Impact of nursing interventions on the prevention of ocular surface disorders in critical care patients: A systematic review

• Published in: Nursing in critical care Vol. 29; no. 6; pp. 1758 - 1767
• Main Authors: Arevalo‐Buitrago, Pedro, Collado, María José Bermejo, Martínez, Ángel Gutiérrez, Villarejo, Raquel Cordón, Recio, Mª. Esther Rincón, Díaz, Encarnación Quero, López, Francisco Javier Dorante, Gomáriz, Antonio Alexis Mena, García, Gumersindo Emilio Calvo, Montoro, Francisco José Cabello, López‐Soto, Pablo Jesús
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-11-2024; Wiley Subscription Services, Inc
• Subjects: Critical Care; Critical Care Nursing; Eye Diseases - nursing; Eye Diseases - prevention & control; Humans; Intensive care; Intensive Care Units; Lubricants & lubrication; Nursing; nursing care; ocular surface disorder; Risk Factors; Systematic review; critical care; nursing care; ocular surface disorder
• ISSN: 1362-1017; 1478-5153; 1478-5153
• DOI: 10.1111/nicc.13141

Background
Intensive care unit (ICU) patients are at an increased risk of ocular surface injuries because of various factors such as reduced tear production and impaired protective mechanisms. Despite the significance of ocular care in ICU settings, there is a lack of consensus on effective interventions, leading to inadequate prevention of ocular surface disease (OSD).
Aim
This systematic review aimed to assess the effectiveness of nursing eye care in preventing OSD in ICU patients. Secondary objectives included identifying primary risk factors for ocular injuries and examining the most effective preventive methods.
Study Design
A systematic review following PRISMA guidelines was conducted, encompassing a literature search, article selection, quality assessment and data synthesis. Studies meeting inclusion criteria were observational studies and clinical trials, focusing on adults admitted to ICUs under sedation and receiving mechanical ventilation.
Results
Of 3545 initially identified articles, 12 studies met inclusion criteria. These studies involved a total of 1853 participants. Various interventions were assessed, including saline rinsing, lubricating drops, gel lubricants, occlusion with polyethylene dressing, passive blinking and eyelid closure with tape. Moist chamber occlusion every 6 h combined with gel lubrication emerged as the most effective method in preventing OSD.
Conclusions
Gel lubrication along with moist chamber occlusion proved to be the most effective strategy in preventing ocular injuries in ICU patients. Conversely, the routine use of physiological saline was associated with increased severity of corneal lesions. Properly defined protocols and well‐trained nursing teams are crucial for reducing ocular injuries in ICU settings.
Relevance to Clinical Practice
The findings underscore the importance of implementing evidence‐based eye care protocols in ICUs, emphasizing the use of gel lubrication and ocular surface protection to mitigate the risk of OSD. This highlights the need for comprehensive training programmes for ICU nursing staff to ensure optimal ocular care delivery.