Ophthalmology in Critical Care

Assessment of eye care practices and health belief model factors among adult intensive care unit nurses in public hospitals of Amhara Region, Ethiopia

BACKGROUND

Eye care is a vital aspect of overall patient health, especially in intensive care units (ICUs) where patients face a heightened risk of ocular complications. Approximately 60% of patients with tracheal tubes and lagophthalmos develop severe ocular surface diseases, such as corneal abrasions, conjunctivitis, and exposure keratopathy, due to insufficient eye protection and lubrication. These complications can adversely affect patient outcomes, including increased mortality rates, extended hospital stays, and reduced satisfaction with care. Despite the importance of effective eye care, practices among intensive care unit nurses can be inconsistent, often influenced by their beliefs and perceptions. The Health Belief Model (HBM) offers a framework to understand these influences, highlighting how nurses' attitudes toward eye care are shaped by their perceptions of patient severity, susceptibility to complications, perceived benefits and barriers to care, cues to action, and self-efficacy.

OBJECTIVE

This study aims to assess eye care practices among adult intensive care unit nurses in public hospitals in the Amhara Region of Ethiopia and to identify factors influencing these practices based on the Health Belief Model.

METHODS

A facility-based cross-sectional study was conducted among 213 nurses working in adult ICUs using simple random sampling. Data were collected through a structured, self-administered questionnaire and an observation checklist utilizing Kobo Collect. The data were analyzed using SPSS. Bivariable and multivariable logistic regression models were employed to identify relationships between the constructs of the Health Belief Model and eye care practices.

RESULTS

In this study, 213 of the 222 respondents participated, resulting in a 96% response rate. Among the participants, 113 nurses (53.1%; 95% CI: 46.5-59.6) demonstrated a high likelihood of providing eye care, while 100 nurses (46.9%; 95% CI: 40.4-53.5) exhibited a lower likelihood based on constructs of the Health Belief Model. Additionally, 125 nurses (58.7%; 95% CI: 52.1-65.3) had inadequate eye care practices, while 133 (62.4%; 95% CI: 55.4-69) possessed adequate knowledge about eye care. Furthermore, 113 participants (53.1%; 95% CI: 46-60.1) held a favorable attitude toward eye care. The multivariable analysis identified several factors associated with eye care practices: monthly salary (AOR = 2.4, 95% CI: 1.1-5.7), educational level (AOR = 0.2, 95% CI: 0.06-0.8), knowledge of eye care (AOR = 2, 95% CI: 1.1-3.4), and availability of eye care equipment (AOR = 0.3, 95% CI: 0.1-0.5).

CONCLUSION AND RECOMMENDATION

The study reveals that fewer than half of the nurses working in adult intensive care units in public hospitals in the Amhara region provide adequate eye care, despite a strong intention to do so. Key factors influencing eye care practices include monthly salary, knowledge level, educational qualifications, and the availability of necessary equipment. To improve eye care delivery, it is essential for relevant authorities to implement targeted training and educational initiatives for nurses, thereby enhancing their skills and knowledge in eye care practices.

Lubratex eye ointment with polyethylene cover significantly reduces corneal abrasion in ICU patients: a randomized controlled trial

Corneal abrasion is a frequent complication in critically ill, intubated patients, potentially leading to visual impairment. This study compares the efficacy of three ocular care methods in preventing corneal abrasion among this vulnerable population. We conducted a randomized controlled trial involving 156 intubated adult patients admitted to the ICU. Participants were randomly allocated to one of three intervention groups (n = 52 per group): (1) polyethylene cover only, (2) polyethylene cover with artificial tear drops, and (3) polyethylene cover with Lubratex eye ointment. One eye per patient was randomly assigned as the control, receiving standard ICU eye care. Daily assessments over five days included a standardized dryness and corneal abrasion checklist, graded strip evaluation of eye dryness, and documentation of corneal abrasion incidence. Data were analyzed using descriptive and inferential statistics (SPSS-18). The incidence of corneal abrasion was significantly lower in the group receiving polyethylene cover with Lubratex eye ointment (4%) compared to the polyethylene cover with artificial tears group (36%, p < 0.001) and the polyethylene cover only group (60%, p < 0.001). The combined application of a polyethylene cover with Lubratex eye ointment effectively prevents corneal abrasion in intubated ICU patients. This method demonstrates superior efficacy compared to polyethylene covers used alone or with artificial tears. We recommend its implementation as standard practice for corneal abrasion prophylaxis in this high-risk population.Trial Registration. This study is registered with the Iranian Registry of Clinical Trials (IRCT201506294736N8) and can be accessed at www.IRCT.ir .

The effect of polyethylene cover intervention on ocular surface disorder of intensive care unit patients: a systematic review and meta-analysis

BACKGROUND

Polyethylene covers have been proven to be effective in protecting the eyes in patients with decreased or disappeared blink reflexes, but their advantages compared to other conventional methods are still unclear. This systematic review and meta-analysis study aimed to elucidate the impact of polyethylene covers in the prevention of ocular surface disease (OSD) in patients admitted to the intensive care unit (ICU).

METHODS

We searched the Scopus, PubMed, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify randomized controlled trial studies. This study followed the PRISMA guidelines and used the Cochrane Collaboration tool to assess the risk of bias.

RESULTS

The findings were expressed as risk ratio (RR) with 95% confidence intervals. The incidence of OSD in the polyethylene cover group was lower than that in the eye drops group (RR = 0.27; 95% CI (0.07, 1.09), P = 0.07) and adhesive tape group (RR = 0.11, 95%CI (0.04, 0.31), P < 0:0001) but the polyethylene cover group showed no significant difference compared to the eye gel group (RR = 0.79, 95%CI (0.18, 3.51), P = 0.76) and the eye ointment group (RR = 0.85; 95% CI (0.36, 1.99), P = 0.71).

CONCLUSION

This study showed that polyethylene covers, eye gels, and eye ointments had an equal effect on preventing OSD in ICU patients, and eye drops and adhesive tapes were relatively less effective. However, other intervention methods had not been compared due to the small number of articles. Hence, further studies should assess the available methods to choose the best practical method.

Bedside assessment of ophthalmic manifestations in neurocritical care: A study in Southern India

PURPOSE

This study aimed to investigate the incidence of Ocular Surface Disorders (OSDs), including Dry Eye Disease, Chemosis, and Exposure Keratitis, among patients admitted to the Neurocritical Care Unit (NCC). Additionally, we sought to assess the correlation between these OSDs, the length of hospitalization at NCC, and the Glasgow Coma Score (GCS). The heightened risk of OSD development in the NCC environment, coupled with pre-existing neurological impairments, can lead to conditions like dry eye disease, chemosis, corneal abrasions, and infectious keratitis, ultimately resulting in corneal opacities and perforations that significantly impact visual acuity and overall quality of life.

METHODS

In this observational cross-sectional study, we examined the ocular health of all patients admitted to an NCC unit from February to May 2022. We assessed the presence of Conjunctivitis, chemosis, Keratitis, and Dry Eyes in relation to the duration of stay at NCC, GCS, lagophthalmos, adherence to the prescribed eye care protocol in NCC, and the use of mechanical ventilation. Our study comprised one hundred subjects over a four-month period, with a mean age of 51.92 ± 18.73 years (ranging from 17 to 89), including 70% males and 30% females (gender ratio of 2.33).

RESULTS

Our findings revealed that 26 eyes (13%) exhibited Conjunctival Hyperemia, 23 eyes (11.5%) displayed Chemosis, and severe dry eye was prevalent in 41 (20.5%) eyes. A statistically significant association was observed between GCS (p-value <0.001) and Keratitis (p-value 0.0035) with dry eyes (Chi-Square Test). Notably, the incidence of dry eyes was significantly higher among patients with a prolonged stay of ≥10 days (p-value 0.003).

CONCLUSIONS

Patients admitted to Neurocritical Care Units necessitate meticulous eye care and structured protocols to mitigate the risk of long-term ocular complications such as exposure keratitis. Given their heightened susceptibility to these conditions, proactive measures are imperative to ensure optimal ocular health among NCC patients.

Care of the Critically Injured Burn Patient

Care of the critically injured burn patient presents unique challenges to the intensivist. Certified burn centers are rare and geographically sparse, necessitating that much of the initial management of patients with severe burn injuries must happen in the pre-burn center setting.1 Severe burn injuries often lead to a wide range of complications that extend beyond the loss of skin integrity and require specialized care. As such, medical intensivists are often called upon to stabilize these critically injured patients. This focused review outlines the clinical care of these medically complex patients, including airway management, post-burn complications, volume resuscitation, nutrition, and end-of-life care.

Risk Factors of Eye Complications in Patients Treated in the Intensive Care Unit

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.