1Department of General Intensive Care, Rabin Medical Center, Campus Beilinson, Petah Tikva, Israel. 2Department of Opthalmology, Rabin Medical Center, Campus Beilinson, Petah Tikva, Israel. 3Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Crit Care Med. 2017 Nov;45(11):1880-1886. doi: 10.1097/CCM.0000000000002681.
To compare the effectiveness of bandage contact lenses and punctal plugs with ocular lubricants in preventing corneal damage in mechanically ventilated and sedated critically ill patients.
Single-center, prospective, randomized, pilot study.
Sixteen-bed, general ICU at a tertiary academic medical center.
Adults admitted to the ICU and anticipated to require mechanical ventilation and continuous sedation for greater than or equal to 4 days.
Patients were randomized to receive eye care with ocular lubricants (n = 38), bandage contact lenses (n = 33), or punctal plugs (n = 33). The bandage contact lenses were changed every 4 days, whereas the punctal plugs remained in situ for the entire study.
The primary endpoint was the presence or absence of corneal damage as assessed by the grade of keratopathy. Patients were examined by an ophthalmologist blinded to the study group every 4 days and at the time of withdrawal from the study, due to cessation of sedation, discharge from the ICU, or death. The mean duration of the study was 8.6 ± 6.2 days. The grade of keratopathy in the ocular lubricant group increased significantly in both eyes (p = 0.01 for both eyes) while no worsening was noted in either the lens or punctal plugs groups. In a post hoc analysis of patients with an initially abnormal ophthalmic examination, significant healing of keratopathy was noted in the lens group (p = 0.02 and 0.018 for left and right eyes, respectively) and in the right eye of the plugs group (p = 0.005); no improvement was noted in the ocular lubricant group.
Compared with ocular lubrication, bandage contact lenses and punctal plugs were more effective in limiting keratopathy, and their use, particularly of bandage contact lenses, was associated with significant healing of existing lesions.
比较绷带接触镜和泪点塞与眼用润滑剂在预防机械通气和镇静的危重症患者角膜损伤中的效果。
单中心、前瞻性、随机、初步研究。
三级学术医疗中心的 16 床综合 ICU。
入住 ICU 且预计需要机械通气和持续镇静 4 天以上的成人。
患者被随机分配接受眼用润滑剂（n = 38）、绷带接触镜（n = 33）或泪点塞（n = 33）的眼部护理。绷带接触镜每 4 天更换一次，而泪点塞在整个研究期间保持原位。
主要终点是通过角膜病变程度评估的角膜损伤的存在或不存在。研究人员每隔 4 天对眼科医生进行一次检查，并且在因镇静停止、从 ICU 出院或死亡而退出研究时进行检查。研究的平均持续时间为 8.6±6.2 天。在眼用润滑剂组中，双眼的角膜病变程度显著增加（p = 0.01，双眼），而在镜片或泪点塞组中均未发现恶化。在对初始眼科检查异常的患者进行的事后分析中，在镜片组中角膜病变显著愈合（左眼和右眼分别为 p = 0.02 和 0.018），在塞组的右眼也显著愈合（p = 0.005）；眼用润滑剂组未见改善。
与眼用润滑剂相比，绷带接触镜和泪点塞在限制角膜病变方面更有效，并且它们的使用，特别是绷带接触镜的使用，与现有病变的显著愈合有关。
