Induced moderate hypothermia is feasible using an endovascular cooling device in most patients with acute ischemic stroke. Further studies are needed to determine if hypothermia improves outcome.

Background and Purpose-Hypothermia is effective in improving outcome in experimental models of brain infarction.We studied the feasibility and safety of hypothermia in patients with acute ischemic stroke treated with thrombolysis. Methods-An open study design was used. All patients presented with major ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score Ͼ15) within 6 hours of onset. After informed consent, patients with a persistent NIHSS score of Ͼ8 were treated with hypothermia to 32Ϯ1°C for 12 to 72 hours depending on vessel patency. All patients were monitored in the neurocritical care unit for complications. A modified Rankin Scale was measured at 90 days and compared with concurrent controls. Results-Ten patients with a mean age of 71.1Ϯ14.3 years and an NIHSS score of 19.8Ϯ3.3 were treated with hypothermia. Nine patients served as concurrent controls. The mean time from symptom onset to thrombolysis was 3.1Ϯ1.4 hours and from symptom onset to initiation of hypothermia was 6.2Ϯ1.3 hours. The mean duration of hypothermia was 47.4Ϯ20.4 hours. Target temperature was achieved in 3.5Ϯ1.5 hours. Noncritical complications in hypothermia patients included bradycardia (nϭ5), ventricular ectopy (nϭ3), hypotension (nϭ3), melena (nϭ2), fever after rewarming (nϭ3), and infections (nϭ4). Four patients with chronic atrial fibrillation developed rapid ventricular rate, which was noncritical in 2 and critical in 2 patients. Three patients had myocardial infarctions without sequelae. There were 3 deaths in patients undergoing hypothermia. The mean modified Rankin Scale score at 3 months in hypothermia patients was 3.1Ϯ2.3. Conclusion-Induced hypothermia appears feasible and safe in patients with acute ischemic stroke even after thrombolysis. Refinements of the cooling process, optimal target temperature, duration of therapy, and, most important, clinical efficacy, require further study. (Stroke. 2001;32:1847-1854.)

There is a broad consensus that 21st century health care will require intensive use of information technology to acquire and analyze data and then manage and disseminate information extracted from the data. No area is more data intensive than the intensive care unit. While there have been major improvements in intensive care monitoring, the medical industry, for the most part, has not incorporated many of the advances in computer science, biomedical engineering, signal processing, and mathematics that many other industries have embraced. Acquiring, synchronizing, integrating, and analyzing patient data remain frustratingly difficult because of incompatibilities among monitoring equipment, proprietary limitations from industry, and the absence of standard data formatting. In this paper, we will review the history of computers in the intensive care unit along with commonly used monitoring and data acquisition systems, both those commercially available and those being developed for research purposes.

New monitoring techniques can provide the neurointensivist with crucial information about brain physiology and metabolism. Combining these techniques ("multimodal monitoring") can produce a more accurate overall picture. This approach, along with new computer systems for integrating data at the bedside, may change the way patients with brain injury are monitored and treated in the future.