1
|
de Oliveira Pinheiro CE, Carneiro E Silva RS, de Sousa FREG, Mantilla NPM, Silva NND, de Assis SF, do Prado PR. Causal validation of the risk for corneal injury in critically ill adults. Nurs Crit Care 2023; 28:1053-1060. [PMID: 35045203 DOI: 10.1111/nicc.12747] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The validity of a nursing diagnosis depends on a continuous investigation process in different populations to provide clinical evidence. The risk for corneal injury nursing diagnosis was approved in 2013 and only reviewed in 2017, demonstrating the need to perform a clinical validation to improve it. AIM To perform a causal validation of the risk for corneal injury nursing diagnosis in critically ill adults. STUDY DESIGN A prospective cohort study was performed in two intensive critical care units in Northern Brazil with adults aged over 18 years without corneal injury at admission. The patients were evaluated for 10 days, using a data collection tool composed of risk factors for the risk for corneal injury nursing diagnosis. The independent variables were described through absolute and relative frequency. The accuracy measures and risk factors were identified through Cox regression, considering a 95% confidence interval. RESULTS The nurses assessed 209 critically ill adults and identified that 76.0% of them presented the risk for corneal injury nursing diagnosis, with 16.3% developing a corneal injury, all having previously presented the risk for corneal injury nursing diagnosis. The risk factors identified were eyeball exposure (hazard ratio: 1.78; 95% CI: 1.27-2.51), Glasgow score < 6 (hazard ratio: 1.73; 95% CI: 1.15-2.60) and periorbital oedema (hazard ratio: 1.43; 95% CI: 1.03-1.99), with these factors showing high specificity, and the mechanical ventilation variable, showing high sensitivity, with ROC curve of .86. CONCLUSION Eyeball exposure, Glasgow score < 6 and periorbital oedema are the risk factors of the risk for corneal injury nursing diagnosis, in critically ill adults. These risk factors guide nursing interventions. This causal validation can improve the risk for corneal injury nursing diagnosis levels of evidence in the NANDA International Taxonomy. RELEVANCE TO CLINICAL PRACTICE It is necessary to guide nursing interventions for critically ill adults with lowered level of consciousness and corneal exposure for the prevention of corneal injury.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Patrícia Rezende do Prado
- Federal University of Acre, Rio Branco, Brazil
- Post-doctoral Student at Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
do Prado PR, Silveira RCCP, Vettore MV, Fossum M, Vabo GL, Gimenes FRE. Nursing interventions to prevent corneal injury in critically ill sedated and mechanically ventilated patients: A systematic review of interventions. Intensive Crit Care Nurs 2023; 78:103447. [PMID: 37172465 DOI: 10.1016/j.iccn.2023.103447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/15/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To identify the effectiveness of interventions to prevent corneal injury in critically ill, sedated, and mechanically ventilated patients. RESEARCH METHODOLOGY A systematic review of intervention studies was conducted in the following electronic databases: Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Literature in Health Sciences, LIVIVO, PubMed, Scopus and Web of Science, and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Study selection and data extraction were performed by two independent reviewers. Quality assessment of the randomized and non-randomized studies was performed using the Risk of Bias (RoB 2.0) and ROBINS-I Cochrane tools, respectively, and the Newcastle-Ottawa Scale for cohort studies. The certainty of the evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS 15 studies were included. Meta-analysis showed that the risk of corneal injury in the lubricants group was 66% lower (RR = 0.34; 95 %CI: 0.13-0.92) than in the eye-taping group. The risk of corneal injury in the polyethylene chamber was 68% lower than in the eye ointment group (RR = 0.32; 95 %CI 0.07-1.44). The risk of bias was low in most of the studies included and the certainty of the evidence was evaluated. CONCLUSIONS The most effective interventions to prevent corneal injury in critically ill sedated mechanically ventilated, who have compromised blinking and eyelid closing mechanisms, are ocular lubrication, preferably gel or ointment, and protection of the corneas with a polyethylene chamber. IMPLICATIONS FOR CLINICAL PRACTICE Critically ill, sedated, and mechanically ventilated patients who have compromised blinking and eyelid closing mechanisms must receive interventions to prevent corneal injury. Ocular lubrication, preferably gel or ointment, and protection of the corneas with a polyethylene chamber were the most effective interventions to prevent corneal injury in critically ill, sedated, and mechanically ventilated patients. A polyethylene chamber must be made commercially available for critically ill, sedated, and mechanically ventilated patients.
Collapse
Affiliation(s)
- Patrícia Rezende do Prado
- Federal University of Acre, Rio Branco, Acre, Brazil; Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
| | | | - Mario Vianna Vettore
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway.
| | - Mariann Fossum
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway.
| | - Grete Lund Vabo
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway.
| | - Fernanda Raphael Escobar Gimenes
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
| |
Collapse
|
4
|
Silva Carneiro E Silva R, Raphael Escobar Gimenes F, Pimentel Moreno Mantilla N, Naissa Duarte Silva N, Eduardo de Oliveira Pinheiro C, da Silva Lima M, Lameira Maciel Amaral T, Rezende do Prado P. Risk for corneal injury in intensive care unit patients: A cohort study. Intensive Crit Care Nurs 2021; 64:103017. [PMID: 33676811 DOI: 10.1016/j.iccn.2021.103017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
AIM To identify the incidence and risk factors for corneal injury amongst critically ill patients. METHOD A prospective cohort study with adult patients from one intensive care unit in Northern Brazil. Logistic regression was performed to predict the risk factors associated with corneal injury. RESULTS Data from 149 patients revealed 18.8% (28/149) corneal injuries. Factors independently associated with corneal injury were patients with eyeball exposure (OR: 27.31; 95% CI: 3.50-212.78); lagophthalmos (OR: 17.15; 95% CI: 5.78-50.85); chemosis (OR: 7.39; 95% CI: 2.28-23.97), periorbital oedema (OR: 7.99; 95% CI: 2.19-29.13) and hospitalisation >7-days (OR: 11.96; 95% CI: 3.27-43.66) had a significantly higher risk of developing corneal injury in this ICU. CONCLUSION Corneal injury was a common complication amongst critically ill patients and was associated with altered physiological function of the eyes such as exposure, lagophthalmos, chemosis and periorbital oedema. This study suggests introduction of a corneal injury prevention protocol for nursing and adding lagophthalmos and chemosis to the NANDA-I Taxonomy, thus contributing to the assessment and monitoring for the risk for corneal injury in critically ill patients.
Collapse
Affiliation(s)
| | - Fernanda Raphael Escobar Gimenes
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
| | | | | | | | - Michelly da Silva Lima
- Acre State Hospital Foundation (FUNDHACRE), Intensive Care Unit, Rio Branco, Acre, Brazil
| | - Thatiana Lameira Maciel Amaral
- Federal University of Acre, Multiprofessional Residency Program in Intensive Care Unit, Rio Branco, Acre, Brazil; Acre State Hospital Foundation (FUNDHACRE), Intensive Care Unit, Rio Branco, Acre, Brazil
| | - Patrícia Rezende do Prado
- Federal University of Acre, Multiprofessional Residency Program in Intensive Care Unit, Rio Branco, Acre, Brazil.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Boal C, Corkin D. The importance of protocol-based eye care in the paediatric intensive care unit. Nurs Child Young People 2019; 31:23-27. [PMID: 31468763 DOI: 10.7748/ncyp.2019.e1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2019] [Indexed: 06/10/2023]
Abstract
Eye care is a fundamental aspect of personal hygiene that should not be neglected in a critically ill child. This article informs nursing care by linking theory to practice, based on a systematic search and critical review of the literature. It explores the significance of evidence related to the eye care of a ventilated child and considers the role of the children's nurse as an agent for change in developing an eye care protocol for use in the paediatric intensive care unit.
Collapse
Affiliation(s)
- Catherine Boal
- Paediatric intensive care unit, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
| | - Doris Corkin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
- Sonal Vyas
- Cornea Services, SBH Eye Hospital, Raipur, Chhattisgarh, India
| | - Ashish Mahobia
- Cornea Services, SBH Eye Hospital, Raipur, Chhattisgarh, India
| | | |
Collapse
|