Study On Influencing Factors And Intervention Of Exposure Keratitis In ICU Patients

Objective1.To systematically evaluate the prevalence,incidence and influencing factors of exposure keratitis(EK)in intensive care unit(ICU)patients.This analysis will provide a basis for the preliminary formulation of an influencing factors questionnaire in the next research phase.2.Using on-site investigations,evaluate the status of EK in ICU patients in the healthcare setting of the intervention subjects,and analyze the main factors affecting the occurrence of EK in patients.This will provide a theoretical basis for the next step of the intervention.3.Construct and apply the ICU eye care protocol(including eyelid massage combined with vitamin A palmitate eye gel),evaluate the effect of this protocol on EK prevention in ICU patients,and provide a reference for the clinical development of safe and effective eye care protocols for the prevention of EK.Methods1.Meta-analysis of the prevalence and influencing factors of exposure keratitis in ICU patientsNine Chinese and English databases,including Pub Med,EMBASE,the Cochrane Library,CINAHL,Web of Science,the Chinese Biomedical Literature Database(CBM),the Chinese Journal Full Text Database(CNKI),the VIP database,and the Wanfang database,were searched for literature on EK in ICU patients.The retrieval time frame was established from the inception of the databases until July 2021,and was updated in June2022.Two researchers independently screened the literature based on inclusion and exclusion criteria,extracted data,evaluated the quality of the literature,and conducted a comprehensive systematic evaluation of the prevalence,incidence,and influencing factors of EK in ICU patients using Stata 14.0 for Meta-analysis.2.Investigation on the factors influencing of exposure keratitis in ICU patients based on propensity score matchingUsing the convenience sampling method,patients in ICU of a tertiary care general hospital in Chongqing between December 2021 and February 2022 were selected as subjects for a prospective cohort study.Data regarding patients’ basic information and influencing factors were collected based on ICU Patient Exposure Keratitis Influencing Factors Questionnaire made by prior Meta-analysis and expert consultation,and the occurrence of EK was observed using a portable slit lamp equipped with cobalt blue light source after fluorescein staining.Frequency and percentage were used to describe the prevalence and severity of EK,and patients were divided into case and control groups based on the presence or absence of EK.After matching the two groups using 1:1 PSM,the factors influencing EK in ICU patients were analyzed by univariate and binary logistic regression.3.Intervention study on the effect of different eye care protocols on exposure keratitis in ICU patientsPatients with a Glasgow Coma Scale(GCS)score of ≤8 admitted to the Neurology ICU and Intensive Care Unit of a tertiary hospital in Chongqing from July 2022 to November 2022 as study subjects.A randomized controlled trial was conducted,and a random number table was generated using Excel software to randomize the grouping according to the order of enrollment,with the control group and experimental group 1 and 2.The control group received routine eye care,with interventions like eye cleaning and coverage of oily gauze or the use of ophthalmic preparations as instructed for patients with lagophthalmos.test group 1 used the ICU eye care guidelines developed by The Royal College of Ophthalmologists(RCO),which mainly included eye assessment,eye cleaning,the use of eyelid patches and/or topical application of vitamin A palmitate eye gel for patients with lagophthalmos.Test group 2 used the eye care protocol constructed in this study,which was designed with the guidance of the Developing and Evaluating Complex Intervention mainly including eye assessment,eye cleaning,and eyelid massage combined with the application of vitamin A palmitate eye gel for all patients.The intervention started from the time of enrollment until the study termination criteria were met,and corneal staining with fluorescein was used to observe the corneal condition of the subjects,comparing the effectiveness and safety of different eye care plans for EK in ICU patients.Results1.Meta-analysis of the prevalence and influencing factors of exposure keratitis in ICU patientsTwenty-three studies from 11 countries,involving 3519 participants,were ultimately included.The results of the meta-analysis indicated that the prevalence and incidence of EK in ICU patients were 34.1% and 22.0%,respectively.A quantitative analysis of 10 potential influencing factors revealed that EK in ICU patients was influenced by(1)ocular-related factors such as lagophthalmos(OR=9.62),chemosis(OR=3.89),and blinking less than 5times per minute(OR=14.43);(2)treatment-related factors such as mechanical ventilation(OR=25.85)and sedation(OR=11.36);and(3)disease-related factors such as low GCS score(OR=1.23)and high Acute Physiology and Chronic Health Evaluation(APACHE II)score(OR=1.09).2.Investigation on the factors influencing of exposure keratitis in ICU patients based on propensity score matchingA total of 489 ICU patients were included,of whom 212(43.4%)were diagnosed with EK and 277(56.6%)were non-EK patients.The severity of EK damage was mainly grade 1to 3.After PSM processing,402 ICU patients were successfully matched with a balanced baseline information level(P>0.05).Logistic regression analysis showed that lagophthalmos(OR=8.447),chemosis(OR=2.321),mechanical ventilation(OR=3.389),general anesthesia surgery(OR=2.069)and GCS score ≤8(OR=2.765)were influencing factors for EK in ICU patients.3.Intervention on the effect of different eye care protocols on exposure keratitis in ICU patients140 patients completed the intervention,with 47 in the control group,46 in test group1,and 47 in test group 2.The incidence of EK in the three groups was 22 cases(46.8%),6cases(13.0%),and 4 cases(8.5%),respectively.Comparison between the groups showed that the incidence of EK in test group 1 and test group 2 was lower than that in the control group(P<0.05),while the difference in the incidence of EK between test group 1 and test group 2 was not statistically significant(P>0.05).The severity of EK in the three study groups was mainly grade 1 to 2,and no grade 4 to 6 occurred.Conclusions1.The prevalence and incidence of EK in ICU patients are high,and EK occurrence is influenced by multiple factors.ICU healthcare professionals should prioritize early identification of high-risk individuals for EK and implement timely eye care protocol.2.Lagophthalmos,chemosis,use of mechanical ventilation,receipt of general anesthesia and GCS score≤8 being the main influencing factors.ICU healthcare professionals should promptly identify these factors and implement targeted eye care programs to prevent and reduce EK occurrence.3.Based on a complex intervention,the eye care protocol developed in this study(including eyelid massage combined with the application of vitamin A palmitate eye gel)and the RCO eye care guidelines were both effective in reducing EK occurrence in the ICU.The use of eyelid massage in this study can avoid damage to the patient’s periocular skin caused by repeated taping of the eyelid and facilitate daily observation of the patient’s eye and pupil by ICU healthcare professionals,and is recommended for clinical use.