Critical care clinics
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Critical care clinics · Oct 1999
ReviewNeuroendovascular rescue. Nonthrombolytic approach to acute brain ischemia.
The field of neuroendovascular therapy is rapidly growing. New technology and operators' expertise is developing at a pace that will make this discipline progressively more available and successful. ⋯ Thus, the concept of neuroendovascular rescue has gone beyond the use of thrombolytic drugs, expanding our capability to restore flow to ischemic brain tissue after prolonged therapeutic windows. It is important for the interventionalist and the intensivist to work closely together to guarantee the most favorable outcome possible.
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Critical care clinics · Oct 1999
ReviewIntra-arterial thrombolysis for vertebrobasilar circulation ischemia.
Acute basilar artery occlusion is usually associated with a poor prognosis despite therapy with antiplatelet and anticoagulant agents. The natural history of this disorder should be fully understood before clinicians make decisions on therapy. Recent advances in angiography technique and the use of newer mobile microcatheters have made intra-arterial thrombolysis therapy feasible. There have been several small, uncontrolled series of intra-arterial thrombolysis in basilar artery occlusion with promising results.
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Serious consequences of stroke dictate that new approaches to the treatment of stroke be investigated. We have developed a method for perfusing the patient's own arterial blood retrograde through the venous system to ischemic brain tissue. ⋯ The laboratory investigation has also demonstrated that this therapy, retrograde transvenous neuroperfusion, can be coupled with hypothermia to potentially increase its benefit. History, experimental development, and the clinical trial are reviewed in this article.
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Many clinicians are concerned that protocol supported care will become rote or "cookbook" care and will be generated without attention to the specific and changing needs of the individual critically ill patient. This article addresses that concern. In addition, the author discusses the potential advantages that this decision-support approach, with bedside computerized protocols, brings to the healthcare delivery system, and what contributions to clinical care and to clinical research might be anticipated from its widespread application.
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The demands of today's health care arena have forced the issue of automation and computerization. Nursing, as the major stakeholder in the collecting, managing, processing, transforming, and communicating of information regarding the patient, has developed a new approach to these tasks. ⋯ Critical care is a data-rich environmental that can benefit from better management and processing of the data derived from the critically ill patient. Nursing and medical informatics joining together to organize the data, coupled with the introduction of good DSS and the addition of information retrieval systems at the bedside and the on-line medical record, will have a positive effect on the critical care environment and on the critical care patient outcomes.