Effect of Implementation of an Eyecare Bundle on Incidence of Exposure Keratopathy in Intensive Care Unit of Tertiary Care Center in North India

Sonu Sama; Ritika Abrol; Renu Dhasmana; Neha Sharma; Sushant Khandhuri; Rahul Chauhan; Prateek Dwivedi

doi:10.5005/jp-journals-10071-24470

Effect of Implementation of an Eyecare Bundle on Incidence of Exposure Keratopathy in Intensive Care Unit of Tertiary Care Center in North India

Indian J Crit Care Med. 2023 Jun;27(6):426-432. doi: 10.5005/jp-journals-10071-24470.

Authors

Sonu Sama¹, Ritika Abrol², Renu Dhasmana³, Neha Sharma⁴, Sushant Khandhuri⁴, Rahul Chauhan¹, Prateek Dwivedi¹

Affiliations

¹ Department of Critical Care Medicine, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
² Department of Internal Medicine, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
³ Department of Ophthalmology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
⁴ Department of Pulmonary Medicine, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.

Abstract

Background: Lack of eyecare protective measures especially in unconscious and sedated critically ill patients, make them prone to ocular surface diseases (OSDs), e.g., exposure keratopathy. This study is aimed to frame an algorithm-based approach to eyecare via eyecare bundle to bring down the burden of OSDs in critically ill patients especially in resource-limited settings.

Materials and methods: After clearance from institutional ethical committee, a quasi-experimental single center study was conducted over a period of 6 months. Incidence of exposure keratopathy was calculated before and after induction of eyecare bundle and was compared. Statistical analysis was done using SPSS software v20. p-value of less than 0.05 was considered significant.

Results: A total of 218 patients were enrolled in the study after obtaining informed written consent and after fulfilling inclusion criteria. Patients were divided into control and experimental groups, with baseline characteristics similar in both the groups, respectively, in terms of gender, age (40 years), APACHE II score, and specialty distribution except predominantly medical patients in experimental group. In control group (n = 99), total 69 patients (41 medical and 28 surgical) developed exposure keratopathy, while in experimental group (n = 109) only 15 patients (6 medical and 9 surgical) developed exposure keratopathy, hence a significant reduction was observed. Further follow-up of patients in the experimental group was also done on Days 5 and 7, respectively.

Conclusion: The proposed protocolized algorithm-based eyecare bundle significantly reduced the incidence of exposure keratopathy in sedated, mechanically ventilated, and vulnerable critically ill patients.

How to cite this article: Sama S, Abrol R, Dhasmana R, Sharma N, Khandhuri S, Chauhan R, et al. Effect of Implementation of an Eyecare Bundle on Incidence of Exposure Keratopathy in Intensive Care Unit of Tertiary Care Center in North India. Indian J Crit Care Med 2023;27(6):426-432.

Keywords: Exposure keratopathy; Eyecare bundle; Ocular surface diseases.