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Biomedical subjects

A Milewski

Publications and source records attributed to A Milewski.

5 recordsLinked to original sources

MRI protocol for critically ill patients.

BACKGROUND Ventilators compatible with magnetic resonance imaging machines are not universally available. However, the lack of such equipment should not preclude magnetic resonance imaging. We have developed a method by which a critically ill patient requiring mechanical ventilation can safely undergo such imaging without compatible equipment. METHOD By using extended ventilator tubing and calculating volume lost due to tubing compliance, safe and reliable mechanical ventilation can be achieved from a distance without impairing scan quality. RESULTS We devised a method to calculate volume lost due to mechanical compliance of the tubing with ventilator circuits employing 20, 30, and 50 feet of tubing. We added the estimated loss of volume to the set tidal volume of 700 mL to give a delivered volume of 700 mL. Twenty breaths were evaluated for each length of tubing. The evaluation of the 20- and 30-foot lengths of tubing demonstrated 10- and 52-mL discrepancies, respectively, between predicted and measured volumes. The 50-foot length showed a 121-mL discrepancy between predicted and measured volumes. CONCLUSIONS Our method appears to be clinically accurate for predicting volume lost due to tubing compliance for lengths of ventilator tubing less than or equal to 30 feet. We have found this technique to be a safe and effective way to ensure patient safety and scan quality in patients requiring mechanical ventilation during magnetic resonance imaging.

Critical Care↗

A nurse-directed protocol using pulse oximetry to wean mechanically ventilated patients from toxic oxygen concentrations.

The usual method of weaning mechanically ventilated patients from high FIO2 in our ICU, in which housestaff ordered all ventilator changes in an unstandardized manner (control group), was compared to a nurse-directed protocol that used a single arterial blood gas (ABG) analysis and multiple pulse oximetry measurements. The protocol required an ABG to be obtained upon the initiation of intubation/mechanical ventilation, followed by pulse oximetry measurements obtained in accordance with a standardized timetable. Decreases in FIO2 were guided by these results. It was concluded that a nurse-directed oxygen weaning protocol utilizing a combination of a single ABG and multiple pulse oximetry measurements was safe, reduced the need for ABGs, and decreased the duration of patient exposure to toxic oxygen concentrations.

Carbon Dioxide↗

Comparison of pulmonary artery, rectal, and tympanic membrane temperatures in adult intensive care unit patients.

Tympanic thermometry using infrared thermography technology offers a noninvasive, rapid temperature measurement tool which may be useful for selected intensive care unit (ICU) patients. Multiple comparisons of pulmonary artery catheter (PAC), rectal (R), and tympanic membrane (TM) temperatures were performed in nine adult ICU patients using PAC temperatures as the gold standard. The correlation between R (r = 0.93) and PAC was significantly better than TM (r = 0.74) temperatures. However, PAC (37.2 +/- 0.06 degrees C; mean +/- SEM) and TM (37.1 +/- 0.08 degrees C) temperatures were not significantly different, whereas R (37.6 +/- 0.07 degrees C) was significantly warmer than both (P less than .05). Differences between either R (+0.4 degrees C) or TM (-0.1 degrees C) and PAC temperatures were consistent over selected ranges between 35 degrees C and 40 degrees C. The performance of TM and R was similar in the ability to predict PAC temperatures.

Adult↗

The performance of two tympanic thermometers in a pediatric emergency department.

In a prospective, unblinded, controlled study, 303 children underwent comparison of rectal (RT) and right-sided tympanic membrane (TMT) temperatures. Digital electronic thermometers were used for RT, while two different infrared detection devices assessed TMT. The performance of TMT devices were compared using correlation with RT, fever detection, and ease of use. Correlation between RT and the two devices was good, r = 0.70 and r = 0.69, with little influence of patient age on performance. Using receiver operating characteristics curves to assess fever screening. Thermoscan performed somewhat better than First Temp. Staff rated the Thermoscan as significantly easier to use.

Age Factors↗