Efeito das intervenções de enfermagem na prevenção de lesão na córnea: ensaio clínico randomizado

Abstract

Critically ill patients are at greater risk for injury to the cornea, since the mechanisms responsible for lubrication and eye protection may be compromised. However, the literature differs on the best clinical practice for prevention and treatment. Objective: To evaluate the effect of nursing interventions: eye care, eye gel, eye drops and polyethylene film for the prevention of corneal injury in critically ill patients. Patients and methods: it included clinical and surgical patients admitted to the ICU of a teaching hospital, to present one of the following criteria: sedated patients (Ramsay scale value of 5 or 6); comatose patients (lower Glasgow Coma Scale or equal to 7); patients on mechanical ventilation; patients using facial mask with oxygen supply greater than 6 liters / minute; reflex blink less than five times per minute; exposure of the eye (conjunctiva and / or cornea). These individuals were randomly allocated to one of the following care: eye care, eye gel, eye drops or polyethylene film. Patients were followed until discharge from the ICU and the outcome (corneal injury) was evaluated daily by visual examination with fluorescein and ophthalmoscope with cobalt blue light. Assessing the effectiveness of eye care was measured by comparing every care to eye care as well as all intervention groups with each other, through the value of the incidence of corneal injury found in each group (primary endpoint). Secondary outcomes were described in relation to demographic and clinical characteristics and eye. Model adjusted to the risk factors for corneal injury was built. Results: 360 patients were included in the study, 90 in each group. The incidence of corneal injury was higher in the control group (p <0.001) when compared to other intervention groups. Comparing the eye gel and eye drops (p = 0.035) and polyethylene eyedrop group (p = 0.018), statistically significant differences were observed. In comparison with the polyethylene group ocular gel (p <0.001), it is concluded that the polyethylene is more effective for the prevention of corneal injury to the eye gel. The model fit the characteristics that affected joint and significantly the occurrence of corneal injury were: type of intervention, sex, bacterial eye disorder and length of stay in the ICU. Conclusions: it was concluded that all treatments impact the results in the control group, reducing the risk for corneal injury and the intervention with the polyethylene film is the most efficient in relation to that implemented in the control group, reducing the risk of occurrence of injury by 98%, but drops intervention was statistically comparable to polyethylene, should be the option of choice for patients who do not tolerate the film. The tested interventions will be proposed to the NIC taxonomy.