Tebyanian Mahsa, Darvishpoor Kakhki Ali, Feizi Sepehr
Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Aust Crit Care. 2024 Oct 9. doi: 10.1016/j.aucc.2024.09.005.
As the population ages, the number of older patient admitted to intensive care units (ICUs) will increase. This age group is at higher risk for developing eye problems because of higher prevalence of dry eye among older people. Inconsistency of early studies' results and less attention to eye care guidelines for older patients in the ICU pose severe consequences such as dry eye and corneal ulcer.
The objective of this study was to investigate the effectiveness of artificial tear gel, polyethylene cover, and conventional eye care methods for preventing dry eye and corneal ulcer in older patients admitted to an ICU.
In this three-arm randomised clinical trial, 99 older ICU patients with Glasgow Coma Scale scores measuring <7 were randomly assigned to one of three treatment groups: (i) participants who received artificial tear gel in one eye and polyethylene cover on the other; (ii) these interventions were applied in the opposite eyes; and (iii) participants who received conventional eye care including antiallergic adhesive to closed eyelids. Development of dry eye and corneal ulcer was assessed based on Schirmer's and the fluorescein tests for 5 days. Repeated measures analysis of variance was used to detect differences between groups.
The mean age of the participants was 70.91 (±9.47). No statistically significant difference was observed between the groups regarding baseline demographic and disease characteristics. While there was a nonsignificant difference between artificial tear gel and polyethylene cover in reducing dry eye and corneal ulcer, each of these methods could reduce dry eye and corneal ulcer significantly (P < 0.001) compared with conventional eye care.
The results revealed that artificial tear gel eye care and polyethylene cover methods were more effective in prevention of dry eye and corneal ulcer than antiallergic adhesive eye care. Nurses can choose an appropriate care method based on clinical conditions, costs, and care burden in older ICU patients.
Iranian Clinical Trial Registry (IRCT20200711048079N1). The first recruitment was conducted in October 2021.
随着人口老龄化，入住重症监护病房（ICU）的老年患者数量将会增加。由于老年人干眼症患病率较高，这个年龄组发生眼部问题的风险更高。早期研究结果不一致，且对ICU老年患者的眼部护理指南关注较少，这会导致诸如干眼症和角膜溃疡等严重后果。
本研究的目的是调查人工泪液凝胶、聚乙烯眼罩和传统眼部护理方法在预防入住ICU的老年患者发生干眼症和角膜溃疡方面的有效性。
在这项三臂随机临床试验中，99名格拉斯哥昏迷量表评分小于7分的老年ICU患者被随机分配到三个治疗组之一：（i）一只眼睛接受人工泪液凝胶，另一只眼睛使用聚乙烯眼罩的参与者；（ii）这些干预措施应用于对侧眼睛；（iii）接受包括在闭合眼睑上使用抗过敏粘合剂在内的传统眼部护理的参与者。基于泪液分泌试验和荧光素试验评估5天内干眼症和角膜溃疡的发生情况。采用重复测量方差分析来检测组间差异。
参与者的平均年龄为70.91（±9.47）。在基线人口统计学和疾病特征方面，各组之间未观察到统计学上的显著差异。虽然人工泪液凝胶和聚乙烯眼罩在减少干眼症和角膜溃疡方面没有显著差异，但与传统眼部护理相比，这两种方法中的每一种都能显著减少干眼症和角膜溃疡（P < 0.001）。
结果显示，与抗过敏粘合剂眼部护理相比，人工泪液凝胶眼部护理和聚乙烯眼罩方法在预防干眼症和角膜溃疡方面更有效。护士可以根据老年ICU患者的临床情况、成本和护理负担选择合适的护理方法。
伊朗临床试验注册中心（IRCT20200711048079N1）。首次招募于2021年10月进行。
