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Nayel AA, Hamdy NA, Massoud TH, Mohamed NM. A comparison of antimicrobial regimen outcomes and antibiogram development in microbial keratitis: a prospective cohort study in Alexandria, Egypt. Graefes Arch Clin Exp Ophthalmol 2024; 262:1865-1882. [PMID: 38240778 PMCID: PMC11106157 DOI: 10.1007/s00417-023-06362-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/12/2023] [Accepted: 12/23/2023] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Antimicrobial resistance in microbial keratitis has not been previously explored in Alexandria. We aim to recommend effective therapies through identification of etiological agents, determination of antimicrobial susceptibilities, and comparing outcomes of empiric topical antimicrobials. METHODS In this 2022 prospective cohort conducted in Alexandria Main University Hospital cornea clinic, antimicrobial susceptibilities of isolated microorganisms from corneal scrapings were detected and antibiograms were developed. Bacterial (BK), fungal (FK), or mixed fungal/bacterial keratitis (MFBK) patients on empiric regimens were compared for ulcer healing, time-to-epithelialization, best-corrected visual acuity, interventions, and complications. RESULTS The prevalent microorganisms in 93 positive-cultures were coagulase-negative staphylococci (CoNS, 30.1%), Pseudomonas aeruginosa (14%), and Aspergillus spp. (12.9%). CoNS were susceptible to vancomycin (VAN, 100%) and moxifloxacin (MOX, 90.9%). Gram-negative bacteria showed more susceptibility to gatifloxacin (90.9%) than MOX (57.1%), and to gentamicin (GEN, 44.4%) than ceftazidime (CAZ, 11.8%). Methicillin-resistance reached 23.9% among Gram-positive bacteria. Fungi exhibited 10% resistance to voriconazole (VRC). Percentages of healed ulcers in 49 BK patients using GEN + VAN, CAZ + VAN and MOX were 85.7%, 44.4%, and 64.5%, respectively (p = 0.259). Their median time-to-epithelialization reached 21, 30, and 30 days, respectively (log-rank p = 0.020). In 51 FK patients, more ulcers (88.9%) healed with natamycin (NT) + VRC combination compared to VRC (39.1%) or NT (52.6%) (p = 0.036). Their median time-to-epithelialization was 65, 60, and 22 days, respectively (log-rank p < 0.001). The VRC group required more interventions (60.9%) than NT + VRC-treated group (11.1%) (p = 0.018). In 23 MFBK patients, none healed using NT + CAZ + VAN, while 50% healed using VRC + CAZ + VAN (p = 0.052). Regimens had comparable visual outcomes and complications. CONCLUSION Based on the higher detected susceptibility, we recommend empiric MOX in suspected Gram-positive BK, gatifloxacin in Gram-negative BK, and GEN + VAN in severe BK. Due to better outcomes, we recommend NT + VRC in severe FK. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT05655689. Registered December 19, 2022- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05655689?cond=NCT05655689.&draw=2&rank=1.
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Affiliation(s)
- Amira A Nayel
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
- Clinical Pharmacy Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Noha A Hamdy
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
| | - Tamer H Massoud
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nelly M Mohamed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
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Vilchez B, Manzanal I, Marcos M, Camacho V, González IM, Laín R, San-Segundo MDM, Manrique G, González R, López-Herce J. Early detection of ocular lesions in critically ill children: Testing an ocular assessment scale. Nurs Crit Care 2023. [PMID: 37905300 DOI: 10.1111/nicc.12984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE There is scarcity of data on the incidence and factors associated with the occurrence of ocular lesions in critically ill children. The objective was to test the applicability and utility of an ocular assessment scale and to identify risk factors of ocular lesions. DESIGN Prospective observational study. SETTING A tertiary care medical-surgical Paediatric Intensive Care Unit. SAMPLE 194 children without previous ocular disease who stayed in the Paediatric Intensive Care Unit for more than 48 h. INTERVENTIONS An ocular lesions risk scale was designed including risk factors lagophthalmos, eye dryness, conjunctival hyperemia, slow blinking, intubation, sedation, relaxation, face mask and hemodynamic instability. Patients were classified as high-, medium-, and low-risk patients. Corneal lesions were examined by fluorescein staining according to their risk and were confirmed by an ophthalmologist. RESULTS 76 patients were examined with fluorescein staining. Thirty-two ocular lesions were detected by nursing staff, 26 confirmed by the ophthalmologist. 53.6% of the high-risk patients developed a corneal lesion. Univariate analysis revealed an association between ocular damage and all factors included in the scale, except for face mask. In the multivariate analysis, ocular lesions were associated with lagophthalmos, hyperemia, invasive mechanical ventilation and inotropic support. CONCLUSIONS The scale was useful to detect corneal lesions in critically ill children. The identification of risk factors will enable the development of measures to reduce the incidence of ocular lesions. RELEVANCE FOR CLINICAL PRACTICE A new, non-validated scale allowed staff to detect eye injuries, study this problem and improve future prevention.
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Affiliation(s)
- Beatriz Vilchez
- Pediatric intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Isabel Manzanal
- Pediatric intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Marta Marcos
- Pediatric intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Verónica Camacho
- Pediatric intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Isabel María González
- Pediatric intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Raquel Laín
- Pediatric intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain
| | | | - Gema Manrique
- Pediatric intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Rafael González
- Pediatric intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain
- Health School, Complutense University of Madrid, Madrid, Spain
| | - Jesús López-Herce
- Pediatric intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain
- Health School, Complutense University of Madrid, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Instituto de Salud Carlos III, Madrid, Spain
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El Hachimi R, El Hadiri R, Benchekroun S, Boutimzine N, Amazouzi A, Cherkaoui L, Maazouzi A. Incidence et facteurs de risque des kératopathies d’exposition en milieu de réanimation : à propos de 91 patients. J Fr Ophtalmol 2022; 45:1137-1143. [DOI: 10.1016/j.jfo.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/21/2022] [Accepted: 03/17/2022] [Indexed: 11/06/2022]
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Mobarez F, Sayadi N, Jahani S, Sharhani A, Savaie M, Farrahi F. The effect of eye care protocol on the prevention of ocular surface disorders in patients admitted to intensive care unit. J Med Life 2022; 15:1000-1004. [PMID: 36188652 PMCID: PMC9514818 DOI: 10.25122/jml-2022-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Eye care is one of the most critical tasks of intensive care unit (ICU) nurses. Patients in this unit are exposed to potential ocular problems due to critical conditions. This study aimed to establish a new eye care protocol for preventing ocular surface disorders in patients admitted to ICU. This was a clinical trial study performed on patients admitted to ICU in 2019. The data gathering tools included the demographic questionnaire, the Schirmer test for dry eye, fluorescein staining and slit lamp manual for examining corneal ulcers, and slit lamp manual to check keratitis and conjunctivitis. A type of eye care protocol was performed on the patient's eyes. After five consecutive days of executing the protocol, the data were analyzed using SPSS software version 18. The use of eye care protocol reduced the risk of keratitis (P=0.027), conjunctivitis (P=0.012), eye dryness (P=0.001), and corneal ulcer (P=0.003) in patients admitted to ICU in the intervention group compared to the control group. Ophthalmology protocols reduced the incidence of keratitis, conjunctivitis, dry eye, and corneal ulcers in ICU patients. Therefore, using this method in ICU patients can improve nursing care.
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Affiliation(s)
- Fariba Mobarez
- Nursing Care Research Centre in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Sayadi
- Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Nursing Care Research Centre in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Simin Jahani
- Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Nursing Care Research Centre in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,Corresponding Author: Simin Jahani, Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Nursing Care Research Centre in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. E-mail:
| | - Asaad Sharhani
- Department of Biostatics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Savaie
- Department of Anesthesiology, School of Medicine, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fereydoun Farrahi
- Department of Ophthalmology, School of Medicine, Infectious Ophthalmologic Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Exposure keratopathy in patients undergoing invasive ventilation: Prevalence, severity, and the role of surface lubrication. Ocul Surf 2022; 25:55-57. [DOI: 10.1016/j.jtos.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/15/2022]
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Effect of Polyethylene Cover for Preventing Corneal Injury in Critically Ill Patients: A Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6578229. [PMID: 35126632 PMCID: PMC8816565 DOI: 10.1155/2022/6578229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
Objective Polyethylene cover has been proved to be an effective method in protecting corneal, but its advantage compared to other conventional methods is still unclear. Our study is aimed at assessing clinical effects of polyethylene cover versus other methods in the prevention of corneal injury for critically ill patients. Methods We searched randomized controlled trials comparing polyethylene cover versus other methods for critically ill patients through the databases of PubMed, Embase, Web of Science, and China National Knowledge database. Forest plots and funnel plots were also performed on the included articles. Results were expressed as risk ratio (RR) with 95% confidence intervals. Results Eight studies were eventually identified. The incidence of corneal injury in the polyethylene cover group was lower than that in the eye drops group (RR = 0.24, 95% CI (0.12, 0.45), P < 0.0001) but had no significant difference when compared to the eye gel group (RR = 0.42, 95% CI (0.13, 1.34), P = 0.14) and the eye ointment group (RR = −0.61, 95% CI (0.23, 1.59), P = 0.31). Conclusion This study showed that polyethylene cover, eye gel, and eye ointment had an equal effect for preventing corneal injury in critically ill patients, and the effect of eye drops was relatively low. However, there were other intervention methods that had not been compared due to the small number of articles; further studies should be performed to assess which method was the best practice method.
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Risk Factors of Eye Complications in Patients Treated in the Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111178. [PMID: 34769697 PMCID: PMC8583589 DOI: 10.3390/ijerph182111178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022]
Abstract
In critically ill patients, normal eye protection mechanisms, such as tear production, blinking, and keeping the eye closed, are impaired. In addition, many other factors related to patients' severe condition and treatment contribute to ocular surface disease. Reducing risk factors and proper eye care can have a significant impact on incidences of eye complications and patient quality of life after discharge from the intensive care unit (ICU). The aim of the study was to determine risk factors for ocular complication, especially those related to nursing care. The study was conducted in the ICU of a university hospital. Methods for estimating and analyzing medical records were used. The patient's evaluation sheet covering 12 categories of risk factors for eye complications was worked out. The study group included 76 patients (34 patients with injuries and 42 without injuries). The Shapiro-Wilk test, the Spearman's rank correlation test, the Mann-Whitney U test and the Friedman's ANOVA test were used. The level of significance was set at α = 0.05. The most important risk factors for eye complications in the study group were: lagophthalmos (p < 0.001), sedation (p < 0.01), use of some cardiological drugs and antibiotics (p < 0.01), mechanical ventilation (p < 0.05), use of an open suctioning system (p < 0.01), presence of injuries (p < 0.01) including craniofacial trauma (p < 0.001), high level of care intensity (p < 0.01), failure to follow eye care protocol (p < 0.001), length of hospitalization at the ICU (p < 0.001), and the frequency of ophthalmological consultations (p < 0.001). There was no correlation between the incidence of these complications and the age and gender of the patients. The exposure of critically ill patients to eye complications was high. It is necessary to disseminate protocols and guidelines for eye care in ICU patients to reduce the risk factors.
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The Effect of Three Eye Care Methods on the Severity of Lagophthalmos in Intensive Care Patients: A Randomized Controlled Clinical Trial. J Ophthalmol 2021; 2021:6348987. [PMID: 34621545 PMCID: PMC8490793 DOI: 10.1155/2021/6348987] [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] [Received: 05/12/2021] [Revised: 08/13/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background Patients admitted to intensive care units are exposed to a variety of eye injuries such as lagophthalmos, which can lead to blindness. There is conflicting evidence regarding the effectiveness of different eye protection methods, and evaluations are ongoing. Therefore, this study was performed to compare the effect of “polyethylene cover,” “polyethylene cover plus artificial tear drops,” and “polyethylene cover plus Lubratex eye ointment” on the severity of lagophthalmos. Methods A total of 156 patients connected to ventilators were included in this clinical trial using the convenience sampling method. They were randomly divided into three groups: “polyethylene cover,” polyethylene cover plus artificial tear drops,” and “polyethylene cover plus Lubratex eye ointment.” In each group, one eye was regarded as control and the other eye as intervention. The control eye received routine interventions, including washing with normal saline. The eyes were examined daily by an ophthalmologist for 5 days for the occurrence of lagophthalmos. Results There was no statistically significant difference in the severity of lagophthalmos among the three groups “polyethylene cover,” “polyethylene cover plus artificial tear drop,” and “polyethylene cover plus Lubratex eye ointment.” However, clinically the severity of lagophthalmos was lower in the “polyethylene cover plus artificial tear drops” group than in the other two groups. Conclusion The results showed that the combination of polyethylene cover and artificial tears drops can be clinically effective in reducing the severity of lagophthalmos. Therefore, the use of this method is recommended for patients admitted to the intensive care unit. Similar studies are recommended.
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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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Dutt S, Nagarajan S, Vadivel SS, Baig AU, Savoy FM, Ganapathy VM, Dominic M, Sivaraman A, Rao DP. Design and Performance Characterization of a Novel, Smartphone-Based, Portable Digital Slit Lamp for Anterior Segment Screening Using Telemedicine. Transl Vis Sci Technol 2021; 10:29. [PMID: 34319384 PMCID: PMC8322723 DOI: 10.1167/tvst.10.8.29] [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: 11/24/2022] Open
Abstract
Purpose Telemedicine-enabled, portable digital slit lamps can help to decentralize screening to close-to-patient contexts. We report a novel design for a portable, digital slit lamp using a smartphone. It works on an advanced optical design and has the capability of instantaneous, objective photodocumentation to capture anterior segment images and is telemedicine-enabled. Methods The device is constructed keeping its usability and the importance of design ergonomics for nonspecialized field personnel in mind. The optical design is described, and the resolution and magnification are compared with traditional desktop-based slit lamps. A Health Insurance Portability and Accountability Act (HIPAA)–compliant, patient management software is integrated to synchronize the captured images with a secure cloud server along with a sharpness algorithm to extract the best focused frames of the cornea, iris, and lens, from videos. We demonstrate its photodocumentation ability and teleophthalmology feasibility by capturing images in a pilot study from nine subjects. Results Images were obtained in various illumination, magnification, and filter settings. Synchronous and asynchronous teleophthalmology consults were conducted. The performance of the device was shown to be limited by the smartphone sensor resolution and not the optical design, because the Air Force target resolution was found to be the same on smartphone-mounted traditional slit lamps despite a lower magnification. Conclusions The novel, portable, digital slit lamp with advanced optical design using smartphones has the ability to screen for anterior segment pathologies using telemedicine. Translational Relevance A portable, telemedicine-friendly, ergonomically designed, slit lamp used by nonspecialist personnel allows for both synchronous and asynchronous modes of consultation at remote locations, facilitating mass screening programs.
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Affiliation(s)
- Sreetama Dutt
- Research & Development, Remidio Innovative Solutions Pvt. Ltd., Bangalore, Karnataka, India
| | | | - Siva S Vadivel
- Research & Development, Remidio Innovative Solutions Pvt. Ltd., Bangalore, Karnataka, India
| | - Adeeb Ulla Baig
- Research & Development, Remidio Innovative Solutions Pvt. Ltd., Bangalore, Karnataka, India
| | | | - Vasudev M Ganapathy
- Research & Development, Remidio Innovative Solutions Pvt. Ltd., Bangalore, Karnataka, India
| | - Mathew Dominic
- Research & Development, Remidio Innovative Solutions Pvt. Ltd., Bangalore, Karnataka, India
| | - Anand Sivaraman
- Research & Development, Remidio Innovative Solutions Pvt. Ltd., Bangalore, Karnataka, India
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Khatiban M, Moradi Amin H, Falahinia G, Moghimbeigi A, Yadollahi M. Polyethylene eye-cover versus artificial teardrops in the prevention of ocular surface diseases in comatose patients: A prospective multicenter randomized triple-blinded three-arm clinical trial. PLoS One 2021; 16:e0248830. [PMID: 33793585 PMCID: PMC8016328 DOI: 10.1371/journal.pone.0248830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Polyethylene covers are claimed to be useful in preventing ocular surface diseases (OSD); however, evidence of their clinical efficacy is limited. This clinical trial aimed to compare the use of polyethylene eye covers and artificial teardrops versus normal saline on the incidence and severity of OSD in comatose patients. Methods Of 90 eligible patients randomly assigned to three treatment groups, 79 patients completed the study, In group A, patients (n = 25) received artificial teardrops for left and normal saline for right eyes, in group B (n = 29) polyethylene covers for left and normal saline for right eyes, and in group C (n = 25) polyethylene covers for left and artificial teardrops for right eyes. As the patients were comatose, their blinding did not applicable, and a blinded observer evaluated the patients’ eyes based on the Corneal Fluorescein Staining Pattern. The blinded analyzer analyzed collected data by SPSS-16 software at a 95% confidential level. Results The OSDs were observed in 65 (41.14%) out of 158 eyes examined. The artificial teardrop was more effective than the normal saline in group A, polyethylene eye cover was more useful than the normal saline in group B, and polyethylene eye cover was more effective than the artificial teardrop in group C in reducing the incidence of OSD (p< 0.01). Polyethylene eye covers had the most impact on reducing the severity of the OSD compared to the other interventions (p< .001). Conclusions Polyethylene eye covers significantly reduced the incidence and severity of OSD. Using polyethylene cover is suggested as a safe, effective, and accessible eye care intervention for preventing OSD in comatose patients. Trial registration (IRCT201609129014N115), Iranian Registry of Clinical Trials.
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Affiliation(s)
- Mahnaz Khatiban
- Department of Medical-Surgical Nursing, Department of Ethics Education in Medical Sciences, Mother & Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hamid Moradi Amin
- Students Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Gholamhosein Falahinia
- Department of Medical-Surgical Nursing, Chronic Disease (Home Care) Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
- * E-mail:
| | - Abbas Moghimbeigi
- Department of Biostatistics and Epidemiology, Modeling of Noncommunicable Disease Research Canter, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehran Yadollahi
- Malayer Mehr Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
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Hsieh YC, Chen CC. Descemetocele and bilateral, severe Pseudomonas keratitis in an intensive care unit patient with Graves' orbitopathy: A case report. Medicine (Baltimore) 2020; 99:e22481. [PMID: 33019441 PMCID: PMC7535751 DOI: 10.1097/md.0000000000022481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Exposure keratopathy (EK) is common among intensive care unit (ICU) patients, especially those under sedation and with incomplete eyelid closure. EK can be mild punctate epithelial erosions exhibiting spontaneous recovery; rarely, severe complications including bacterial ulcers causing corneal perforation or opacity could occur. We describe a patient with pre-existing Graves' orbitopathy (GO) who developed bilateral, rapidly progressing bacterial keratitis due to EK with secondary aerosol inoculation from respiratory pathogens in ICU. PATIENT CONCERNS A 49-year-old intubated and sedated woman who underwent urgent craniotomy was admitted to ICU. The ophthalmology department was consulted for progressive chemosis. History of poorly controlled GO was revealed based on external ocular signs, including proptosis with lid retraction, and careful ophthalmological history taking. After 2 days of ICU admission, slit lamp examination revealed large inferior corneal epithelial defects and dellen (OU). Despite prescribing gentamicin ointment and lubricants, purulent discharge with corneal infiltration and thinning (OU) was observed 2 days later. Owing to a characteristic Pseudomonas odor from her endotracheal tube, corneal and endotracheal sputum cultures were obtained, which revealed Pseudomonas aeruginosa infection. DIAGNOSIS Pseudomonas keratitis secondary to EK INTERVENTIONS:: Topical fortified anti-Pseudomonas antibiotic eye drops with temporary tarsorrhaphy and lubricants OUTCOMES:: Despite multiple treatments, she developed enlarging descemetocele in the left eye with severe corneal stromal destruction and severe visual impairment due to central corneal scar formation in the right eye. After 2 months, the descemetocele ruptured owing to generalized tonic-clonic seizures after cranioplasty. Therefore, she underwent urgent penetrating keratoplasty in the left eye. LESSONS GO increases ocular surface inflammation and exposure, which may exacerbate EK and subsequent complication risks. Careful monitoring and aggressive treatment through appropriate eye care regimen are required in these patients.
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Affiliation(s)
- Yun Chen Hsieh
- Department of Ophthalmology, Taipei City Hospital, Renai Branch
- School of Medicine, Taipei Medical University
| | - Chun-Chen Chen
- Department of Ophthalmology, Taipei City Hospital, Renai Branch
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Sanghi P, Malik M, Hossain IT, Manzouri B. Ocular Complications in the Prone Position in the Critical Care Setting: The COVID-19 Pandemic. J Intensive Care Med 2020; 36:361-372. [PMID: 32985317 DOI: 10.1177/0885066620959031] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Ocular complications are common in the critical care setting but are frequently missed due to the focus on life-saving organ support. The SARS-CoV-2 (COVID-19) pandemic has led to a surge in critical care capacity and prone positioning practices which may increase the risk of ocular complications. This article aims to review all ocular complications associated with prone positioning, with a focus on challenges posed by COVID-19. MATERIALS AND METHODS A literature review using keywords of "intensive care", "critical care", "eye care", "ocular disorders", "ophthalmic complications," "coronavirus", "COVID-19," "prone" and "proning" was performed using the electronic databases of PUBMED, EMBASE and CINAHL. RESULTS The effects of prone positioning on improving respiratory outcomes in critically unwell patients are well established; however, there is a lack of literature regarding the effects of prone positioning on ocular complications in the critical care setting. Sight-threatening ophthalmic disorders potentiated by proning include ocular surface disease, acute angle closure, ischemic optic neuropathy, orbital compartment syndrome and vascular occlusions. CONCLUSIONS COVID-19 patients may be more susceptible to ocular complications with increased proning practices and increasing demand on critical care staff. This review outlines these ocular complications with a focus on preventative and treatment measures to avoid devastating visual outcomes for the patient.
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Affiliation(s)
- Priyanka Sanghi
- Department of Ophthalmology, Barking Havering and Redbridge University Hospitals NHS Trust, 156727Queens Hospital, Romford, UK
| | - Mohsan Malik
- Department of Ophthalmology, Barking Havering and Redbridge University Hospitals NHS Trust, 156727Queens Hospital, Romford, UK
| | - Ibtesham T Hossain
- Department of Ophthalmology, Barking Havering and Redbridge University Hospitals NHS Trust, 156727Queens Hospital, Romford, UK
| | - Bita Manzouri
- Department of Ophthalmology, Barking Havering and Redbridge University Hospitals NHS Trust, 156727Queens Hospital, Romford, UK
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Abstract
Ophthalmic disease encountered in the intensive care unit (ICU) has a wide spectrum of prevalence and severity. Prolonged exposure of the cornea is common and preventable. Trauma, glaucoma, infection, vascular disease, and burns are among the potential causes of vision loss. Patients are predisposed to ocular complications by the ICU environment and critical illness itself. Critically ill patients require prioritization of life-sustaining interventions, and less emphasis is placed on ophthalmic disease, leading to missed opportunities for vision-saving intervention. It is therefore imperative for intensivists, nurses, and other providers to have an increased awareness and understanding of the broad range of ocular conditions potentially seen in the ICU.
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Kocaçal E, Eşer İ, Eğrilmez S. Effect of polyethylene cover on the treatment of exposure keratopathy in ICU. Nurs Crit Care 2020; 26:282-287. [PMID: 32830416 DOI: 10.1111/nicc.12542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Exposure keratopathy may lead to serious complications such as microbial keratitis, corneal perforation, and visual impairment if not treated. AIM To compare the effect of carbomer eye drops when used alone and in combination with polyethylene covers in the healing of exposure keratopathy. METHODS A single blind randomized-controlled trial (RCT) in two intensive care units (ICUs) was carried out in a university hospital in Western Turkey between September 2011 and December 2012. The control group received only carbomer, eye drops while the intervention group received both carbomer eye drops and polyethylene covers. The primary outcome was the decrease or absence of corneal damage, which refers to healing. Corneal damage was followed up with a fluorescein dye test (decrease/absence of the corneal staining) by the same ophthalmologist for 10 days. RESULTS A total of 43 corneas in 24 patients were studied. Corneal epithelial defects decreased in the intervention group by day 2 and progressed or remained unchanged in the control group every day (P = .001). Patient characteristics did not affect the grade ranges of corneal staining in the groups except for level of consciousness. CONCLUSION Carbomer eye drops, when used in combination with polyethylene covers, were effective in managing exposure keratopathy. RELEVANCE TO CLINICAL PRACTICE Corneal damage and further ocular complications can be reduced with the utilization of polyethylene covers in nursing care and treatment.
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Affiliation(s)
- Elem Kocaçal
- Department of Fundamentals of Nursing, İzmir Demokrasi University, Faculty of Health Sciences, İzmir, Turkey
| | - İsmet Eşer
- Department of Fundamentals of Nursing, Ege University Faculty of Nursing, İzmir, Turkey
| | - Sait Eğrilmez
- Department of Ophthalmology, Ege University Medical Hospital, İzmir, Turkey
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Abstract
OBJECTIVES Sedated intensive care patients have impaired ocular protective mechanisms putting them at risk for ocular surface disease with potential vision loss. Historically, routine eye care has been limited to critically ill patients receiving neuromuscular blockade. The aim of this project was to determine the occurrence rate of ocular surface disease in sedated and ventilated children, identify risk factors, and determine the progression of injury with routine eye care. DESIGN Prospective cohort study. SETTING A tertiary care medical-surgical PICU. PATIENTS All intubated patients admitted from May 2015 to December 2016. INTERVENTIONS Staff education regarding corneal examination with fluorescein, and routine eye care as per a PICU eye care protocol. MEASUREMENTS AND MAIN RESULTS We evaluated 479 patients (1,242 corneal exams) and found that 15% had ocular surface disease at admission to the PICU: keratopathy 62, abrasion 16. The highest incidence was in trauma patients (39.0%) and those intubated in the emergency department (22.2%) or prehospital setting (42.9%). Of the 245 patients with multiple ocular assessments, 32.2% displayed ocular surface disease at some point during their hospitalization: keratopathy 73, abrasion 24. Ourprotocol dictated increased frequency of eye care if ocular surface disease worsened. As a result, the overall incidence of ocular surface disease decreased to 8.6% by the last examination (keratopathy 19, mild abrasion 2), but more severe ocular abnormalities such as corneal infiltrates, ulcers, or scarring were not observed. Based on multivariate analysis, clinical factors associated with increased risk of ocular surface disease included primary diagnosis, and lagophthalmos (incomplete eyelid closure). CONCLUSIONS Ocular surface disease is an under-recognized process in critically ill pediatric patients. A standardized and dynamic protocol may improve corneal health, which in turn may reduce injury, pain, infection, and long-term vision loss.
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Nikseresht T, Abdi A, Khatony A. Effectiveness Of Polyethylene Cover Versus Polyethylene Cover With Artificial Tear Drop To Prevent Dry Eye In Critically Ill Patients: A Randomized Controlled Clinical Trial. Clin Ophthalmol 2020; 13:2203-2210. [PMID: 32009776 PMCID: PMC6859212 DOI: 10.2147/opth.s233404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/24/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the effectiveness of polyethylene cover versus polyethylene cover with artificial tear drop to prevent dry eye in critically ill patients. Methods In this clinical trial, 208 patients were randomly assigned into two groups of polyethylene cover, and polyethylene cover with artificial tear drop. In each of the two groups, one eye was randomly selected as a control eye and the other was considered as an intervention eye. In the polyethylene cover group, the eye was covered with polyethylene. In the polyethylene cover and artificial tear drop group, an artificial tear drop was applied every 8 hrs to the eye, and then it was covered with polyethylene. The control eye received the routine intensive care unit eye care (washing the inside of the eye and the eyelids with distilled water). In both groups, the eyes were examined for eye dryness by an ophthalmologist for 5 days. Results The incidence of dry eye after the use of both polyethylene cover and polyethylene cover with artificial tear drop methods was lower than that of a conventional method. Both methods of polyethylene covering and polyethylene covering with artificial tear drop were effective, but clinically, the method of polyethylene cover with artificial tear drop was more effective. Conclusion Both methods of polyethylene covering and polyethylene covering with artificial tear drop were more effective than a conventional method, but the method of polyethylene cover with artificial tear drop was clinically more effective. Therefore, it is recommended for use in critically ill patients.
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Affiliation(s)
- Tahereh Nikseresht
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Health Institute, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Abstract
PURPOSE To determine the prevalence and risk factors of exposure keratopathy (EK) across different intensive care units (ICU) at Columbia University Medical Center, including the Pediatric ICU (PICU), Medical ICU (MICU), and Neurologic ICU (NICU). METHODS In this prospective cohort study, 65 patients were examined daily during their admission in the PICU (27 patients), MICU (15 patients), and NICU (23 patients). Data on eyelid position, conjunctival and corneal changes, Bell's and blink reflexes, medications, Glasgow Coma Scale rating, and ventilation type were collected. RESULTS Overall EK percentages were as follows: PICU 19%, MICU 60%, and NICU 48%. The prevalence of EK was lowest in the PICU (P = 0.013). Factors associated with EK were lagophthalmos (P < 0.001), an absent Bell's reflex (P = 0.003), an absent blink reflex (P < 0.001), conjunctival injection (P < 0.001), a low Glasgow Coma Scale score (P < 0.001), intubation (P < 0.001), surgery before examination (P < 0.001), dialysis (P = 0.002), and administration of opioid (P < 0.001), sedative (P < 0.001), and neuromuscular blocking medications (P = 0.006). CONCLUSIONS This is the first study to examine the rates and risk factors of EK across different ICU settings. The prevalence of EK was lowest in the PICU, which may partly be explained by the increased number of PICU patients receiving noninvasive ventilation and the absence of conjunctival chemosis.
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Vyas S, Mahobia A, Bawankure S. Knowledge and practice patterns of Intensive Care Unit nurses towards eye care in Chhattisgarh state. Indian J Ophthalmol 2018; 66:1251-1255. [PMID: 30127134 PMCID: PMC6113811 DOI: 10.4103/ijo.ijo_115_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The aim of the study was to present the level of knowledge and practice patterns regarding exposure keratopathy in mechanically ventilated patients among Intensive Care Unit (ICU) nurses in Chhattisgarh state. Methods A previously validated semi-structured questionnaire was administered in the ICU of six multispecialty hospitals in Chhattisgarh in 2014-2015. Demography included age, gender, level of education, and months of working in ICU. Most of the questions dealt with frequency of eyelid closure assessment, frequency of cleaning of eyes with saline gauze, using a protocol-based approach for eye care, and documentation of ophthalmic complications. Common barriers to delivery of eye care such as shortage of time and too much writing tasks were also inquired. Results Our study included 120 nurses. They worked for mean 22.9 ± 17.8 months in ICU. Knowledge about high risk of exposure keratopathy in ventilated patient was present in 93% (78%; 95% confidence interval [CI]) nurses. Only six nurses (5%) followed a strict protocol for eye care, 52 nurses (43%) checked for eyelid closure in the ventilated patients, and 58 (48%) cleaned the eyes frequently. Those who were aware of exposure keratopathy checked eyelid closure (73% vs. 48%) and cleaned eyes with saline gauze more frequently (24% vs. 4%). Nurses in cardiac ICU were significantly lesser aware of exposure complications compared to medical ICU nurses (40% reduction in awareness, 95% CI = 0.37-0.98, P = 0.04). Conclusion Although there is high awareness, practice patterns of ICU nurses were less than desired. Educational initiatives should focus on weaknesses in knowledge and practice noted to improve eye care of patients in ICU.
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Affiliation(s)
- Sonal Vyas
- Cornea Services, SBH Eye Hospital, Raipur, Chhattisgarh, India
| | - Ashish Mahobia
- Cornea Services, SBH Eye Hospital, Raipur, Chhattisgarh, India
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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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Davoodabady Z, Rezaei K, Rezaei R. The Impact of Normal Saline on the Incidence of Exposure Keratopathy in Patients Hospitalized in Intensive Care Units. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:57-60. [PMID: 29344048 PMCID: PMC5769187 DOI: 10.4103/ijnmr.ijnmr_187_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Patients in the intensive care unit (ICU) have impaired ocular protective mechanisms that lead to an increased risk of ocular surface diseases including exposure keratopathy (EK). This study was designed to evaluate the effect of normal saline (NS) on the incidence and severity of EK in critically ill patients. Materials and Methods This single-blind randomized controlled trial was conducted on 50 patients admitted to ICUs. The participants were selected through purposive sampling. One eye of each patient, randomly was allocated to intervention group (standard care with NS) and the other eye to control group (standard care). In each patient, one eye (control group) randomly received standard care and the other eye (intervention group) received NS every 6 h in addition to standard care. The presence and severity of keratopathy was assessed daily until day 7 of hospitalization using fluorescein and an ophthalmoscope with cobalt blue filter. Chi-square test was used for statistical analysis in SPSS software. Results Before the study ( first day) there were no statistically significant differences in the incidence and severity of EK between groups. Although, the incidence and severity of EK after the study (7th day) was higher in the intervention group compared to the control group, their differences were not statistically significant. Although, the incidence and severity of EK, from the 1st day until the 7th, increased within both groups, this increase was statistically significant only in the intervention (NS) group. Conclusions The use of NS as eye care in patients hospitalized in ICUs can increase the incidence and severity of EK and is not recommended.
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Affiliation(s)
- Zohreh Davoodabady
- Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
| | - Korosh Rezaei
- Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
| | - Reza Rezaei
- Department of Ophtalmology, Medical School, Arak University of Medical Sciences, Arak, Iran
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Exposure keratopathy: Incidence, risk factors and impact of protocolised care on exposure keratopathy in critically ill adults. J Crit Care 2017; 44:413-418. [PMID: 29353117 DOI: 10.1016/j.jcrc.2017.11.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 11/08/2017] [Accepted: 11/27/2017] [Indexed: 02/08/2023]
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.
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Prevention of Exposure Keratopathy in Critically Ill Patients: A Single-Center, Randomized, Pilot Trial Comparing Ocular Lubrication With Bandage Contact Lenses and Punctal Plugs. Crit Care Med 2017; 45:1880-1886. [PMID: 28820753 DOI: 10.1097/ccm.0000000000002681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the effectiveness of bandage contact lenses and punctal plugs with ocular lubricants in preventing corneal damage in mechanically ventilated and sedated critically ill patients. DESIGN Single-center, prospective, randomized, pilot study. SETTING Sixteen-bed, general ICU at a tertiary academic medical center. PATIENTS Adults admitted to the ICU and anticipated to require mechanical ventilation and continuous sedation for greater than or equal to 4 days. INTERVENTIONS Patients were randomized to receive eye care with ocular lubricants (n = 38), bandage contact lenses (n = 33), or punctal plugs (n = 33). The bandage contact lenses were changed every 4 days, whereas the punctal plugs remained in situ for the entire study. MEASUREMENTS AND MAIN RESULTS The primary endpoint was the presence or absence of corneal damage as assessed by the grade of keratopathy. Patients were examined by an ophthalmologist blinded to the study group every 4 days and at the time of withdrawal from the study, due to cessation of sedation, discharge from the ICU, or death. The mean duration of the study was 8.6 ± 6.2 days. The grade of keratopathy in the ocular lubricant group increased significantly in both eyes (p = 0.01 for both eyes) while no worsening was noted in either the lens or punctal plugs groups. In a post hoc analysis of patients with an initially abnormal ophthalmic examination, significant healing of keratopathy was noted in the lens group (p = 0.02 and 0.018 for left and right eyes, respectively) and in the right eye of the plugs group (p = 0.005); no improvement was noted in the ocular lubricant group. CONCLUSIONS Compared with ocular lubrication, bandage contact lenses and punctal plugs were more effective in limiting keratopathy, and their use, particularly of bandage contact lenses, was associated with significant healing of existing lesions.
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Keita H, Devys JM, Ripart J, Frost M, Cochereau I, Boutin F, Guérin C, Fletcher D, Compère V. Eye protection in anaesthesia and intensive care. Anaesth Crit Care Pain Med 2017; 36:411-418. [PMID: 28790010 DOI: 10.1016/j.accpm.2017.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hawa Keita
- Department of anaesthesia, AP-HP, CHU Louis-Mourier, 178, rue des Renouillers, 92700 Colombes, France.
| | - Jean-Michel Devys
- Department of anaesthesia and intensive care, fondation Adolphe-Rotschild, 29, rue Manin, 75019 Paris, France
| | - Jacques Ripart
- Department of anaesthesia, pain and intensive care, GHU Caremeau, place du Pr-Debré, 30029 Nimes cedex 09, France
| | - Marie Frost
- Department of anaesthesia, hôpital Michallon, BP 217, 38043 Grenoble cedex 9, France
| | | | - Frédérique Boutin
- Department of anaesthesia and critical care III, CHU de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Leon, 33000 Bordeaux, France
| | - Claude Guérin
- Department of intensive care, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - Dominique Fletcher
- Department of anaesthesia and intensive care, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France
| | - Vincent Compère
- Department of anaesthesia and intensive Care, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France
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Cho OH, Yoo YS, Yun SH, Hwang KH. Development and validation of an eye care educational programme for intensive care unit nurses. J Clin Nurs 2017; 26:2073-2082. [PMID: 27859802 DOI: 10.1111/jocn.13635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To develop and validate an eye care educational programme for intensive care unit nurses. BACKGROUND Eye care guidelines and protocols have been developed for increasing eye care implementation in intensive care units. However, the guidelines lack consistency in assessment or intervention methodology. DESIGN This was a one-sample pre/postprogramme evaluation study design for testing the effects of the eye care educational programme, developed for and applied to intensive care unit nurses, on their levels of knowledge and awareness. METHODS The eye care educational programme was developed based on literature review and survey of educational needs. Thirty intensive care unit nurses served as subjects for the study. RESULTS The levels of eye care-related knowledge, awareness and practice were enhanced following the implementation of the educational programme. Moreover, satisfaction with the educational programme was high. CONCLUSION It is necessary to intensify eye care education aimed at new nurses who are inexperienced in intensive care unit nursing and provide continuing education on the latest eye care methods and information to experienced nurses. RELEVANCE TO CLINICAL PRACTICE The eye care educational programme developed in this study can be used as a strategy to periodically assess the eye status of patients and facilitate the appropriate eye care.
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Affiliation(s)
- Ok-Hee Cho
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju, Korea
| | - Yang-Sook Yoo
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | - Sun-Hee Yun
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Hye Hwang
- Department of Nursing, Suwon Science College, Hwaseong, Korea
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Casillas-Chavarin NL, Alvarado-Castillo B, Ramirez-Padilla MA, Navarro-Solares A, Gonzalez-Gomez HS. Prevalencia de queratitis por exposición en pacientes en estado crítico. REVISTA MEXICANA DE OFTALMOLOGÍA 2017. [DOI: 10.1016/j.mexoft.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kocaçal Güler E, Eşer İ, Eğrilmez S. Nurses can play an active role in the early diagnosis of exposure keratopathy in intensive care patients. Jpn J Nurs Sci 2017; 15:31-38. [PMID: 28169512 DOI: 10.1111/jjns.12165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/06/2016] [Accepted: 12/15/2016] [Indexed: 11/30/2022]
Abstract
AIM This study was conducted in order to determine nurses' ability to diagnose exposure keratopathy reliably in the early stage in intensive care patients. METHODS This methodological and descriptive study was carried out between 2011 and 2012 in the Neurology and Anesthesiology and Reanimation Intensive Care Units of a teaching hospital in western Turkey. The sample consisted of 4354 ocular assessments in 156 corneas of 78 patients. A patient identification form and a fluorescein test patient tracking chart were used in the data collection. The corneas of the patients were checked by a fluorescein dye test by the same nurse and ophthalmologist. RESULTS The mean age of the patients was 59 ± 15.5 years and 47.4% of them were female. The consistency between the nurse and the ophthalmologist was almost perfect in terms of determining the presence of exposure keratopathy, characteristics, and the grade of corneal staining. Exposure keratopathy was detected at a rate of 2% by the ophthalmologist. A significant relationship was found between the presence of lagophthalmos and the development of exposure keratopathy. A positive correlation was found between the grade of corneal staining and the degree of the eyelid position of the patients and the duration of mechanical ventilation therapy. CONCLUSION After eye care and assessment training, intensive care nurses can play an effective role in detecting early-stage exposure keratopathy in intensive care patients.
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Affiliation(s)
- Elem Kocaçal Güler
- Department of Fundamentals of Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
| | - İsmet Eşer
- Department of Fundamentals of Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
| | - Sait Eğrilmez
- Department of Ophthalmology, Ege University Medical Hospital, İzmir, Turkey
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Solano A, DiazGranados JF, Rodríguez MF. Prevención y manejo de queratopatía por exposición en pacientes de cuidado intensivo. Revisión de la literatura. REPERTORIO DE MEDICINA Y CIRUGÍA 2016. [DOI: 10.1016/j.reper.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Güler EK, Eşer İ, Fashafsheh IHD. Intensive Care Nurses' Views and Practices for Eye Care: An International Comparison. Clin Nurs Res 2016; 26:504-524. [PMID: 26893447 DOI: 10.1177/1054773816631471] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Eye care is an important area of critical care. However, lack of eye care studies is a common issue across the globe. The aim of this study is to determine the views and practices of intensive care unit (ICU) nurses on eye care in Turkey and Palestine. This descriptive study was conducted using a self-administrated questionnaire. The data were collected from 111 nurses in nine kinds of ICUs in two education hospital. Normal saline (75.9%) was the most commonly reported solution for eye hygiene among the Palestinian nurses, and gauze soaked in normal saline or sterile water (64.3%) were the most frequently used supplies by the Turkish nurses. Although both Palestinian and Turkish ICU nurses took some precautions to prevent eye complications in critical patients, there were some gaps and insufficiencies in the eye care of ICU patients. There is a need for continuing training in this area.
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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kalhori RP, Ehsani S, Daneshgar F, Ashtarian H, Rezaei M. Different Nursing Care Methods for Prevention of Keratopathy Among Intensive Care Unit Patients. Glob J Health Sci 2015; 8:212-7. [PMID: 26925905 PMCID: PMC4965641 DOI: 10.5539/gjhs.v8n7p212] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/12/2015] [Indexed: 11/12/2022] Open
Abstract
Background: Patients with reduced consciousness level suffer from eye protection disorder and Keratopathy. This study was conducted to compare effect of three eye care techniques in prevention of keratopathy in the patients hospitalized in intensive care unit of Kermanshah. Methods: This clinical trial was conducted in 2013 with sample size of 96 persons in three random groups. Routine care included washing of eyes with normal saline and three eye care methods were conducted with poly ethylene cover, liposic ointment, and artificial tear drop randomly on one eye of each sample and a comparison was made with the opposite eye as the control. Eyes were controlled for 5 days in terms of keratopathy. Data collection instrument was keratopathy severity index. Data statistical analysis was performed with SPSS-16 software and chi-squared test, Fisher’s exact test, ANOVA and Kruskal–Wallis one-way analysis of variance. Findings: The use of poly ethylene cover (0.59±0.665) was significantly more effective in prevention of keratopathy than other methods (P=0.001). There was no statistically significant difference between two care interventions of liposic ointment and artificial tear drop (P=0.844) but the results indicated the more effective liposic ointment (1.13±0.751) than the artificial tear drop (1.59±0.875) in prevention of corneal abrasion (P<0.001). Conclusion: Results of the study suggest the use of poly ethylene cover as a non-aggressive and non-pharmaceutical nursing and therapeutic method for prevention of keratopathy in the patient hospitalized in intensive care unit.
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Ebadi A, Saeid Y, Ashrafi S, Taheri-Kharameh Z. Development and psychometric evaluation of a questionnaire on nurses' clinical competence eye care in intensive care unit patients. Nurs Crit Care 2015; 22:169-175. [PMID: 26549526 DOI: 10.1111/nicc.12113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/09/2014] [Accepted: 05/21/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Given the high prevalence of eye disorders in intensive care units, evaluating critical care nurses' competence in providing standard eye care is a matter of utmost importance. However, to the best of our knowledge, there is no valid questionnaire for measuring nurses' competence to undertake eye care. AIMS The aim of this study was to develop and evaluate the psychometric properties of a questionnaire on nurses' clinical competence in providing eye care to patients hospitalized in intensive care units. DESIGN This was a psychometric study. METHODS We initially performed a literature review and developed a 38-item questionnaire consisting of knowledge, attitude and practice domains. We invited a panel of experts and a group of critical care nurses to assess the content and face validity of the questionnaire. Thereafter, we evaluated its construct validity by using the exploratory factor analysis and the known-groups comparison technique. Moreover, the test-retest and the internal consistency evaluation techniques were used for assessing the reliability of the questionnaire. RESULTS Totally, 35 items remained in the final version of the questionnaire. Based on the results of the exploratory factor analysis, we categorized the items of the questionnaire into three factors. The Cronbach's alpha for the attitude and the practice domains as well as the Kuder-Richardson 20 for the knowledge domain showed satisfactory internal consistency. The Cronbach's alpha for the whole questionnaire also was 0·83. CONCLUSION The results of this study suggest that the nurses' clinical competence in eye care questionnaire has a good factor structure and an acceptable reliability. RELEVANCE TO CLINICAL PRACTICE A complication of sedation and coma is that some patients are unable to maintain effective eyelid closure. These patients present a higher risk of eye complications. Development of tools for evaluating nurses' competence in providing standard eye care is a fundamental prerequisite for improving the quality of eye care.
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Affiliation(s)
- Abbas Ebadi
- Behavioral Sciences Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Yaser Saeid
- Trauma Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Shahrbanoo Ashrafi
- Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Lai CT, Yao WC, Lin SY, Liu HY, Chang HW, Hu FR, Chen WL. Changes of Ocular Surface and the Inflammatory Response in a Rabbit Model of Short-Term Exposure Keratopathy. PLoS One 2015; 10:e0137186. [PMID: 26334533 PMCID: PMC4559311 DOI: 10.1371/journal.pone.0137186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 08/14/2015] [Indexed: 12/13/2022] Open
Abstract
Purpose To evaluate the ocular surface change and the inflammatory response in a rabbit model of short-term exposure keratopathy. Methods Short term exposure keratopathy by continuous eyelid opening was induced in New Zealand white rabbits for up to 4 hours. Ultrasound pachymetry was used to detect central total corneal thickness. In vivo confocal microscopy and impression cytology were performed to evaluate the morphology of ocular surface epithelium and the infiltration of inflammatory cells. Immunohistochemistry for macrophage,neutrophil, CD4(+) T cells, and CD8(+) T cells were performed to classify the inflammatory cells. Scanning electron microscopy(SEM) was performed to detect ocular surface change.The concentrations of IL-8, IL-17, Line and TNF-αwere analyzed by multiplex immunobead assay. TUNEL staining was performed to detect cellular apoptosis. Results Significant decrease ofcentral total cornealthickness were found within the first 5 minutes and remained stable thereafter, while there were no changes of corneal epithelial thickness.No significant change of corneal, limbal and conjunctival epithelial morphology was found by in vivo confocal microscopy except the time dependent increase of superficial cellular defects in the central cornea. Impression cytology also demonstrated time dependent increase of sloughing superficial cells of the central cornea. Aggregations ofinflammatory cells were found at 1 hour in the limbal epithelium, 2 hours in the perilimbal conjunctival epithelium, and 3 hours in the peripheral corneal epithelium.In eyes receiving exposure for 4 hours, the infiltration of the inflammatory cells can still be detected at 8 hours after closing eyes.Immunohistochemical study demonstrated the cells to be macrophages, neutrophils, CD4-T cells and CD-8 T cells.SEM demonstrated time-depending increase of intercellular border and sloughing of superficial epithelial cells in corneal surface. Time dependent increase of IL-8, IL-17 and TNF-α in tear was found.TUNEL staining revealed some apoptotic cells in the corneal epithelium and superficial stroma at 3 hours after exposure. Conclusions Short term exposure keratopathy can cause significant changes to the ocular surface and inflammatory response. Decrease of central total corneal thickness, aggregation of inflammatory cells, and cornea epithelial cell and superficial keratocyte apoptosis were found no less than 4 hours following the insult.
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Affiliation(s)
- Chun-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chieng Yao
- Department of Anesthesia, Min-Sheng General Hospital, Tao-Yuan City, Taiwan
| | - Szu-Yuan Lin
- Deparment of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
| | - Hsin-Yu Liu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Huai-Wen Chang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Li Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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Alansari MA, Hijazi MH, Maghrabi KA. Making a Difference in Eye Care of the Critically Ill Patients. J Intensive Care Med 2015; 30:311-7. [PMID: 24212598 DOI: 10.1177/0885066613510674] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/19/2013] [Indexed: 11/16/2022]
Abstract
Ocular surface disorders are frequently encountered in patients under sedation and paralyzed patients in intensive care units (ICUs). In the ICUs, treatment is usually focused on the management of organ failures, and eye care becomes a side issue. As a result, ophthalmological complications do occur (incidence ranges from 3.6% to 60%) and are frequently overlooked in this setting. To identify the best available evidence in providing the best eye care to prevent exposure keratopathy, a literature review was performed. The databases of PUBMED, COCHRAN, and EMBASE library were searched. We only looked at higher quality articles. Among various eye care measures that have been advocated to prevent exposure keratopathy, the most effective is the application of polyethylene covers. Early diagnosis and effective treatment will help prevent microbial keratitis and visual loss.
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Affiliation(s)
- Mariam A Alansari
- Department of Adult Critical Care Medicine, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed H Hijazi
- Department of Critical Care Medicine (MBC 94), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Khalid A Maghrabi
- Department of Critical Care Medicine (MBC 94), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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Moisture chamber versus lubrication for corneal protection in critically ill patients: a meta-analysis. Cornea 2015; 33:1179-85. [PMID: 25170579 DOI: 10.1097/ico.0000000000000224] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Critically ill patients in the intensive care unit are at increased risk of exposure keratopathy. There is limited evidence available to make the best choice of eye care modality. This meta-analysis aimed to evaluate the effect of moisture chamber compared with lubrication for corneal protection in critically ill patients. METHODS Studies were identified through PubMed, Embase, The Cochrane Library, and complementary manual searches, up to May 31, 2014. Randomized controlled trials of critically ill patients in the intensive care unit comparing moisture chamber with lubrication and evaluating risk of corneal damage were included. RESULTS Seven trials were included. The pooled analysis showed that the use of moisture chambers resulted in a reduction of the incidence of corneal damage [risk ratio (RR), 0.27; 95% confidence interval (CI): 0.11-0.67; P = 0.005]. In 1 subgroup analysis, there was a significant difference between the use of moisture chambers and lubricating drops, and the moisture chamber group had a decreased incidence of corneal damage (RR, 0.13; 95% CI: 0.05-0.35; P < 0.0001). In the other subgroup analysis, no statistically significant difference was observed between the use of moisture chambers and lubricating ointments (RR, 0.81; 95% CI: 0.51-1.29; P = 0.38). The overall quality of evidence was low. CONCLUSIONS The use of moisture chambers is associated with more effective corneal protection compared with lubrication. The analytic result is limited by serious risk of bias and imprecision.
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Incidence and risk factor evaluation of exposure keratopathy in critically ill patients: A cohort study. J Crit Care 2015; 30:400-4. [DOI: 10.1016/j.jcrc.2014.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/27/2014] [Accepted: 10/07/2014] [Indexed: 11/18/2022]
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Cabalag MS, Wasiak J, Syed Q, Paul E, Hall AJ, Cleland H. Early and late complications of ocular burn injuries. J Plast Reconstr Aesthet Surg 2014; 68:356-61. [PMID: 25465150 DOI: 10.1016/j.bjps.2014.10.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 10/19/2014] [Accepted: 10/21/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ocular involvement in facial burns may lead to significant long-term morbidity. The aims of this study were to analyse the epidemiology, management and outcomes of ocular burn injuries, as well as to identify risk factors for developing early and late ocular complications. METHODS A retrospective medical chart review was conducted for 125 patients with ocular burns who were admitted to the Victorian Adult Burns Service (VABS), from November 2000 to January 2010. Univariate analyses was utilised to identify demographic and injury related variables associated with early and late complications. RESULTS The majority of patients were male (n=101, 80.8%), and the mean (range) age was 40.7 (15-86) years. The most common mechanism was flame burns (n=77, 61.6%), and most were accidental (n=114, 91.2%). Early ocular complications occurred in 50 (40.0% [95% CI: 31.3%-49.1%]) patients, with the commonest being visual loss (n=39, 31.2%). Chemical burns, ocular discomfort, peri-orbital oedema, corneal injury, as well as eyelid and facial burns of increasing severity were associated with developing an early complication. Late ocular complications occurred in 19 (15.2% [95% CI: 9.4%-22.7%]) patients, with visual loss being the most frequent (n=13, 10.4%). Chemical burns, ocular discomfort, corneal injury of increasing severity, visual loss on presentation, ectropion, as well as eyelid burns of increasing depth were associated with late morbidity. CONCLUSION Chemical burns, ocular discomfort, as well as corneal injury and eyelid burns of increasing severity were risk factors for both early and late ocular complications. LEVEL OF EVIDENCE III (retrospective comparative study).
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Affiliation(s)
- Miguel S Cabalag
- Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia.
| | - Jason Wasiak
- Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, VIC, Australia
| | - Quaderi Syed
- Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, VIC, Australia
| | - Anthony J Hall
- Department of Surgery, Central and Eastern Clinical School, Monash University, Melbourne, VIC, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia; Department of Ophthalmology, The Alfred Hospital, Melbourne, VIC, Australia
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Talreja D, Muraleedharan C, Gunathilaka G, Zhang Y, Kaye KS, Walia SK, Kumar A. Virulence properties of multidrug resistant ocular isolates of Acinetobacter baumannii. Curr Eye Res 2014; 39:695-704. [PMID: 24502411 DOI: 10.3109/02713683.2013.873055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Acinetobacter (A.) baumannii is an opportunistic pathogen and has been reported as a causative agent of ocular infections. The aim of this study is to identify virulence properties (biofilm formation, adhesion, invasion and cytotoxicity) and antibiotic resistance among A. baumannii isolates recovered from the eye. MATERIALS AND METHODS The Microscan Walk-Away®, an automated bacterial identification and susceptibility testing system was used to determine antibiotic resistance. Clonal relatedness was assessed by Pulsed-field gel electrophoresis (PFGE) and plasmid profile analysis. Conjugation experiments were carried out to determine the transfer of antibiotic resistance genes and PCR was used to confirm gene transfer. Virulence properties of the isolates were determined by biofilm formation using crystal violet and immunofluorescence staining, adherence and internalization using cultured corneal epithelial cells, and cytotoxicity by TUNEL-staining and LDH release assays. RESULTS All ocular isolates (n = 12) exhibited multidrug resistant (MDR) phenotype and one of the isolate (AB12) was resistant to 18 antibiotics (β-lactam, aminoglycosides, tetracycline, chloramphenicol and quinolones). The plasmid profile analysis showed the presence of multiple plasmids in each isolate and a total of 10 different profiles were observed. However, PFGE analysis was more discriminatory which revealed 12 distinct genotypes. Antibiotic resistance (tetracycline and quinolone) was transferable from the isolate AB12 to a recipient Escherichia coli J53. Ten isolates were strong biofilm producers and the remaining two (AB5 and AB7) were moderate producers. All isolates demonstrated adherence and invasive properties towards HCECs. A similar trend was observed in their ability to cause cell death and toxicity. CONCLUSIONS Our results indicate that ocular isolates of A. baumannii are biofilm producers and adherent and invasive to corneal epithelium, a first step in the pathogenesis of ocular infection. In addition, they demonstrated plasmid-mediated transfer of MDR traits making them a reservoir of resistance genes at ocular surface.
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Affiliation(s)
- Deepa Talreja
- Kresge Eye Institute, Wayne State University , Detroit, MI , USA
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Demirel S, Cumurcu T, Fırat P, Aydogan MS, Doğanay S. Effective management of exposure keratopathy developed in intensive care units: The impact of an evidence based eye care education programme. Intensive Crit Care Nurs 2014; 30:38-44. [DOI: 10.1016/j.iccn.2013.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 07/31/2013] [Accepted: 08/04/2013] [Indexed: 11/26/2022]
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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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Masoudi Alavi N, Sharifitabar Z, Shaeri M, Adib Hajbaghery M. An audit of eye dryness and corneal abrasion in ICU patients in Iran. Nurs Crit Care 2013; 19:73-7. [DOI: 10.1111/nicc.12052] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kam KYR, Haldar S, Papamichael E, Pearce KCS, Hayes M, Joshi N. Eye Care in the Critically Ill: A National Survey and Protocol. J Intensive Care Soc 2013. [DOI: 10.1177/175114371301400213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sedated and ventilated critically ill patients often have inadequate eyelid closure and are susceptible to developing exposure keratopathy and microbial keratitis. Preventative measures reduce the risk of complications and visual loss. A telephone survey of all intensive care units in England was performed to elucidate the measures being used and their prevalence. Of 267 units, 217 participated (81%). Of these, 130 (60%) had an eye care protocol and 143 (66%) of all participating units formally assessed eyelid closure. The presence of an eye care protocol did not improve the likelihood of a unit assessing eyelid closure, a key component of the detection of patients at risk of ophthalmic complications; 66% of units with eye care protocols assessed eyelid closure formally, compared to eyelid closure assessment occurring in 65% of units that did not employ an eye care protocol. Most units used at least two protective methods per unit, the most popular being Geliperm application and Lacrilube. Self-reported complication rates in the last year were low, but only 13% of units audited eye-related complications. To improve eye care and replace current protocols, we propose a simple protocol encouraging vigilant eyelid closure assessment, administration of preventative therapy where indicated and referral if there is any corneal opacity or continuous exposure.
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Affiliation(s)
- KY Ronald Kam
- Honorary Clinical Lecturer, Magill Department of Anaesthesia, Intensive Care and Pain Management, Imperial College London: Ophthalmology Specialist Trainee, Western Eye Hospital, Imperial College Healthcare NHS Trust
| | - Shreyar Haldar
- Intensive Care Medicine Senior House Officer, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham, London
| | - Esther Papamichael
- Ophthalmology Specialist Trainee, Department Ophthalmology, Hillingdon Hospital, Middlesex
| | - Kirsten CS Pearce
- Foundation House Officer, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester
| | - Michelle Hayes
- Consultant Anaesthetist and Intensivist, Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital NHS Foundation Trust, London
| | - Naresh Joshi
- Consultant Ophthalmologist, Department of Ophthalmology, Chelsea and Westminster Hospital NHS Foundation Trust, London
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Jammal H, Khader Y, Shihadeh W, Ababneh L, AlJizawi G, AlQasem A. Exposure keratopathy in sedated and ventilated patients. J Crit Care 2012; 27:537-41. [DOI: 10.1016/j.jcrc.2012.02.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 01/05/2012] [Accepted: 02/14/2012] [Indexed: 11/29/2022]
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Grixti A, Sadri M, Edgar J, Datta AV. Common Ocular Surface Disorders in Patients in Intensive Care Units. Ocul Surf 2012; 10:26-42. [DOI: 10.1016/j.jtos.2011.10.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 10/20/2011] [Accepted: 10/20/2011] [Indexed: 10/28/2022]
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Kam KR, Hayes M, Joshi N. Ocular care and complications in the critically ill. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2011. [DOI: 10.1016/j.tacc.2011.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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47
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Lindfield D, Strong S. Corneal Perforation from Facemask Delivered Oxygen - Not Just an Intubation/Sedation Issue. J Intensive Care Soc 2011. [DOI: 10.1177/175114371101200318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Dan Lindfield
- Department of Ophthalmology, Frimley Park Hospital, Camberley, Surrey
| | - Stacey Strong
- ST2 Ophthalmology
- Department of Ophthalmology, Frimley Park Hospital, Camberley, Surrey
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Abstract
A retrospective study of patients admitted to MetroHealth Medical Center was performed to identify the risk factors for short- and long-term ophthalmologic complications related to burn injury. From 2000 to 2007, the authors identified 293 patients with the inclusion criteria of facial burns, TBSA ≥20%, or smoke inhalation injury. Seventy (24%) developed ocular complications, and 16 (11%) developed long-term complications. Statistically significant risk factors identified for short-term complications were burn size, chemical burns, depth of facial burns, initial Glasgow Coma Scale, and need for mechanical ventilation/sedation. Risk factors for long-term complications included wound infection with Pseudomonas or Acinetobacter, third-degree burn size, hours to ophthalmology evaluation, LOS, time on mechanical ventilation, and need for STSG. In addition to facial burns, the requirement of mechanical ventilation, prolonged sedation, and presence of infection with Pseudomonas or Acinetobacter increase the risk of injury to the eye after burn injury, and these patients may benefit from serial eye examinations for early identification of ocular complications.
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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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Mela EK, Drimtzias EG, Christofidou MK, Filos KS, Anastassiou ED, Gartaganis SP. Ocular surface bacterial colonisation in sedated intensive care unit patients. Anaesth Intensive Care 2010; 38:190-3. [PMID: 20191796 DOI: 10.1177/0310057x1003800129] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated the time-dependent ocular surface bacterial colonisation of sedated patients hospitalised in an intensive care unit and aimed to evaluate whether proper topical antibiotic prophylaxis could prohibit corneal infection. The study lasted 12 months and included 134 patients undergoing sedation and mechanical respiratory support for various medical reasons. Patients hospitalised for less than seven days and those with pre-existing ocular surface pathology were excluded. All patients were examined on admission by inspecting the cornea for erosions. Followup examinations were performed each subsequent day. Cultures were also obtained from the conjunctival sac of both eyes on admission and every seventh day until the end of sedation. Standard laboratory techniques were used for isolation, identification and antibiotic susceptibility testing of bacteria. Antibiotic treatment for prophylaxis was administered accordingly. Analysis was carried out for 70 patients. Duration of sedation ranged from seven to 122 days. Fifty-four (77%) patients were colonised by at least one bacterial species other than normal flora within seven to 42 days. Multiple bacteria were isolated from 28 patients undergoing prolonged sedation. Prevalent isolates were Pseudomonas aeruginosa, Acinetobacter spp. and Staphylococcus epidermidis. Infectious keratitis was prohibited in all cases. Ocular surface of long-term sedated patients was found to be colonised by various bacterial species and their isolation was closely associated with the time period of hospitalisation. The results of this study suggest that the early identification of ocular surface bacteria colonisation and the administration of topical antibiotics for prophylaxis can prohibit corneal infection in these patients.
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Affiliation(s)
- E K Mela
- Department of Ophthalmology, Microbiology and Anesthesiology, Patras University Hospital, Rion, Patras, Greece
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