Preventing corneal abrasions in critically ill children receiving neuromuscular blockade: A randomized, controlled trial

Lauren R. Sorce, Susan M. Hamilton, Kimberlee Gauvreau, Marilyn B. Mets, David G. Hunter, Bahram Rahmani, Carolyn Wu, Martha A.Q. Curley

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)171-175+279+280+281
JournalPediatric Critical Care Medicine
Volume10
Issue number2
DOIs
StatePublished - Mar 1 2009

Keywords

  • Adolescent
  • Child
  • Cornea
  • Infant
  • Lubrication
  • Neuromuscular blockade
  • Ophthalmic solution
  • Pediatric critical care
  • Prospective study

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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