Efeito de intervenções de enfermagem na prevenção de olho seco em pacientes críticos: ensaio clínico randomizado

Abstract

Objective: To evaluate the effect of nursing interventions (artificial tear on gel and liquid artificial tear) in the prevention of dry eye in patients hospitalized in an adult General Intensive Care Unit of a philanthropic hospital in Brazil. Casuistry and Methods: We included clinical and surgical patients admitted to the General Intensive Care Unit of adults of a philanthropic hospital, who met the following criteria: being over 18 years old; dry eye at admission; being in mechanical ventilation therapy; blink of less than 5 per minute and Glasgow coma scale score less than or equal to 7. The final sample consisted of 140 individuals randomly allocated to the study groups, of which 70 were patients for the liquid artificial tear group and 70 patients for the artificial tear gel group. The patients were followed for 5 consecutive days and evaluated daily through the ocular examination with the fluorescein test, which evaluates the presence of corneal lesions, and the Schirmer I test, in order to verify the amount of tear produced. The evaluation of the ocular care effect was measured by comparing each group as well as the two groups with each other, using the value of dry eye incidence (primary outcome) found in each group. The results were presented by means of simple frequency, measures of central tendency (average) and measures of variability (standard deviation), in order to characterize and describe the population of patients. Comparisons between groups were performed by Fisher's exact test and the non-parametric Mann-Whitney test. The overall incidence rate of dry eye was calculated and the effect of the interventions was expressed by relative risk and 95% confidence interval, adjusted for risk factors (age, sex and ocular exposure) in a model of regression. Results: The overall incidence of dry eye up to the 5th day of hospitalization was higher in the liquid artificial tear group, and among the 70 patients who received it, 15 (21.4%) developed the outcome, and among the 70 patients which was implemented the artificial tear gel, 6 (8.6%), presented dry eye. The intervention, artificial tear gel was more effective (RR = 0.40, 95% CI 0.166, 0.964, p = 0.043) in dry eye prevention when compared to liquid artificial tear. Conclusion: It is concluded that the artificial tear gel intervention directly impacted the result in relation to liquid artificial tear, reducing the risk for the development of dry eye. Besides the application in clinical practice, the results may also subsidize the Taxonomy of Nursing Interventions Classification (NIC) with strong scientific evidence. Record in ClinicalTrials.gov - NCT02767258 and in the Brazilian Registry of Clinical Trials - RBR-5r8syp