{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T07:25:21Z","timestamp":1775028321881,"version":"3.50.1"},"reference-count":10,"publisher":"Association of University Professors of Ophthalmology","issue":"02","license":[{"start":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T00:00:00Z","timestamp":1658880000000},"content-version":"vor","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Academic Ophthalmology"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Purpose\u2003In this pilot study, we aimed to investigate the efficacy of an electronic medical record (EMR) order set for lubricating ointment (four times daily) in the prevention of exposure keratopathy in ventilated patients in the intensive care unit (ICU) at the University of Utah. We attempted to capture the magnitude of morbidity, cost, and care burden in ventilated patients, as well as the utility of a systematic EMR-based preventative lubrication protocol in the ICU setting.<\/jats:p><jats:p>\n          Methods\u2003After implementation of the order set, a retrospective chart review was performed to capture all ventilated ICU patients pre- and postintervention. Three separate study periods were used: (1) Six months prior to coronavirus disease 2019 (COVID-19) and prior to the ocular lubrication intervention; (2) the subsequent 6-month period including COVID-19 patients but prior to any intervention; and (3) the subsequent 6-month period postintervention, including COVID-19 patients. The primary endpoint of ointment use per day was analyzed with a Poisson regression model. Secondary endpoints including rates of ophthalmologic consultation and exposure keratopathy were compared with Fisher's exact test. A poststudy survey of ICU nurses was included.<\/jats:p><jats:p>\n          Results\u2003A total of 974 ventilated patients were included in the analysis. Ointment use per day increased by 155% (95% confidence interval [CI] 132\u2013183%, p\u2009&lt;\u20090.001) following the intervention. Rates also increased 80% (95% CI 63\u201399%, p\u2009&lt;\u20090.001) during the COVID-19 study period but prior to intervention. The percentage of ventilated patients requiring a dilated eye exam for any indication was 3.2, 4, and 3.7% in each of the study periods, respectively. There was an overall down trend in the rate of exposure keratopathy which was diagnosed in 33.3, 20, and 8.3% of those receiving ophthalmologic consultation, though these rates were not statistically significant.<\/jats:p><jats:p>\n          Conclusion\u2003These preliminary data show a statistically significant increase in the rates of lubrication in mechanically ventilated patients using an EMR-based order set in the ICU setting. There was no statistically significant decrease in the rates of exposure keratopathy. Our preventative protocol with lubrication ointment was of minimal cost burden to the ICU. Further longitudinal and multicenter studies are needed to better assess the efficacy of such a protocol.<\/jats:p>","DOI":"10.1055\/s-0042-1750020","type":"journal-article","created":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T21:36:11Z","timestamp":1658957771000},"page":"e141-e146","source":"Crossref","is-referenced-by-count":7,"title":["Prevention of Exposure Keratopathy in the Intensive Care Unit: Evaluation of an EMR-Based Lubrication Order Protocol for Ventilated Patients"],"prefix":"10.62199","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0006-893X","authenticated-orcid":false,"given":"Cole J.","family":"Swiston","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.S","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Simpson","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.J","family":"Brintz","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"48610","published-online":{"date-parts":[[2022,7,27]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"A731","DOI":"10.1186\/2197-425X-3-S1-A731","article-title":"The risk factors for developing exposure keratopathy in ICU patients","volume":"3","author":"O Kousha","year":"2015","journal-title":"Intensive Care Med Exp"},{"issue":"12","key":"ref2","doi-asserted-by":"crossref","first-page":"3151","DOI":"10.1097\/CCM.0b013e31818f0ee7","article-title":"Eye care in the intensive care unit: narrative review and meta-analysis","volume":"36","author":"J B Rosenberg","year":"2008","journal-title":"Crit Care Med"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.jcrc.2012.02.005","article-title":"Exposure keratopathy in sedated and ventilated patients","volume":"27","author":"H Jammal","year":"2012","journal-title":"J Crit Care"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"188","DOI":"10.4037\/ajcc2000.9.3.188","article-title":"Eye care for patients receiving neuromuscular blocking agents or propofol during mechanical ventilation","volume":"9","author":"S B Lenart","year":"2000","journal-title":"Am J Crit Care"},{"issue":"04","key":"ref5","first-page":"346","article-title":"Prevention of exposure keratopathy in intensive care unit","volume":"3","author":"H Shan","year":"2010","journal-title":"Int J Ophthalmol"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s00134-008-1284-4","article-title":"Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill","volume":"35","author":"D G Ezra","year":"2009","journal-title":"Intensive Care Med"},{"issue":"08","key":"ref7","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1136\/bjo.2004.062406","article-title":"Preventing exposure keratopathy in the critically ill: a prospective study comparing eye care regimes","volume":"89","author":"D G Ezra","year":"2005","journal-title":"Br J Ophthalmol"},{"issue":"11","key":"ref8","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1097\/ICO.0000000000000224","article-title":"Moisture chamber versus lubrication for corneal protection in critically ill patients: a meta-analysis","volume":"33","author":"Y Zhou","year":"2014","journal-title":"Cornea"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2307\/1269547","article-title":"Zero-inflated Poisson regression, with an application to defects in manufacturing","volume":"34","author":"D Lambert","year":"1992","journal-title":"Technometrics"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1007\/s00134-004-2203-y","article-title":"A randomised controlled study of the efficacy of hypromellose and Lacri-Lube combination versus polyethylene\/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient","volume":"30","author":"N Koroloff","year":"2004","journal-title":"Intensive Care Med"}],"container-title":["Journal of Academic Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0042-1750020.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T22:56:56Z","timestamp":1753397816000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.aupojournal.org\/jao\/vol14\/iss2\/4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":10,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2022,7,27]]},"published-print":{"date-parts":[[2022,7]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0042-1750020","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2475-4757"],"issn-type":[{"value":"2475-4757","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7]]}}}