DOI QR코드

DOI QR Code

중환자실 입원환자의 눈 간호 프로토콜 적용 효과: 무작위 대조군 전후 실험연구

Effectiveness of the Eye Care Protocol in the Intensive Care Unit Patients: A Randomized Controlled Trial

  • Lim, Kyu Won (Emergency Intensive Care Unit, Pusan National University Hospital) ;
  • Ha, Shin Young (College of Nursing, Pusan National University) ;
  • Kang, In Soon (College of Nursing, Pusan National University)
  • 투고 : 2024.02.16
  • 심사 : 2024.06.11
  • 발행 : 2024.08.31

초록

Purpose: This study investigated the effects of an eye care protocol (ECP) on patients in the intensive care unit (ICU). Methods: This study utilized a randomized controlled design. Participants were patients who met the inclusion criteria and were admitted to the ICU (36 in the experimental group and 38 in the control group). The experimental group received an ECP, while the control group received standard eye care, starting the day after admission, for a duration of 10 days. The ECP classifies the degree of eyelid obstruction into three stages based on the degree of exposure to the lower eyelid conjunctiva and cornea. The protocol included cleansing with normal saline gauze, administering eye drops, applying silicone and polyurethane films, and recommending consultation with an ophthalmologist if necessary. The effectiveness of ECP was assessed by analyzing tear volume, hyperemia, chemosis, and eye discharge. Data analysis was conducted using SPSS 27.0, employing the Mann-Whitney U-test and generalized estimating equations. Results: On day 5, the experimental group demonstrated a significant increase in tear volume in both eyes compared with the control group. However, no statistically significant differences were observed in the incidence of hyperemia, chemosis, and eye discharge on days 5 and 10 of the intervention. Conclusion: The application of the ECP in this study increased tear volume in ICU patients, thereby reducing discomfort caused by dry eyes. It has the potential to prevent complications such as damage to the surface of the eyeball resulting from decreased tear volume.

키워드

참고문헌

  1. Pourghaffari Lahiji A, Gohari M, Mirzaei S, Nasiriani K. The effect of implementation of evidence-based eye care protocol for patients in the intensive care units on superficial eye disorders. BMC Ophthalmology. 2021;21(1):275.  https://doi.org/10.1186/s12886-021-02034-x
  2. Grixti A, Sadri M, Edgar J, Datta AV. Common ocular surface disorders in patients in intensive care units. The Ocular Surface. 2012;10(1):26-42.  https://doi.org/10.1016/j.jtos.2011.10.001
  3. McHugh J, Alexander P, Kalhoro A, Ionides A. Screening for ocular surface disease in the intensive care unit. Eye. 2008; 22(12):1465-1468. https://doi.org/10.1038/sj.eye.6702930
  4. Song KY, Chung SK, Yang JH, Choi DW, Kim YH, Kim SS, et al. Fundamentals of nursing. Rev. ed. Soomoonsa; 2021. p. 487.
  5. Hearne BJ, Hearne EG, Montgomery H, Lightman SL. Eye care in the intensive care unit. Journal of the Intensive Care Society. 2018;19(4):345-350.  https://doi.org/10.1177/1751143718764529
  6. Kuruvilla S, Peter J, David S, Premkumar PS, Ramakrishna K, Thomas L, et al. Incidence and risk factor evaluation of exposure keratopathy in critically ill patients: A cohort study. Journal of Critical Care. 2015;30(2):400-404.  https://doi.org/10.1016/j.jcrc.2014.10.009
  7. Alansari MA, Hijazi MH, Maghrabi KA. Making a difference in eye care of the critically ill patients. Journal of Intensive Care Medicine. 2015;30(6):311-317.  https://doi.org/10.1177/0885066613510674
  8. Fernandes APNL, Araujo JNM, Botarelli FR, Pitombeira DO, Ferreira Junior MA, Vitor AF. Dry eye syndrome in intensive care units: A concept analysis. Revista Brasileira de Enfermagem. 2018;71(3):1162-1169.  https://doi.org/10.1590/0034-7167-2016-0582
  9. Herdman TH, Kamitsuru S. Nursing diagnoses: Definitions and classification 2018-2020. 11th ed. Thieme Medical Publishers; 2018. p. 392.
  10. Werli-Alvarenga A, Ercole FF, Herdman TH, Chianca TC. Nursing interventions for adult intensive care patients with risk for corneal injury: A systematic review. International Journal of Nursing Knowledge. 2013;24(1):25-29.  https://doi.org/10.1111/j.2047-3095.2012.01218.x
  11. Soares RPDS, Fernandes APNL, Botarelli FR, Araujo JNM, Olimpio JA, Vitor AF. Clinical indicators of dry eye severity nursing outcome in intensive care unit. Revista Latino-Americana de Enfermagem. 2019;27:e3201.  https://doi.org/10.1590/1518-8345.2983.3201
  12. Araujo JNM, Botarelli FR, Fernandes APNL, Oliveira-Kumakura ARS, Ferreira Junior MA, Vitor AF. Predictive clinical factors for ocular dryness in patients admitted to the Intensive Care Unit. Revista da Escola de Enfermagem da USP. 2019;53:e03493.  https://doi.org/10.1590/S1980-220X2018036603493
  13. Oncul H, Yektas A. Eye problems, eye care and ocular awareness in stage 3 intensive care unit. Turkish Journal of Intensive Care. 2020;18(2):70-77.  https://doi.org/10.4274/tybd.galenos.2019.13471
  14. Fashafsheh IHD, Morsy WYM, Ismaeel MS, Alkaiasi AAE. Impact of a designed eye care protocol on nurses knowledge, practices and on eye health status of unconscious mechanically ventilated patients at North Palestine hospitals. Journal of Education and Practice. 2013;4(28):107-120.
  15. Kousha O, Kousha Z, Paddle J. Exposure keratopathy: Incidence, risk factors and impact of protocolised care on exposure keratopathy in critically ill adults. Journal of Critical Care. 2018;44:413-418.  https://doi.org/10.1016/j.jcrc.2017.11.031
  16. Demirel S, Cumurcu T, Firat P, Aydogan MS, Doganay S. Effective management of exposure keratopathy developed in intensive care units: The impact of an evidence based eye care education programme. Intensive and Critical Care Nursing. 2014;30(1):38-44.  https://doi.org/10.1016/j.iccn.2013.08.001
  17. Mobarez F, Sayadi N, Jahani S, Sharhani A, Savaie M, Farrahi F. The effect of eye care protocol on the prevention of ocular surface disorders in patients admitted to intensive care unit. Journal of Medicine and Life. 2022;15(8):1000-1004.  https://doi.org/10.25122/jml-2022-0139
  18. de Franca CF, Fernandes AP, Carvalho DP, de Mesquita Xavier SS, Junior MA, Botarelli FR, et al. Evidence of interventions for the risk of dry eye in critically ill patients: An integrative review. Applied Nursing Research. 2016;29:e14-e17. https://doi.org/10.1016/j.apnr.2015.05.016
  19. Rosenberg JB, Eisen LA. Eye care in the intensive care unit: Narrative review and meta-analysis. Critical Care Medicine. 2008;36(12):3151-3155.  https://doi.org/10.1097/CCM.0b013e31818f0ee7
  20. Ahmadinejad M, Karbasi E, Jahani Y, Ahmadipour M, Soltaninejad M, Karzari Z. Efficacy of simple eye ointment, polyethylene cover, and eyelid taping in prevention of ocular surface disorders in critically ill patients: A randomized clinical trial. Critical Care Research and Practice. 2020:6267432. https://doi.org/10.1155/2020/6267432
  21. Davoodabady Z, Rezaei K, Rezaei R. The impact of normal saline on the incidence of exposure keratopathy in patients hospitalized in intensive care units. Iranian Journal of Nursing and Midwifery Research. 2018;23(1):57-60.  https://doi.org/10.4103/ijnmr.IJNMR_187_16
  22. Kalhori RP, Ehsani S, Daneshgar F, Ashtarian H, Rezaei M. Different nursing care methods for prevention of keratopathy among intensive care unit patients. Global Journal of Health Science. 2015;8(7):212-217.  https://doi.org/10.5539/gjhs.v8n7p212
  23. Kocacal E, Eser I, Egrilmez S. Effect of polyethylene cover on the treatment of exposure keratopathy in ICU. Nursing in Critical Care. 2021;26(4):282-287.  https://doi.org/10.1111/nicc.12542
  24. Nikseresht T, Rezaei M, Khatony A. The effect of three eye care methods on the severity of lagophthalmos in intensive care patients: A randomized controlled clinical trial. Journal of Ophthalmology. 2021:6348987.  https://doi.org/10.1155/2021/6348987
  25. Oh EG, Chu SH, Ko IS, Lee WH, Yoo JS, Kim SS, et al. Knowledge, perception & practice of eye care nursing among nurses in intensive care units. Journal of Korean Academy of Fundamentals of Nursing. 2007;14(4):437-445.
  26. Yoo JS, Lee WH, Kim SS, Ko IS, Oh EG, Chu SH, et al. Development of an eye care protocol for ICU patients. Journal of Korean Academy of Fundamentals of Nursing. 2008;15(1): 34-44.
  27. Suresh P, Mercieca F, Morton A, Tullo AB. Eye care for the critically ill. Intensive Care Medicine. 2000;26(2):162-166. https://doi.org/10.1007/s001340050040
  28. Kojima T, Matsumoto Y, Ibrahim OM, Wakamatsu TH, Uchino M, Fukagawa K, et al. Effect of controlled adverse chamber environment exposure on tear functions in silicon hydrogel and hydrogel soft contact lens wearers. Investigative Ophthalmology & Visual Science. 2011;52(12):8811-8817. https://doi.org/10.1167/iovs.10-6841
  29. Dogru M, Ishida K, Matsumoto Y, Goto E, Ishioka M, Kojima T, et al. Strip meniscometry: A new and simple method of tear meniscus evaluation. Investigative Ophthalmology & Visual Science. 2006;47(5):1895-1901.  https://doi.org/10.1167/iovs.05-0802
  30. Jarvis C. Physical examination & health assessment. 8th ed. Hakjisa Medical; 2020. p. 197.
  31. Stevens S. Cleaning and dressing the eye after surgery. Community Eye Health. 2016;29(94):36.
  32. Gudgel DT. How to put in eye drops [Internet]. American Academy of Ophthalmology; c2023 [cited 2024 Jan 17]. Available from: https://www.aao.org/eye-health/treatments/ how-to-put-in-eye-drops.
  33. Horng CT, Chou HL, Tsai KL, Hsiao HY, Lin SY, Huang SF, et al. The observation for ocular surface diseases in respiratory care center in one regional teaching hospital in Southern Taiwan. Life Science Journal. 2014;11(6):672-679.  https://doi.org/10.7537/marslsj110614.102
  34. Werli-Alvarenga A, Ercole FF, Botoni FA, Oliveira JA, Chianca TC. Corneal injuries: Incidence and risk factors in the intensive care unit. Revista Latino-Americana de Enfermagem. 2011;19(5):1088-1095.  https://doi.org/10.1590/s0104-11692011000500005
  35. Masoudi Alavi N, Sharifitabar Z, Shaeri M, Adib Hajbaghery M. An audit of eye dryness and corneal abrasion in ICU patients in Iran. Nursing in Critical Care. 2014;19(2):73-77.  https://doi.org/10.1111/nicc.12052
  36. Kim EC. Diagnosis and treatment of dry eye syndrome. Journal of the Korean Medical Association. 2018;61(6):352-364. https://doi.org/10.5124/jkma.2018.61.6.352
  37. The definition and classification of dry eye disease: Report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). The Ocular Surface. 2007;5(2):75-92.  https://doi.org/10.1016/s1542-0124(12)70081-2
  38. Pine KR, Sloan B, Stewart J, Jacobs RJ. The response of the anophthalmic socket to prosthetic eye wear. Clinical and Experimental Optometry. 2013;96(4):388-393.  https://doi.org/10.1111/cxo.12004
  39. Singh RB, Liu L, Anchouche S, Yung A, Mittal SK, Blanco T, et al. Ocular redness - I: Etiology, pathogenesis, and assessment of conjunctival hyperemia. The Ocular Surface. 2021; 21:134-144. https://doi.org/10.1016/j.jtos.2021.05.003
  40. Sivasankar S, Jasper S, Simon S, Jacob P, John G, Raju R. Eye care in ICU. Indian Journal of Critical Care Medicine. 2006;10(1):11-14.  https://doi.org/10.4103/0972-5229.24683
  41. Narmawala W, Jani HC. Exposure keratopathy: Prophylaxis and impact of eye care education programme in ICU patients. Journal of Clinical and Diagnostic Research. 2017;11(10):NC06-NC09.  https://doi.org/10.7860/JCDR/2017/25906.10717
  42. Huh Y, Yoo J. Fluid management of trauma patients. Journal of the Korean Fracture Society. 2023;36(2):69-76.  https://doi.org/10.12671/jkfs.2023.36.2.69
  43. Sethuraman U, Kamat D. The red eye: Evaluation and management. Clinical Pediatrics. 2009;48(6):588-600.  https://doi.org/10.1177/0009922809333094
  44. Oh EG, Lee WH, Yoo JS, Kim SS, Ko IS, Chu SH, et al. Factors related to incidence of eye disorders in Korean patients at intensive care units. Journal of Clinical Nursing. 2009;18(1):29-35.  https://doi.org/10.1111/j.1365-2702.2008.02388.x