Eyecare in the critically ill : clinical practice guideline

Objective: The Intensive Care Collaborative project was established with the specific aim of developing recommendations for clinical practice that are underpinned by the best available evidence to support the objective of improving the standard of care delivered in NSW Intensive Care Units. The eyecare clinical practice guideline for intensive care patients were developed as a result of this initiative. Methods: Search: The bibliographic databases (PubMed; The Cummulative Index of Nursing and Allied Health Literature (CINAHL); Medline and The Cochrane Library) were searched. The search terms used alone and in combination were: intensive care; prevention; eye; eyecare; and guidelines. In addition, reference lists of relevant papers were assessed to identify additional studies and Google Scholar was searched using the keywords eyecare and intensive care. The search strategy was limited to the English language but was not limited by year of publication. Study selection criteria: All relevant observational and interventional studies were included, regardless of study design. Review process: Each paper was reviewed by at least two Guideline Development Network (GDN) members independently using a data extraction tool. Papers were assessed against the National Health and Medical Research Council (NHMRC) levels of evidence. Recommendations were assigned using a modified Delphi process to ensure consensus. Summary of recommendations: We recommend that each patient is assessed for the risk factors of iatrogenic ophthalmologic complications; the ability to maintain eyelid closure; for iatrogenic ophthalmologic complications. It is also recommended that; the rates of iatrogenic ophthalmologic complications are monitored; referral is made in a timely manner for any suspected iatrogenic ophthalmologic complications; eyelid closure is maintained if eyelid closure cannot be maintained passively; all patients who cannot achieve eyelid closure independently should receive eye care every 2 h. Conclusions: The recommendations from this clinical practice guideline were peerreviewed and examined by ophthalmology experts. Despite the heavy reliance on only a small number of studies and low level of evidence, the recommendations have the potential to positively affect patient outcomes by encouraging clinicians to assess and monitor for ophthalmological complications and to provide appropriate preventative interventions if implemented extensively