Corneal Injury and Impact of a Standard Eye Care Protocol in the Pediatric Intensive Care Unit
Angela Niemi, BS; Brooke E. Geddie, DO; John W. Winters, MD; Surender Rajasekaran, MD; Nikita VanDenBosch, CPCP-AC; Caryn Steenland, ACCNS-P; Alan T. Davis, PhD
Helen DeVos Children’s Hospital
Grand Rapids, MI
Introduction: Patients in intensive care units (ICU) have impaired ocular protective mechanisms putting them at risk of ocular complications. The aim of this project was to delineate risk factors for corneal injury (CI) in critically ill children and to assess the impact of a standardized eye care protocol (ECP).
Methods: This prospective, observational project documented ophthalmologic findings and frequency of eye care in ventilated/sedated pediatric patients admitted to a tertiary care ICU between May 2015 and December 2016. Critical care staff were trained to implement the ECP which included routine ocular assessment with fluorescein staining and protocolized eye care.
Results: We evaluated 479 patient encounters and found that 15% had CI on admission (keratopathy 62, abrasion 16). Significant risk factors included age, primary diagnosis (trauma-39%, respiratory infection-17.8%, neurologic disorders-19.5%, shock-24.4%) and location of intubation (emergency department/field-22.2%). Of the 245 patients with multiple ocular assessments, 32.2% displayed CI at some point during their hospitalization (keratopathy 73, abrasion 24). Continued application of the ECP reduced this incidence to 8.5% (keratopathy 19, abrasion 2) by the last exam with no corneal infiltrates/ulcers or other complications. Clinical factors associated with increased risk of injury include lagophthalmos, chemosis, positive tracheal cultures, and sedation level.
Discussion: Corneal injury is a significant problem in the critically ill (up to 60%)1,2. Early diagnosis and treatment can prevent microbial keratitis and vision loss,3. This standardized ECP reduced the incidence of CI, potentially preventing severe long-term ophthalmologic complications.
Conclusion: Implementation of an ECP should be initiated in all critically ill children with impaired ocular reflexes.
References: 1. Grixti A, Sadri M, Edgar J, et al. Common Ocular Surface Disorders in Patients in Intensive Care Units. Ocul Surf 2012;10(1):26-42.
2. Jammal H, Khader Y, Shidhadeh W, et al. Exposure Keratopathy in Sedated and Ventilated Patients. J Crit Care. 2012;27(6):537-541.
3. Alansari M, Hijazi M, Maghrabi K. Making a Difference in Eye Care of the Critically Ill Patients. J Int Care Med. 2015;30(6):311-317.