Evidence-Based Nursing for an Unconscious Patient Undergoing Mechanical Ventilation with Eye Complication_Chinese Journal of Evidence-Based Medicine

Authors：

WU Lingling ¹ ,  WANG Jiping ²

1. ICU, Jinshan Hospital, Fudan University, Shanghai 200540, China;2. Nursing Department, Jinshan Hospital, Fudan University, Shanghai 200540, China;

Corresponding author：

WANG Jiping, Email: 8753126@qq.com

Keywords：

Eye care; Intensive care unit; Keratitis; Iatrogenic ophthalmologic complication; Evidence-based treatment

DOI：

10.7507/1672-2531.20120197

Video：

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Objective 　To formulate an evidence-based nursing scheme of eye care for an unconscious patient undergoing mechanical ventilation with eye complication.
Methods 　Under the principle of PICO, the issue was put forward aiming directly at patient’s clinical manifestations, and the following databases as The Cochrane Library (Issue 12, 2011), PubMed (January 1980 to November 2011), EMbase (1974 to 2011) and CBM (1978 to 2011) were searched.
Results 　A total of 3 guidelines, 2 systematic reviews and 9 randomized controlled trials (RCTs) were included. The evidence showed that eye cleaning was the very important part of eye care, and the commonly-used cleaning or rinsing solutions were saline and sterile water. Both moist cover and lubricating eye drops / ointment were used to prevent dryness in the eyes. For instance, polyethylene moisture covers could effectively prevent corneal abrasion, and lubricating eye drops / ointment were beneficial to eye observation, so these two methods needed to be properly selected in combination with patient’s conditions. Nurses had to assess the ability of the patient to close eyelids daily and helped the patient to close eyes, but the passive eyelids closure was inferior to the artificial tear ointment in the effect on preventing corneal abrasions; the integrated intervention of maintaining eyelids closure and forming eyeballs moisture chamber was more effective to prevent eye complications. According to the available evidence mentioned herein and the patient’s conditions, the following nursing scheme of eye care was formulated: cleaning the eyelids and peripheral skin using 0.9% saline gauze, covering the eyes with sterile polyethylene films which were fixed by anti-allergic adhesive tapes, changing the dressing every 12 hours, and observing closure of the eyelids every day. Seven days later, eye symptoms got obviously improved, with decreasing secretion, without congestion and chemosis, and negative results of fluorescein staining test.
Conclusion 　Eye cleaning removes secretion and bacteria from the eyes. Polyethylene film prevents tear from evaporation and fully promotes the immune function of tears which can reduce the risk of infection. Eyelids closure and local moisture environment benefit the corneal epithelial repair.

Citation： WU Lingling,WANG Jiping. Evidence-Based Nursing for an Unconscious Patient Undergoing Mechanical Ventilation with Eye Complication. Chinese Journal of Evidence-Based Medicine, 2012, 12(10): 1270-1274. doi: 10.7507/1672-2531.20120197 Copy

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9.	Cortese D, Capp L, Mckinley S. Moisture chamber versus lubrication for the prevention of corneal epithelial breakdown. Am J Crit Care, 1995, 4(6): 425-428.
10.	Lenart SB, Garrity JA. Eye care for patients receiving neuromuscular blocking agents or propofol during mechanical ventilation. Am J Crit Care, 2000, 9(3): 188-191.
11.	Koroloff N, Boots R, Lipman J, et al. 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, 2004, 30(6): 1122-1126.
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14.	Ezra DG, Chan MP, Solebo L, et al. Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill. Intensive Care Med, 2009, 35(3): 455-461.
15.	Kocacal GE, Eser I, Egrilmez S. Effectiveness of polyethylene covers versus carbomer drops (Viscotears) to prevent dry eye syndrome in the critically ill. J Clin Nurs, 2011, 20(13-14): 1916-1922.
16.	Shan H, Sun YZ. Comparison of three types of eye care for preventing exposure keratopathy in the Intensive Care Unit. International Journal of Ophthalmology, 2011, 11(5): 757-759.
17.	李连娣. 自制眼睛保护罩在神经外科昏迷病人中的应用. 现代护理, 2005, 11(18): 1564.
18.	Higgins JP, Green S. Cochrance Handbook for Systematic Reviews of Interventions 4.2.6. 2006: The Cochrane Collaboration.
19.	Trees GR, Tomlinson A. Effect of artificial tear solutions and saline on tear film evaporation. Optom Vis Sci, 1990, 67(12): 886-890.

1. Rosenberg JB, Eisen LA. Eye care in the intensive care unit: narrative review and meta-analysis. Crit Care Med, 2008, 36(12): 3151-3155.
2. Joyce N. Eye care for the Intensive Care Patient: A systematical review. Australia: The Joanna Briggs Institute for Evidence Based Nursing and Midwifery, 2002, 12.
3. Cunningham C, Gould D. Eyecare for the sedated patient undergoing mechanical ventilation: the use of evidence-based care. Int J Nurs Stud, 1998, 35(1-2): 32-40.
4. Jbiebnm. Eye care for intensive care patients. JBI Best Practice, 2002, 32(5): 1-6.
5. Haynes RB. Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based health care decisions. ACP J Club, 2006, 145(3): A8.
6. Dawson D. Development of a new eye care guideline for critically ill patients. Intensive Crit Care Nurs, 2005, 21(2): 119-122.
7. Marshall AP, Elliott R, Rolls K, et al. Eyecare in the critically ill: clinical practice guideline. Aust Crit Care, 2008, 21(2): 97-109.
8. Douglas L, Berry S. Developing clinical guidelines in eye care for intensive care units. Nurs Child Young People, 2011, 23(5): 14-20.
9. Cortese D, Capp L, Mckinley S. Moisture chamber versus lubrication for the prevention of corneal epithelial breakdown. Am J Crit Care, 1995, 4(6): 425-428.
10. Lenart SB, Garrity JA. Eye care for patients receiving neuromuscular blocking agents or propofol during mechanical ventilation. Am J Crit Care, 2000, 9(3): 188-191.
11. Koroloff N, Boots R, Lipman J, et al. 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, 2004, 30(6): 1122-1126.
12. So HM, Lee CC, Leung AK, et al. Comparing the effectiveness of polyethylene covers (Gladwrap) with lanolin (Duratears) eye ointment to prevent corneal abrasions in critically ill patients: a randomized controlled study. Int J Nurs Stud, 2008, 45(11): 1565-1571.
13. Sorce L R, Hamilton S M, Gauvreau K, et al. Preventing corneal abrasions in critically ill children receiving neuromuscular blockade: a randomized, controlled trial. Pediatr Crit Care Med, 2009, 10(2): 171-175.
14. Ezra DG, Chan MP, Solebo L, et al. Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill. Intensive Care Med, 2009, 35(3): 455-461.
15. Kocacal GE, Eser I, Egrilmez S. Effectiveness of polyethylene covers versus carbomer drops (Viscotears) to prevent dry eye syndrome in the critically ill. J Clin Nurs, 2011, 20(13-14): 1916-1922.
16. Shan H, Sun YZ. Comparison of three types of eye care for preventing exposure keratopathy in the Intensive Care Unit. International Journal of Ophthalmology, 2011, 11(5): 757-759.
17. 李连娣. 自制眼睛保护罩在神经外科昏迷病人中的应用. 现代护理, 2005, 11(18): 1564.
18. Higgins JP, Green S. Cochrance Handbook for Systematic Reviews of Interventions 4.2.6. 2006: The Cochrane Collaboration.
19. Trees GR, Tomlinson A. Effect of artificial tear solutions and saline on tear film evaporation. Optom Vis Sci, 1990, 67(12): 886-890.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Nursing for an Unconscious Patient Undergoing Mechanical Ventilation with Eye Complication

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