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


METHODS
Randomized controlled clinical trial.


METHODS
Three pediatric intensive care units at two free-standing, university-affiliated children's hospitals.


METHODS
Consecutive intubated, mechanically ventilated patients receiving NMB <36 hours, 2 weeks to 18 years of age.


METHODS
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.


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.
Sorce
Lauren R
LR
Children's Memorial Hospital, Chicago, IL, USA. LSorce@childrensmemorial.org
Hamilton
Susan M
SM
Gauvreau
Kimberlee
K
Mets
Marilyn B
MB
Hunter
David G
DG
Rahmani
Bahram
B
Wu
Carolyn
C
Curley
Martha A Q
MA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D065306:Corneal Injuries; D016638:Critical Illness; D005131:Eye Injuries / Q000517:prevention & control*; D005135:Eye Protective Devices; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D054327:Lubricants / Q000627:therapeutic use; D008297:Male; D019148:Neuromuscular Blockade / Q000009:adverse effects*
D054327:Lubricants