Obaid Kousha1, Zubaid Kousha2, Jonathan Paddle3. 1. Critical Care Unit, Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Trust, Treliske, Truro TR1 3LJ, United Kingdom. Electronic address: okousha@nhs.net. 2. UCL Medical School, University College London, Gower Street, London WC1E 6BT, United Kingdom. Electronic address: zubaid.kousha.10@ucl.ac.uk. 3. Critical Care Unit, Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Trust, Treliske, Truro TR1 3LJ, United Kingdom. Electronic address: jonathan.paddle@nhs.net.
Abstract
PURPOSE: We aimed to determine the rate of exposure keratopathy (EK) in critically ill patients, identify risk factors for developing EK and ascertain the effectiveness of a protocol to prevent EK. MATERIALS AND METHODS: We undertook a two-phase prospective cohort study in a general adult ICU with first-phase being observational and an eye care protocol was introduced in the second-phase. Daily ophthalmic assessment was carried out along with recording of various risk factors. 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 was 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 sequential organ failure assessment score respectively. Following the introduction of the protocol, the overall rate of EK reduced to 2.6% (3 cases); χ2 (1, N=371)=18.6, p<0.001. CONCLUSIONS: EK is common in critically ill patients and a simple protocol substantially reduces the incidence of EK and is easily achieved in clinical practice.
PURPOSE: We aimed to determine the rate of exposure keratopathy (EK) in critically illpatients, identify risk factors for developing EK and ascertain the effectiveness of a protocol to prevent EK. MATERIALS AND METHODS: We undertook a two-phase prospective cohort study in a general adult ICU with first-phase being observational and an eye care protocol was introduced in the second-phase. Daily ophthalmic assessment was carried out along with recording of various risk factors. 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 was 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 sequential organ failure assessment score respectively. Following the introduction of the protocol, the overall rate of EK reduced to 2.6% (3 cases); χ2 (1, N=371)=18.6, p<0.001. CONCLUSIONS:EK is common in critically illpatients and a simple protocol substantially reduces the incidence of EK and is easily achieved in clinical practice.
Authors: Raffaela Patrícia da Silva Soares; Ana Paula Nunes de Lima Fernandes; Fabiane Rocha Botarelli; Jéssica Naiara de Medeiros Araújo; Jéssica de Araújo Olímpio; Allyne Fortes Vitor Journal: Rev Lat Am Enfermagem Date: 2019-10-28