ABSTRACT
BACKGROUND: Exposure keratopathy (EK) has a high incidence in critically ill patients. We aimed to determine the rate of EK in patients admitted to our intensive care unit (ICU), identify risk factors for developing EK and ascertain the effectiveness of a protocol to prevent EK. METHODS: We undertook a two-phase prospective cohort single-centre study in a general adult ICU. The first phase of the study was observational. In the second phase of the study an eye care protocol was introduced. Daily ophthalmic assessment was carried out using a portable slit lamp. We also recorded Acute Physiology and Chronic Health Evaluation II score, daily Sequential Organ Failure Assessment score, mechanical ventilation, Richmond Agitation-Sedation Scale, and level of eye care. Student's t test and χ 2 statistics were used for simple analysis of continuous data and categorical data, respectively. Binary logistic regression was used to analyse the relationship between EK (yes/no), as the dependent variable, and multiple independent variables, calculating unadjusted and adjusted odds ratios. RESULTS: We studied 371 patients. In the first phase, the overall rate of EK was 21% but the rate in mechanically ventilated patients was 56%; χ 2 (1, N = 257) = 80.8, p < 0.001. Adjusted odds ratios (AOR) for development of EK were 28.6 (8.19-43.37), 13.0 (3.16-54.38) and 1.2 (1.03-1.33) with incomplete eye closure, mechanical ventilation, and higher SOFA score, respectively. Following the introduction of the protocol in the second phase, the overall rate of EK reduced to 2.6% (three cases); χ 2 (1, N = 371) = 18.6, p < 0.001. Compliance with the protocol was 97%. CONCLUSIONS: EK is common in critically ill patients, and is associated with mechanical ventilation and incomplete eye closure. A simple protocol substantially reduces the incidence of EK and is easily achieved in clinical practice.
Subject(s)
Corneal Injuries/prevention & control , Guidelines as Topic/standards , Incidence , APACHE , Adult , Aged , Aged, 80 and over , Cohort Studies , Corneal Injuries/therapy , Critical Illness/epidemiology , Critical Illness/rehabilitation , Deep Sedation/adverse effects , Female , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Length of Stay , Logistic Models , Male , Middle Aged , Organ Dysfunction Scores , Prospective Studies , Respiration, Artificial/adverse effects , Respiration, Artificial/statistics & numerical data , Risk FactorsABSTRACT
PURPOSE: We aimed to determine the rate of exposure keratopathy (EK) in critically ill patients, identify risk factors for developing EK and ascertain the effectiveness of a protocol to prevent EK. MATERIALS AND METHODS: We undertook a two-phase prospective cohort study in a general adult ICU with first-phase being observational and an eye care protocol was introduced in the second-phase. Daily ophthalmic assessment was carried out along with recording of various risk factors. RESULTS: We studied 371 patients. In the first phase, the overall rate of EK was 21% but the rate in mechanically ventilated patients was 56%; χ2 (1, N=257)=80.8, p<0.001. Adjusted odds ratios (AOR) for development of EK was 28.6 (8.19-43.37), 13.0 (3.16-54.38) and 1.2 (1.03-1.33) with incomplete eye closure, mechanical ventilation, and higher sequential organ failure assessment score respectively. Following the introduction of the protocol, the overall rate of EK reduced to 2.6% (3 cases); χ2 (1, N=371)=18.6, p<0.001. CONCLUSIONS: EK is common in critically ill patients and a simple protocol substantially reduces the incidence of EK and is easily achieved in clinical practice.
Subject(s)
Clinical Protocols , Corneal Injuries/therapy , Critical Care/methods , Critical Illness/therapy , Adult , Corneal Injuries/etiology , Eyelid Diseases/complications , Eyelid Diseases/therapy , Female , Humans , Incidence , Intensive Care Units , Male , Middle Aged , Physical Examination/methods , Prospective Studies , Respiration, Artificial/adverse effects , Risk Factors , Xerophthalmia/complications , Xerophthalmia/therapyABSTRACT
BACKGROUND: Glycaemia control (GC) remains an important therapeutic goal in critically ill patients. The enhanced Model Predictive Control (eMPC) algorithm, which models the behaviour of blood glucose (BG) and insulin sensitivity in individual ICU patients with variable blood samples, is an effective, clinically proven computer based protocol successfully tested at multiple institutions on medical and surgical patients with different nutritional protocols. eMPC has been integrated into the B.Braun Space GlucoseControl system (SGC), which allows direct data communication between pumps and microprocessor. The present study was undertaken to assess the clinical performance and safety of the SGC for glycaemia control in critically ill patients under routine conditions in different ICU settings and with various nutritional protocols. METHODS: The study endpoints were the percentage of time the BG was within the target range 4.4 - 8.3 mmol.l(-1), the frequency of hypoglycaemic episodes, adherence to the advice of the SGC and BG measurement intervals. BG was monitored, and insulin was given as a continuous infusion according to the advice of the SGC. Nutritional management (enteral, parenteral or both) was carried out at the discretion of each centre. RESULTS: 17 centres from 9 European countries included a total of 508 patients, the median study time was 2.9 (1.9-6.1) days. The median (IQR) time-in-target was 83.0 (68.7-93.1) % of time with the mean proposed measurement interval 2.0 ± 0.5 hours. 99.6% of the SGC advices on insulin infusion rate were accepted by the user. Only 4 episodes (0.01% of all BG measurements) of severe hypoglycaemia <2.2 mmol.l(-1) in 4 patients occurred (0.8%; 95% CI 0.02-1.6%). CONCLUSION: Under routine conditions and under different nutritional protocols the Space GlucoseControl system with integrated eMPC algorithm has exhibited its suitability for glycaemia control in critically ill patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT01523665.
Subject(s)
Blood Glucose/metabolism , Critical Care/methods , Critical Illness/therapy , Decision Support Systems, Clinical , Insulin/administration & dosage , Intensive Care Units , Aged , Blood Glucose/drug effects , Decision Support Systems, Clinical/instrumentation , Europe/epidemiology , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND: Although therapeutic hypothermia for neuroprotection has been in use for over half a century but its use has been controversial in absence of proper guidelines. However for over two decades there has been revived interest in mild therapeutic hypothermia (32 - 34 degrees C) for neuroprotection. CASE: A 17 year-old female tourist was rescued from sea. She received cardio-pulmonary resuscitation for about 16 minutes. But she had sustained significant neurological insult as a result of hypoxic brain injury. Therapeutic hypothermia was added to her regime of neuroprotection in intensive care unit, and her neurological status improved in just 8 hours with full correction of her coma score by day 4.
