluated research evidence. The items were reviewed for content and face validity. The bundle was validated with 5 items with a total CVI of 0.96, a face validity of 1, and a Scale-Level Content Validity Index/Universal Agreement calculation method value of 0.8. This bundle can help critical care nurses, doctors, academics, and students assess and provide standard EC for mechanically ventilated patients.
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Affiliation(s)
- Sahar Ahmed Ali
- Author Affiliations:Faculty of Nursing (Drs Ali and T.A. Mohammed), Faculty of Medicine (Dr M.A. Mohammed), Assiut University; and Faculty of Nursing (Dr Mahgoub), Badr University, Assiut, Egypt
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Sosuan GMN, Sandoval Jr PF, Torrefranca Jr AB, Tan RRG, Lim Bon Siong R. Online Questionnaire-Based Study on the Knowledge, Attitude, and Practices of Non-Ophthalmic Physicians-in-Training Regarding Exposure Keratopathy Among Patients Admitted in a Tertiary Referral Hospital. Clin Ophthalmol 2023; 17:303-312. [PMID: 36711258 PMCID: PMC9875580 DOI: 10.2147/opth.s399665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
Objective This study aimed to determine the knowledge, attitude, and practices of non-ophthalmic physicians-in-training regarding recognition and prevention of exposure keratopathy among patients admitted in a tertiary referral hospital. Methods This study was a single-center cross-sectional study. An anonymous self-administered online questionnaire was distributed among non-ophthalmic physicians-in-training at the Philippine General Hospital (PGH) using convenience and snowball sampling. Results A total of 77 responses were recorded with a response rate of 37%. The majority of the respondents uniformly reported the absence of an established eye care protocol or policy being implemented for different subsets of patients at risk for developing exposure keratopathy. Ninety-six percent (96%) was aware of exposure keratopathy. The most urgent reason for referral to the ophthalmology service was the presence of whitish of opacity at 46.8%, while the least urgent reason was the presence of eye redness at 36.4%. Only 43% of the patients with incomplete eyelid closure was referred to the ophthalmology service. The most frequently used modality of prophylactic eye protection treatment was eyelid taping (84.4%) followed by lubricants (drops and gels, 79.1%). The most common reason for not referring was the absence of an established protocol on the appropriate indication for referral to the ophthalmology service. Conclusion This study showed that the majority of non-ophthalmic physicians-in-training had adequate knowledge and favorable attitude regarding recognition and prevention of exposure keratopathy among patient admitted at the PGH; however, the absence or the unavailability of an eye care protocol among patients with inadequate eyelid closure in our institution on the prevention of exposure keratopathy and its early treatment and appropriate indications for ophthalmology referral resulted in non-uniformity and varied practice patterns on its management.
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Affiliation(s)
- George Michael N Sosuan
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines,Correspondence: George Michael N Sosuan, Email
| | - Pablito F Sandoval Jr
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Aramis B Torrefranca Jr
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Reginald Robert G Tan
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines,Eye Institute, St. Luke’s Medical Center, Quezon City, Philippines
| | - Ruben Lim Bon Siong
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines,Eye Institute, St. Luke’s Medical Center, Quezon City, Philippines
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Ekici Gok Z, Gok A, Acun Delen L, Kasapoglu US, Gurbuz E, Mutlu K. Evaluation of eye care and ocular findings in critically ill COVID-19 patients. Int J Clin Pract 2021; 75:e14909. [PMID: 34553470 PMCID: PMC8646937 DOI: 10.1111/ijcp.14909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/19/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The current study aimed to evaluate eyecare needs along with ocular findings in patients treated in intensive care units because of Covid-19 infection. MATERIALS AND METHODS A total of 93 patients, 58 men and 35 women, who were under follow-up and treatment in intensive care because of COVID-19 infection from 1 January 2021 to 15 February 2021 were included in the study. Detailed eye examinations of the patients were performed with a portable handheld biomicroscope, direct and indirect ophthalmoscope. Cases requiring treatment for eye diseases were identified and treated. RESULTS The mean patient age was 68.32 ± 9.97 years; 35 patients were followed up and treated with non-invasive mechanical ventilation and 58 patients with invasive mechanical ventilation support. Mild, moderate, and severe chemosis was observed in 19 patients (20.4%), 10 patients (10.8%) and 4 patients (4.3%), respectively. Conjunctivitis (8.6%) was observed in eight patients. Corneal abrasion was present in seven patients (7.5%). Keratitis secondary to exposure keratopathy was observed in one patient. Eye care and medical treatment were initiated for these patients. We noted eight patients (8.6%) with retinal haemorrhage; however, to the best of our knowledge, these patients may show acute retinal involvement secondary to systemic diseases or have previous retinal findings other than Covid-19 infection or treatments. CONCLUSION Findings of ocular involvement because of COVID-19 infection were detected in the present study. Retinal haemorrhages were detected in addition to the common findings in viral infections. Especially in patients supported with mechanical ventilation, the detection and treatment of conditions that require eye care for exposure keratopathy are very important for recovering from the disease and the quality of vision.
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Affiliation(s)
- Zarife Ekici Gok
- Department of OphthalmologyMalatya Training and Research HospitalMalatyaTurkey
| | - Abdullah Gok
- Department of Anesthesiology and ReanimationMalatya Training and Research HospitalMalatyaTurkey
| | - Leman Acun Delen
- Department of Anesthesiology and ReanimationMalatya Training and Research HospitalMalatyaTurkey
| | - Umut S. Kasapoglu
- Department of Pulmonary and Critical Care MedicineMalatya Training and Research HospitalMalatyaTurkey
| | - Esra Gurbuz
- Department of Infectious Diseases and Clinical MicrobiologyVan Training and Research HospitalVanTurkey
| | - Kayhan Mutlu
- Department of OphthalmologyAksaray University School of MedicineAksarayTurkey
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Ramani K, Kaliaperumal S, Sarkar S, Sistla S. Study of Conjunctival Microbial Flora in Patients of Intensive Care Unit. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 35:318-324. [PMID: 34379970 PMCID: PMC8357601 DOI: 10.3341/kjo.2020.1112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The objective of the study was to evaluate the type of conjunctival microbial flora in intensive care unit patients and their antimicrobial sensitivity pattern. Methods A total of 272 samples (conjunctival swabs) were taken from patients in various intensive care units and sent for culture and sensitivity. An ocular examination was done to look for lagophthalmos, conjunctival discharge, exposure keratitis, and corneal perforation. Results Majority (82.1%) of the samples showed at least one microbial isolate while 29 (10.7%) samples showed multiple microbial growth. The most common microbes were coagulase negative Staphylococcus spp. (41.5% of isolates), diphtheroids (11.0% of isolates), and Staphylococcus aureus (9.6% of isolates) which are the usual commensals of the ocular surface. Of the other microbes isolated, Pseudomonas aeruginosa (4.0%) was the most common. Eighty-four percent isolates of coagulase negative Staphylococcus sp., 81.8% isolates of diphtheroids and 100% isolates of Staphylococcus aureus were penicillin resistant. All isolates of Enterococcus fecalis were sensitive only to vancomycin. Two hundred and twenty eyes (80.9%) had varying degrees of lagophthalmos. Nineteen (7.0%) had severe corneal exposure changes leading to infectious corneal ulcer and perforation in all of them. Conclusions The isolates in patients of intensive care units were no different from the normal conjunctival flora though few pathogenic organisms such as Pseudomonas aeruginosa and Acinetobacter sp. were also isolated. Most of the isolates were penicillin resistant. This knowledge will help take appropriate prophylactic measures to contain ocular infections in the intensive care units.
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Affiliation(s)
- Kadambari Ramani
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Subashini Kaliaperumal
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Sandip Sarkar
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Sujatha Sistla
- Department of Microbiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Ajibawo T, Zahid E, Leykind Y. An Unusual Case of Bilateral Hemorrhagic Chemosis in the Intensive Care Unit. Cureus 2020; 12:e9679. [PMID: 32923272 PMCID: PMC7486016 DOI: 10.7759/cureus.9679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Critically ill patients cannot complain about eye problems. Eyecare is often overlooked in the intensive care units (ICUs) because treatment is mainly focused on failures of organ which results in eye complications which are preventable. Therefore, we report a case of a patient admitted to the ICU who developed unusual bilateral hemorrhagic chemosis. Although, chemosis has been encountered often in the ICU, hemorrhagic chemosis without prior direct trauma is unusual.
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Kousha O, Kousha Z, Paddle J. Incidence, risk factors and impact of protocolised care on exposure keratopathy in critically ill adults: a two-phase prospective cohort study. Crit Care 2018; 22:5. [PMID: 29338772 PMCID: PMC5771067 DOI: 10.1186/s13054-017-1925-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Exposure keratopathy (EK) has a high incidence in critically ill patients. We aimed to determine the rate of EK in patients admitted to our intensive care unit (ICU), identify risk factors for developing EK and ascertain the effectiveness of a protocol to prevent EK. Methods We undertook a two-phase prospective cohort single-centre study in a general adult ICU. The first phase of the study was observational. In the second phase of the study an eye care protocol was introduced. Daily ophthalmic assessment was carried out using a portable slit lamp. We also recorded Acute Physiology and Chronic Health Evaluation II score, daily Sequential Organ Failure Assessment score, mechanical ventilation, Richmond Agitation-Sedation Scale, and level of eye care. Student’s t test and χ2 statistics were used for simple analysis of continuous data and categorical data, respectively. Binary logistic regression was used to analyse the relationship between EK (yes/no), as the dependent variable, and multiple independent variables, calculating unadjusted and adjusted odds ratios. Results We studied 371 patients. In the first phase, the overall rate of EK was 21% but the rate in mechanically ventilated patients was 56%; χ2 (1, N = 257) = 80.8, p < 0.001. Adjusted odds ratios (AOR) for development of EK were 28.6 (8.19–43.37), 13.0 (3.16–54.38) and 1.2 (1.03–1.33) with incomplete eye closure, mechanical ventilation, and higher SOFA score, respectively. Following the introduction of the protocol in the second phase, the overall rate of EK reduced to 2.6% (three cases); χ2 (1, N = 371) = 18.6, p < 0.001. Compliance with the protocol was 97%. Conclusions EK is common in critically ill patients, and is associated with mechanical ventilation and incomplete eye closure. A simple protocol substantially reduces the incidence of EK and is easily achieved in clinical practice.
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Affiliation(s)
- Obaid Kousha
- Critical Care Unit, Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, TR1 3LJ, UK.
| | - Zubaid Kousha
- UCL Medical School, University College London, Gower Street, London, WC1E 6BT, UK
| | - Jonathan Paddle
- Critical Care Unit, Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, TR1 3LJ, UK
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de Araújo DD, Almeida NG, Silva PMA, Ribeiro NS, Werli-Alvarenga A, Chianca TCM. Prediction of risk and incidence of dry eye in critical patients. Rev Lat Am Enfermagem 2016; 24:e2689. [PMID: 27192415 PMCID: PMC4863418 DOI: 10.1590/1518-8345.0897.2689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/05/2015] [Indexed: 12/03/2022] Open
Abstract
Objectives: to estimate the incidence of dry eye, to identify risk factors and to establish a
risk prediction model for its development in adult patients admitted to the
intensive care unit of a public hospital. Method: concurrent cohort, conducted between March and June, 2014, with 230 patients
admitted to an intensive care unit. Data were analyzed by bivariate descriptive
statistics, with multivariate survival analysis and Cox regression. Results: 53% out of 230 patients have developed dry eye, with onset mean time of 3.5 days.
Independent variables that significantly and concurrently impacted the time for
dry eye to occur were: O2 in room air, blinking more than five times per minute
(lower risk factors) and presence of vascular disease (higher risk factor). Conclusion: dry eye is a common finding in patients admitted to adults intensive care units,
and care for its prevention should be established.
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Affiliation(s)
- Diego Dias de Araújo
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Montes Claros, MG, Brazil
| | | | | | - Nayara Souza Ribeiro
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Ocular surface disorders in intensive care unit patients. ScientificWorldJournal 2013; 2013:182038. [PMID: 24285933 PMCID: PMC3830763 DOI: 10.1155/2013/182038] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/17/2013] [Indexed: 02/01/2023] Open
Abstract
Patients in intensive care units (ICU) are at increased risk of corneal abrasions and infectious keratitis due to poor eyelid closure, decreased blink reflex, and increased exposure to pathogenic microorganisms. The aim of this retrospective study was to evaluate the ocular surface problems in patients who stayed in ICU more than 7 days and were consulted by an ophthalmologist. There were 26 men and 14 women with a mean age of 40.1 ± 18.15 years (range 17–74 years). Conjunctiva hyperemia, mucopurulent or purulent secretion, corneal staining, and corneal filaments were observed in 56.25%, 36.25%, 15%, and 5% of the eyes, respectively. Keratitis was observed in 4 patients (10%) who were treated successfully with topical antibiotics. Mean Schirmers test results were 7.6 ± 5.7 mm/5 min (median 6.5 mm/5 min) in the right, and 7.9 ± 6.3 mm/5 min (median 7 mm/5 min) in the left eyes. Schirmers test results were <5 mm/5 min in 40% of the subjects. The parameters did not show statistically significant difference according to mechanical ventilation, sedation, and use of inotropes. As ICU patients are more susceptible to develop dry eye, keratopathy, and ocular infections, they should be consulted by an ophthalmologist for early diagnosis of ocular surface disorders.
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Azfar MF, Khan MF, Alzeer AH. Protocolized eye care prevents corneal complications in ventilated patients in a medical intensive care unit. Saudi J Anaesth 2013; 7:33-6. [PMID: 23717229 PMCID: PMC3657921 DOI: 10.4103/1658-354x.109805] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Eye care is an essential component in the management of critically ill patients. Standardized eye care can prevent corneal complications in ventilated patients. OBJECTIVE This study was designed to compare old and new practices of corneal care for reduction in corneal complications in ventilated patients. METHODS This study was done in three phases each of six month duration. Phase 1 was the ongoing practice of eye care in the unit. Before the start of phase 2, a new protocol was made for eye care. Corneal complications were observed in terms of haziness, dryness, and ulceration. All nursing staffs were educated and made compliant with the new protocol. In phase 2, a follow-up audit was done to check the effectiveness and compliance to protocol. In phase 3, a follow-up audit was started 3 months after phase 2. RESULTS In phase 1, total ventilated patients were 40 with 240 ventilator days. The corneal dryness rate was 40 per 1000 ventilator days while the haziness and ulceration rate was 16 per 1000 ventilator days each. In the second phase 2, total ventilated patients were 53 making 561 ventilator days. The rate of corneal haziness and dryness was 3.52 and 1.78 per 1000 ventilator days, respectively, with no case of corneal ulceration. In phase 3, the number of ventilated patients was 91 with 1114 ventilator days. The corneal dryness rate was 2.69 while the haziness and ulceration rate was 1.79 each. CONCLUSION Protocolized eye care can reduce the risk of corneal complications in ventilated patients.
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Affiliation(s)
- Mohammad Feroz Azfar
- Department of Critical Care, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Abstract
The goal of pediatric intensive care is early identification, severity assessment and resuscitation of critical patients by utilizing standardized protocols. The primary or precipitating disorder should be the focus of attention and specific intervention. But in order to provide holistic care to a patient, due attention should also be rendered to supportive care. Monitoring of sick children in PICU is an essential part of management. Various monitoring technologies add to the clinical monitoring but cannot replace clinical monitoring. The treating team should follow a checklist to ensure all aspects of supportive care are taken care of in every patient. Due attention should be paid to glucose control, skin and eye care, oral hygiene, prevention of stress ulcer, care of various lines and catheters and prevention of nosocomial infections.
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Shan H, Min D. Prevention of exposure keratopathy in intensive care unit. Int J Ophthalmol 2010; 3:346-8. [PMID: 22553589 DOI: 10.3980/j.issn.2222-3959.2010.04.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 11/20/2010] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the efficacy for preventing exposure keratopathy of three forms of eye care (artificial tear, moist chamber and polyethylene covers) for intensive care patients. METHODS Eighty-four patients in Intensive Care Unit (ICU) were randomized to three treatment groups, including artificial tears group, moist chambers group and polyethylene film group. Patients of artificial tear group received two drops of carboxymethylcellulose drops to each eye every 2 hours. The moist chambers and the polyethylene were changed every 12 hours or as needed if they became unclean or torn. The corneal fluorescein stains were performed daily. RESULTS No of 28 patients (0%) in the polyethylene group and one of the 27 patients (3.70%) in the moist chamber group had exposure keratopathy, compared to 8 of the 29 patients (27.59%) in the artificial tear group. There were statistical significance between the artificial tear group and the moist chamber group (P=0.02), and the artificial tear group and the polyethylene group (P=0.003). The time on eye care every day of the artificial tear group, the moist chamber group and the polyethylene group was 26.69±2.39 minutes, 35.33±2.63 minutes and 7.48±0.87 minutes, respectively. The eye care of the polyethylene group were statistically more time-save than that of the artificial tear group (P<0.001) and the moist chamber group (P<0.001). CONCLUSION Polyethylene covers are more effective and more time-saving in reducing the incidence of corneal damage in intensive care patients.
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Affiliation(s)
- Hua Shan
- Department of Ophthalmology, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Koroloff N, Boots R, Lipman J, Thomas P, Rickard C, Coyer F. A randomised controlled study of the efficacy of hypromellose and Lacri-Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient. Intensive Care Med 2004; 30:1122-6. [PMID: 15014864 DOI: 10.1007/s00134-004-2203-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2003] [Accepted: 01/26/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the efficacy of two forms of eye care (hypromellose and Lacri-Lube combination vs polyethylene/Cling wrap covers) for intensive care patients. DESIGN Randomised-controlled trial. SETTING University affiliated, tertiary referral hospital. PATIENTS AND PARTICIPANTS One hundred ten patients with a reduced or absent blink reflex were followed through until they regained consciousness, were discharged from the facility during study enrolment, died or developed a positive corneal ulcer or eye infection. INTERVENTIONS All patients received standard eye cleansing every 2 h. In addition to this, group one ( n=60) received a treatment combining hypromellose drops and Lacri-Lube (HL) to each eye every 2 h. Group two ( n=50) had polyethylene covers only placed over the eye to create a moisture chamber. MEASUREMENTS AND RESULTS Corneal ulceration was determined using corneal fluorescein stains and mobile slit lamp evaluation, performed daily. No patients had corneal ulceration in the polyethylene cover group, but 4 patients had corneal ulceration in the HL group. CONCLUSIONS Polyethylene covers are as effective as HL in reducing the incidence of corneal damage in intensive care patients.
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Affiliation(s)
- Natasha Koroloff
- Department of Intensive Care Medicine, Royal Brisbane Hospital, Level 3 Ned Hanlon Building, 4029 Herston, Queensland, Australia
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