Incidence, risk factors and impact of protocolised care on exposure keratopathy in critically ill adults: a two-phase prospective cohort study

Abstract

BackgroundExposure 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.MethodsWe 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.ResultsWe 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%.ConclusionsEK 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.

<b>Ação educativa com profissionais de terapia intensiva sobre lesão na córnea: relato de experiência/Educational action with professionals of intensive therapy on corneal injury: experience report<b>

“…No tocante à prevenção de lesões oculares, verifica-se que a prestação de cuidados fundamentados em um corpo fidedigno de conhecimentos amplia o olhar qualificado para os fatores predisponentes à lesão, especialmente no âmbito da terapia intensiva, onde tais fatores se sobrepujam. Isso contribui para o raciocínio clínico necessário à elaboração e aplicação de intervenções com o intuito de prevenir eventos adversos, balizando-se nas evidências da literatura científica (7,20) . A atuação do enfermeiro intensivista é, portanto, imprescindível ao controle dos fatores de risco e monitoramento para identificar lesões na córnea (3,13) .…”

Periorbital lesions in severely burned patients

“…Multiple causes lead to exposure keratopathy in critical patients, including burns victims: sedation, reduced consciousness (as sedation effect or in neurologic injuries), mechanical ventilation, miorelaxing agents, incomplete eye closure, reduced blink and tear production, affected corneal reflex and increased vascular permeability [ 30 ].…”

Cuidados de enfermagem na prevenção da ceratopatia por exposição na unidade de terapia intensiva

“…Determinar a taxa de ceratopatia por exposição em pacientes internados em Unidade de Terapia Intensiva (UTI), identificar os fatores de risco para o desenvolvimento de ceratopatia por exposição e verificar a eficácia de um protocolo para prevenir ceratopatia por exposição [12].…”

“…O estudo de duas fases ocorreu com 371 pacientes, divididos em dois grupos: controle (257 pacientes observados com intervenções quando necessárias) e intervenção (114 pacientes assistidos a partir de um protocolo específico baseado nos fatores de risco do local). A taxa global de ceratopatia por exposição no grupo controle foi de 21% e houve queda para 2,6% na fase de intervenção protocolizada [12].…”