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Published on: July 10, 2018
Preventing corneal abrasions in critically ill children receiving neuromuscular blockade: a randomized, controlled
Lauren R Sorce1, Susan M Hamilton, Kimberlee Gauvreau
1Children's Memorial Hospital, Chicago, IL, USA. LSorce@childrensmemorial.org
Insights
Corneal abrasions are a significant risk for critically ill children on neuromuscular blockade (NMB). Moisture chambers did not prevent these eye injuries more effectively than standard lubrication and eye closure.
Area of Science:
- Critical care medicine
- Ophthalmology
- Pediatrics
Background:
- Critically ill children requiring neuromuscular blockade (NMB) are at risk for corneal abrasions.
- Standard care involves lubrication and eye closure, but its efficacy in preventing abrasions is unclear.
Purpose of the Study:
- To determine the incidence of corneal abrasions in critically ill children receiving NMB.
- To compare the effectiveness of moisture chambers versus standard therapy in preventing corneal abrasions.
Main Methods:
- Randomized controlled clinical trial conducted in three pediatric intensive care units.
- Inclusion of intubated, mechanically ventilated patients aged 2 weeks to 18 years receiving NMB for less than 36 hours.
- Randomization to either standard care (lubrication and eye closure) or treatment (lubrication, eye closure, and moisture chamber), with daily eye examinations.
Main Results:
- 207 patients were randomized; 21 (10%) developed corneal abrasions.
- The incidence of corneal abrasions was not significantly different between the control and treatment groups (p = 0.58).
- Eight abrasions occurred in control eyes, five in treatment eyes, and eight in both eyes.
Conclusions:
- Corneal abrasions are a non-trivial complication in critically ill children on NMB.
- Moisture chambers offer no additional benefit over standard lubrication and eye closure for preventing corneal abrasions in this population.
Objective:
To determine the incidence of corneal abrasions in critically ill children requiring neuromuscular blockade (NMB) and to determine whether a moisture chamber over the eye is more effective in preventing corneal abrasions compared with standard therapy.
Design:
Randomized controlled clinical trial.
Setting:
Three pediatric intensive care units at two free-standing, university-affiliated children's hospitals.
Patients:
Consecutive intubated, mechanically ventilated patients receiving NMB <36 hours, 2 weeks to 18 years of age.
Intervention:
After confirming the absence of a corneal abrasion, patients' eyes were randomized to either control (Q6H lubrication and eye closure) or treatment (Q6H lubrication, eyelid closure and moisture chamber). Eyes were examined daily for 3 days then every other day until NMB was discontinued, a corneal abrasion developed, or on study day 9. Data were analyzed on an intention-to-treat basis.
Measurements And Main Results:
Two hundred thirty-seven patients were enrolled. Thirty patients exited the study before randomization (17 upon confirmation of a corneal abrasion on initial examination [7%; 95% confidence interval 4%-11%]; 12 upon discontinuation of NMB; 1 patient death). The remaining 207 patients were randomized and evaluated twice (median; interquartile range [IQR] 1-4 observations). Twenty-one patients developed a corneal abrasion over the course of the study (10%; 95%confidence interval 6%-15%). Median time from enrollment to abrasion was 2 days (IQR 1-3 days). The incidence of corneal abrasion was not different between the patient's control and treatment eyes; specifically, eight corneal abrasions developed in the control eye, five corneal abrasions in the treatment eye, and eight corneal abrasions in both eyes (McNemar's test; p = 0.58).
Conclusions:
The occurrence of corneal abrasions in critically ill children receiving NMB is not trivial. The additional use of a moisture chamber over the eye was no more effective than Q6H lubrication and eye closure alone in preventing corneal abrasions in this at-risk patient group.
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