Eye Care for the Intensive Care Patient; A Systematic Review

Abstract

Objective The objective of this systematic review was to present the best available evidence related to the effectiveness of eye care within the intensive care unit. Interventions of interest related to those used to maintain the integrity of the ocular surface in critically ill intensive care patients whose normal defences may be compromised. Method Inclusion Criteria • Participants of interest were: patients of all ages who were unconscious, sedated and/or paralysed and mechanically ventilated in an intensive care setting. • Interventions included in the review were those related to eye hygiene regimes, prevention of dry eyes, eyelid closure and programs of eye care. • Outcome measures of interest were those related to the incidence and severity of ocular surface injury or disease whilst the patient was in an intensive care setting, and included corneal abrasions, infection and oedema. • Randomised controlled trials were the study design of choice, for inclusion in the systematic review. Exclusion Criteria Papers were excluded from this review if they were presented in a language other than English, involved animals or patients with facial burns or eye trauma. Search Strategy The search covered the electronic databases CINAHL, MEDLINE, Current Contents, Dissertations, ProceedingsFirst and Expanded Academic Index, utilising a range of optimal search terms. Hand searching of relevant journals and conference proceedings was also undertaken to reveal additional literature and unpublished studies. Critical Appraisal Methodological quality of randomised controlled trials, was assessed by two people utilising checklists that focused on sources of bias as a result of the selection of participants, their treatment, attrition and measurement of outcomes. Data Collection Data were collected from study reports using a data collection tool developed for this review. Data Synthesis Studies were summarised using both tabular and narrative summaries. When two or more comparable randomised controlled trials were identified, the results were pooled in a meta-analysis to determine the effectiveness of eye care interventions. Results The literature search identified 3 randomised controlled trials that fulfiled the review inclusions criteria (1-3). The only outcome measure of interest used in all of the randomised controlled trials was corneal abrasions. An uncontrolled trial (4), a controlled trial (5), and a before and after study (6), were also identified and their findings discussed, due to the limited number of randomised controlled trials obtained. Based on the findings of a very limited number of the randomised controlled trials, this systematic review found: • Polyethylene films/covers (Gladwrap) are more effective than regular instillation of methylcellulose drops (Methopt Forte), in reducing the incidence of corneal abrasions (OR 6.05; 95%CI 1.48 to 24.66) (1). • Artificial tear ointment (Duratears) is more effective than passive eyelid closure in reducing the incidence of corneal abrasions (OR 0.20;95%CI 0.05 to 0.76) (3). • Polyethylene films/covers (Gladwrap) are more effective than regular eye instillations (Methopt Forte drops, Lacrilube ointment), in reducing the incidence of corneal abrasions (OR 6.22; 95%CI 1.97 to 19.63). An additional finding of this review, was the identification of the risk of corneal abrasions for the intensive care population. All of the randomised controlled trials in this review revealed that corneal abrasions is a relatively common occurrence within this population (1-3). Implications for Practice Based on available evidence for the intervention of prevention of dry eyes, polyethylene films are viewed as the optimum intervention for reducing the incidence of corneal abrasions, however, more research is needed to supplement the work already done and further investigation of this intervention is required. There appears to be no rigorous research for the other eye care interventions of eye hygiene regimes, eyelid closure and programs of eye care, upon TRUNCATED AT 600 WORDS