Top

Published in:

01-03-2009 | Original

Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill

Authors: Daniel G. Ezra, Michelle P. Y. Chan, Lola Solebo, Aeesha P. Malik, Elizabeth Crane, Andrew Coombes, Marie Healy

Published in: Intensive Care Medicine | Issue 3/2009

Abstract

Purpose

To compare the cost and effectiveness of the two most popular forms of eye care in intensive care, ocular lubricant (Lacrilube) and polyacrylamide hydrogel dressings (Geliperm); for the prevention of exposure keratopathy in the critically ill.

Methods

A prospective randomised contralateral eye study was conducted at the Intensive Care Unit (ICU), Royal London Hospital, London, UK. Eighty eyes of 40 patients were recruited. Each patient received both Lacrilube and Geliperm allocated at random to different sides. A daily ophthalmology ward round was conducted. The outcome measures included the greatest palpebral aperture length, conjunctival oedema, and any exposure keratopathy.

Results

There was no statistically significant difference in the maximum corneal exposure score between the eyes treated with Lacrilube and Geliperm (P = 0.38). No significant difference in degree of chemosis or palpebral aperture was identified.

Conclusions

Our data suggest that Geliperm is as effective as Lacrilube in the prevention of exposure keratopathy in the critically ill. We also note that nursing staff must be fully trained in its application for eye care.

Wilson L (1982) Bacterial corneal ulcers. In: Duane T (ed) Clinical ophthalmology. Harper & Row, Hagerstown, pp 5–9

Hutton WL, Sexton RR (1972) Atypical Pseudomonas corneal ulcers in semicomatose patients. Am J Ophthalmol 73:37–39PubMed

Laight SE (1996) The efficacy of eye care for ventilated patients: outline of an experimental comparative research pilot study. Intensive Crit Care Nurs 12:16–26PubMedCrossRef

Marshall AP, Elliott R, Rolls K, Schacht S, Boyle M (2008) Eyecare in the critically ill: clinical practice guideline. Aust Crit Care 21:97–109PubMedCrossRef

King D, Healy M (2003) Prevention of eye disease in intensive care—a telephone survey. Int Care Med 29:15(suppl)

Ezra DG, Lewis G, Healy M, Coombes A (2005) Preventing exposure keratopathy in the critically ill: a prospective study comparing eye care regimes. Br J Ophthalmol 89:1068–1069PubMedCrossRef

Lenart SB, Garrity JA (2000) Eye care for patients receiving neuromuscular blocking agents or propofol during mechanical ventilation. Am J Crit Care 9:188–191PubMed

Ezra D, Chan MPY, Solebo LA, Malik ANJ, Ahmadi-Lari S, Hersch D, Hanouka A, Al-Hakim H, Crane B, Coombes AC, Healy M (2006) Randomised controlled trial comparing Geliperm and Lacrilube Eye care in the Critically ill. Intensive care medicine Int Care Med 32:227(suppl)

Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRef

10.

McClellan KA (1997) Mucosal defense of the outer eye. Surv Ophthalmol 42:233–246PubMedCrossRef

11.

Kirwan JF, Potamitis T, el-Kasaby H, Hope-Ross MW, Sutton GA (1997) Microbial keratitis in intensive care. BMJ 314:433–434PubMed

12.

Mercieca F, Suresh P, Morton A, Tullo A (1999) Ocular surface disease in intensive care unit patients. Eye 13(Pt 2):231–236PubMed

13.

Ommeslag D, Colardyn F, De Laey JJ (1987) Eye infections caused by respiratory pathogens in mechanically ventilated patients. Crit Care Med 15:80–81PubMedCrossRef

14.

Dua HS (1998) Bacterial keratitis in the critically ill and comatose patient. Lancet 351:387–388PubMedCrossRef

15.

Johnson KL, Kearney PA, Johnson SB, Niblett JB, MacMillan NL, McClain RE (1994) Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med 22:658–666PubMedCrossRef

16.

Parkin B, Turner A, Moore E, Cook S (1997) Bacterial keratitis in the critically ill. Br J Ophthalmol 81:1060–1063PubMedCrossRef

17.

Cunningham C, Gould D (1998) Eyecare for the sedated patient undergoing mechanical ventilation: the use of evidence-based care. Int J Nurs Stud 35:32–40PubMedCrossRef

18.

Koroloff N, Boots R, Lipman J, Thomas P, Rickard C, Coyer F (2004) A randomised controlled study of the efficacy of hypromellose and Lacri–Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient. Intensive Care Med 30:1122–1126PubMedCrossRef

19.

So HM, Lee CC, Leung AK, Lim JM, Chan CS, Yan WW (2008) Comparing the effectiveness of polyethylene covers (Gladwraptrade mark) with lanolin (Duratears((R))) eye ointment to prevent corneal abrasions in critically ill patients: a randomized controlled study. Int J Nurs Stud

20.

Cortese D, Capp L, McKinley S (1995) Moisture chamber versus lubrication for the prevention of corneal epithelial breakdown. Am J Crit Care 4:425–428PubMed

21.

Ezra DG, Healy M, Coombes A (2005) Assessment of corneal epitheliopathy in the critically ill. Intensive Care Med 31:313PubMedCrossRef

22.

Landsberger HA (1958) Hawthorne revisited: management and the worker: its critics, and developments in human relations in industry. New York State School of Industrial and Labor Relations, Cornell University, Ithaca

23.

Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477PubMedCrossRef

Title: Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill
Authors: Daniel G. Ezra
Michelle P. Y. Chan
Lola Solebo
Aeesha P. Malik
Elizabeth Crane
Andrew Coombes
Marie Healy
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 3/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1284-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2009

Predictive factors of non invasive ventilation failure in critically ill children: a prospective epidemiological study

Continued survival gains in recent years among critically ill myeloma patients

The relationship between the intracranial pressure–volume index and cerebral autoregulation

Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients

Bacterial community-acquired pneumonia: risk factors for mortality and supportive therapies

A national analysis of the relationship between hospital factors and post-cardiac arrest mortality