Critical care clinics
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Critical care clinics · Oct 2000
ReviewBioartificial organ support for hepatic, renal, and hematologic failure.
The current strategy to the treatment of SIRS and MODS uses a multidisciplinary approach that emphasizes supportive therapy. Herein, we have presented a futuristic approach that focuses on replacing the function of failed organs using bioartificial technology (Table 1). Bioartificial organ technology may allow the intensivist to provide physiologic organ replacement either as a bridge to transplantation or as a "time-buying" element until native organs that have become acutely dysfunctional or nonfunctional in a variety of clinical settings, can recover their function or regenerate their mass. As bioartificial organ technology matures, it is conceivable as an ultimate goal that non-immunogenic bioartificial organs would be miniaturized or redesigned and acutely placed within the intracorporeal space as replacement organs.
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The new paradigm of POCT as integrated into the ICU will allow for an improved and more efficient critical care workplace and possibly improvements in outcome and costs. Technologic advances in POCT will focus on enhancements of current devices, connectivity, and data management and on the introduction of novel diagnostic and therapeutic approaches. It is hoped that in the future the regulatory, laboratory, and L/HIS communities will recognize the need to accept, integrate, accommodate, and expand POCT, thereby promoting bedside diagnostics. For ongoing follow-up of the myriad of POCT projects, refer to the POCT websites listed in Table 1.
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This article takes a broad sweep at some of the forces that will impact pharmacy in the intensive care units of tomorrow. Each of the topics covered has journals or societies devoted to these issues. The incredible change from 10 years ago is that one can easily put these topics into a search engine on the Internet and receive more information than it is possible to read in one setting. ⋯ The old axiom of not being the first or the last to change is still a safe approach, but the speed at which the decision must be made is ever increasing. We must all put pressure on our professional societies and our employers to assure that we have adequate access to the rapidly developing technology and a level of expert review prior to its adoption. Future technology is already in our intensive care units but what we do with the technology and the information will determine the future healthcare outcomes of our patients.
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Telemedicine offers off-site physicians the ability to care for patients by providing them with audio-video links and access to relevant clinical data. Traditionally, this care modality has been used to overcome geographic barriers by bringing needed expertise to patients in remote locations. ⋯ A recent clinical trial has confirmed the efficacy of remote ICU care, with decreases in mortality, complications, and costs that are analogous to those observed with on-site intensivists. If a single, intensivist-led care team can provide round-the-clock, proactive care to patients in multiple ICUs simultaneously, this care modality can be used to overcome current deficiencies in ICU care related to inadequate intensivist availability.
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Today's intensivists are provided with more information than ever before, yet current monitors present data from multiple sources in a relatively raw form with virtually no intelligent data integration and processing. In the next century, technological advances in miniaturization, biosensors and computer processing, coupled with an improved understanding of critical illnesses at the molecular level, will lead to the development of a new generation of monitors. ⋯ Nanotechnology will permit monitoring of critical changes in the intracellular environment or the by-products of cellular metabolism and signal messaging. This article discusses monitoring technologies that hold promise for further development in the next century and point out techniques likely to be abandoned.