Prediction of risk and incidence of dry eye in critical patients

Araújo, Diego Dias de; Almeida, Natália Gherardi; Silva, Priscila Marinho Aleixo; Ribeiro, Nayara Souza; Werli-Alvarenga, Andreza; Chianca, Tânia Couto Machado

doi:10.1590/1518-8345.0897.2689

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Revista Latino-Americana de Enfermagem

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Original Articles • Rev. Latino-Am. Enfermagem 24 • 2016 • https://doi.org/10.1590/1518-8345.0897.2689 copy

Prediction of risk and incidence of dry eye in critical patients¹ 1 Paper extracted from Master's Thesis "Prediction of risk and incidence of dry eye in critically ill patients" presented to Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), process # 479539/2012-0.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives:

to estimate the incidence of dry eye, to identify risk factors and to establish a risk prediction model for its development in adult patients admitted to the intensive care unit of a public hospital.

Method:

concurrent cohort, conducted between March and June, 2014, with 230 patients admitted to an intensive care unit. Data were analyzed by bivariate descriptive statistics, with multivariate survival analysis and Cox regression.

Results:

53% out of 230 patients have developed dry eye, with onset mean time of 3.5 days. Independent variables that significantly and concurrently impacted the time for dry eye to occur were: O2 in room air, blinking more than five times per minute (lower risk factors) and presence of vascular disease (higher risk factor).

Conclusion:

dry eye is a common finding in patients admitted to adults intensive care units, and care for its prevention should be established.

Dry Eye Syndromes; Corneal Diseases; Intensive Care Units; Nursing; Nursing Diagnosis

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Diego Dias de Araújo Universidade Estadual de Montes Claros. Departamento de Enfermagem Campus Universitário Prof. Darcy Ribeiro Av. Ruy Braga, s/n Bairro: Vila Mauriceia , Prédio 6 (CCBS) CEP: 39401-089, Montes Claros, MG, Brasil E-mail: diego.dias1508@gmail.com

Variables	Group	Dry eye	Hazard Ratio (HR) (CI 95%)	p value
		Yes		No
		n	%		n	%
Sedation	No	51	41.8		96	88,9	2.10 (1.46 - 3.02)	< 0.001
Sedation	Yes	71	58.2		12	11.1
Intubation	No	27	22.1		93	86.1	2.10 (1.46 - 3.02)	< 0.001	3.16 (2.06 - 4.85)	< 0.001
Intubation	Yes	95	77.9		15	13.9			3.16 (2.06 - 4.85)	< 0.001
Mechanical Ventilation	No	24	19.7		92	85.2	3.40 (2.17 - 5.32)	< 0.001
Mechanical Ventilation	Yes	98	80.3		16	14.8
O2 on room air	No	116	95.1		50	46.3	3.40 (2.17 - 5.32)	< 0.001	0.12 (0.05 - 0.29)	< 0.001
O2 on room air	Yes	6	4.9		58	53.7			0.12 (0.05 - 0.29)	< 0.001
O2 by nasal catheter	No	103	84.4		46	42.6	0.27 (0.16 - 0.44)	< 0.001
O2 by nasal catheter	Yes	19	15.6		62	57.4
Oral diet allowed	No	62	50.8		37	34.3	0.27 (0.16 - 0.44)	< 0.001	0.43 (0.30 - 0.63)	< 0.001
Oral diet allowed	Yes	60	49.2		71	65.7			0.43 (0.30 - 0.63)	< 0.001
Feeding tube	Enteral feeding	45	75.0		11	15.5	3.01 (1.64 - 5.49)	< 0.001
Blinking	Up to five times per minute	101	82.8		11	10.2	0.16 (0.10 - 0.26)	< 0.001
Blinking	More than five times per minute	21	17.2		97	89.8
Eyeball exposure	No	62	50.8		104	96.3	0.16 (0.10 - 0.26)	< 0.001	2.43 (1.70 - 3.48)	< 0.001
Eyeball exposure	Yes	60	49.2		4	3.7			2.43 (1.70 - 3.48)	< 0.001
Oedema	No	12	9.8		40	37.0	2.39 (1.31 - 4.34)	0.004
Oedema	Yes	110	90.2		68	63.0
Oedema site	Chemosis - left eye	45	36.9		9	8.3	2.39 (1.31 - 4.34)	0.004	1.79 (1.24 - 2.59)	0.002
	Chemosis - right eye	45	36.9		9	8.3	1.79 (1.24 - 2.59)	0.002
	MMII	70	57.4		34	31.5	1.47 (1.03 - 2.11)	0.033
	Anasarca	9	7.4		1	0.9	3.05 (1.53 - 6.09)	0.001
Anticoagulants	Yes	82	67.2		84	77.8	0.64 (0.43 - 0.93)	0.022
Hypnotics/sedatives/anxiolytics	Yes	71	58.2		20	18.5	1.58 (1.10 - 2.27)	0.013
Antihypertensives	Yes	19	15.6		32	29.6	0.53 (0.32 - 0.87)	0.013
Analgesic	Yes	22	18.0		43	39.8	0.62 (0.39 - 0.99)	0.048
SOFA*†	Yes	6.8	3.7		4.0	3.5	1.10 (1.05 - 1.15)	< 0.001
APACHE II*‡	Yes	25.4	7.5		19.0	9.7	1.03 (1.01 - 1.04)	< 0.001
TISS 28*§	Yes	35.8	8.1		26.7	8.7	1.06 (1.03 - 1.08)	< 0.001
Postoperative time*	Yes	2.9	1.0		2.6	1.1	0.44 (0.31 - 0.63)	< 0.001
Hospitalization Time*	Yes	3.0	0.9		2.8	1.2	0.05 (0.02 - 0.13)	< 0.001
Glasgow Coma Scale*	Yes	8.9	4.2		14.2	1.3	0.84 (0.80 - 0.89)	< 0.001
Mechanical Ventilation Time*	Yes	3.2	1.2		2.1	1.0	0.64 (0.50 - 0.82)	< 0.001
O2 flow catheter*	Yes	2.3	1.4		1.6	0.7	1.41 (1.01 - 1.97)	0.039
Anticoagulants*	Yes	82	67.2		84	77.8	0.64 (0.43 - 0.93)	0.022
Hypnotics/sedatives/anxiolytics*	Yes	71	58.2		20	18.5	1.58 (1.10 - 2.27)	0.013
Antihypertensives*	Yes	19	15.6		32	29.6	0.53 (0.32 - 0.87)	0.013
Fluid balance/Daily developments (Positive)*	Yes	894.3	978.1		595.2	1022.0	1.00 (1.000003 - 1.0004)	0.046

Variables	p*	T^†	p value
O₂ per room air	-0.20126	3.69	0.0547
Blinking more than five times per minute	0.12170	1.89	0.1691
Vascular disease	0.02095	0.05	0.8185
GLOBAL	NA	5.52	0.1373