ABSTRACT
BACKGROUND: The presence of a corneal reflex and the ability to maintain eye closure are instrumental in protecting the cornea. Use of neuromuscular blocking agents or propofol can result in impaired eyelid closure and loss of corneal reflex, leading to corneal exposure. The cornea is then at risk for drying, infection, and scarring, which may lead to permanent visual loss. OBJECTIVES: To determine whether applying artificial tear ointment to the eyes of paralyzed or heavily sedated patients receiving mechanical ventilation decreases the prevalence of exposure keratitis more than does passive closure of the eyelid. METHODS: A prospective, randomized control trial was done. The sample was 50 patients in the intensive care unit receiving either neuromuscular blocking agents or propofol during mechanical ventilation. In each patient, artificial tear ointment was applied to one eye; passive closure of the eyelid was used for the other eye (control eye). RESULTS: Nine patients had evidence of exposure keratitis in the untreated eye, and 2 had corneal abrasions in both the treated and the control eyes. The remaining 39 patients did not have corneal abrasions in either eye. Use of the artificial tear ointment was more effective in preventing corneal exposure than was passive eyelid closure (P = .004). CONCLUSIONS: Eye care with a lubricating ointment on a regular, set schedule can effectively reduce the prevalence of corneal abrasions in patients who are either paralyzed or heavily sedated and thus can help prevent serious complications such as corneal ulceration, infection, and visual loss.
Subject(s)
Hypnotics and Sedatives/adverse effects , Keratitis/prevention & control , Neuromuscular Blocking Agents/adverse effects , Ophthalmic Solutions/therapeutic use , Propofol/adverse effects , Adult , Eyelids , Female , Humans , Intensive Care Units , Keratitis/etiology , Male , Middle Aged , Prospective Studies , Respiration, Artificial , Risk Factors , Treatment OutcomeABSTRACT
Patient death is a stressful experience for the patient, family, and the healthcare team. Nurses-often have only informal resources for coping with the sadness and grief they might experience. Realizing the need for nursing grief support, a group of staff nurses from the intensive care unit formed a grief support group. Using information from the literature and critical incident stress debriefing, the group developed support interventions to aid intensive care unit staff after patient death.
