Incidence and risk factors of corneal epithelial defects in mechanically ventilated children

Objective: To determine the incidence of corneal defects and the main risk factors in children exposed to mechanical ventilation (MV) in the pediatric intensive care unit between March 28 and November 4, 2001. Methods: A cohort study where characteristics of 53 children exposed to MV were evaluated and risk factors relating to the occurrence of corneal defects were identified. Patients' corneas were evaluated on a daily basis using a fluorescein test and a portable slit lamp. Risk ratios and 95% confidence intervals were calculated. A multiple logistic regression analysis was performed using a nonconditional model. The model selects variables that maintain associations with corneal defects at a 5% level of significance. The variables with the highest predictive value were identified. Results: Twenty-five percent of children exposed to MV developed corneal defects. From this percent, almost 54% of the defects occurred in both eyes, and 46% in the left eye alone. Most defects (69%) were detected within the first week of MV, and a large number were detected within the first 48 hours (46% of cases). In those children who exhibited failure of at least one organ in addition to the lungs, 43% developed defects. Among the children who died, 44% showed corneal defects. After adjusting for potential confounding variables in the multivariate analysis, the maintenance of opened eyes and sepsis remained as prognostic factors for corneal defects. Conclusions: A high incidence (25%) of corneal defects was found in children exposed to MV, as is also observed with adult patients. The main risk factors associated with corneal defects were the maintenance of opened eyes and the presence of sepsis. (Crit Care Med 2009; 37:1097-1100)