Exposure keratopathy in sedated and ventilated patients

• Published in: Journal of critical care 2012-12, Vol.27 (6), p.537-541
• Main Authors: Jammal, Hisham, FRCSEd, Khader, Yousef, PhD, Shihadeh, Wisam, MD, Ababneh, Laila, MBBS, AlJizawi, Ghazal, MBBS, AlQasem, Arqam, MBBS
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Anesthesia; Chemosis; Critical Care; Deep Sedation; Exposure; Female; Hospitals; Humans; Intensive care; Intensive Care Units; Jordan; Keratitis - etiology; Keratopathy; Lagophthalmos; Length of Stay; Male; Middle Aged; Patients; Prospective Studies; Respiration, Artificial - adverse effects; Risk Factors; Sedated; Sex Factors; Statistical analysis; Studies; Time Factors; Ventilation
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2012.02.005

Abstract Purpose The purpose of this study is to determine the frequency of exposure keratopathy in sedated/mechanically ventilated patients in the intensive care unit and its risk factors. Materials and Methods This is a prospective cohort study including all patients admitted to an adult intensive care unit department between March and October 2010 who were sedated and mechanically ventilated. Patients were examined by an ophthalmologist 1 to 5 days after commencing ventilation and subsequently every day. Examination included assessment of lid position, conjunctival edema (chemosis), and corneal changes. Results Of the 74 patients included in the study, 57% had exposure keratopathy. Fifty-four percent of patients developed chemosis, and 31% of patients developed lagophthalmos. Frequency of exposure keratopathy differed significantly according to degree of chemosis and lagophthalmos ( P < .0001); lagophthalmos was also significantly related to chemosis ( P < .0001). For lagophthalmos score of 3, the odds ratio of association with higher exposure keratopathy score was 136 (95% confidence interval [CI], 14.97-1242.6); for lagophthalmos score of 2, it was 14.4 (95% CI, 2.67-77.2). For any edema, the odds ratio of association with exposure keratopathy was 5.50 (95% CI, 2.02-15.00). Conclusion The frequency of exposure keratopathy in sedated/mechanically ventilated patients is high with lagophthalmos and chemosis as the main risk factors.