Papers by Daniel Stollery
Chest, Sep 1, 2022
PURPOSE: We describe the diagnostic performance of EBUS-TBNA in a heterogeneous population of pat... more PURPOSE: We describe the diagnostic performance of EBUS-TBNA in a heterogeneous population of patients with mediastinal and hilar lymphadenopathy in a geographical region with a high prevalence of histoplasmosis related granulomatous inflammation. METHODS: A review was performed of all patients referred for EBUS-TBNA over a 7 month period at two institutions. Cytological analysis of EBUS-TBNA aspirates were compared to a reference standard of definitive pathological tissue diagnosis or a composite of ≥6 month's clinical follow-up with radiographic imaging. Pre-EBUS CT chest studies were screened for evidence of calcified granulomatous inflammation. Definitive lymph node sampling was defined by lymphoid tissue, granulomatous inflammation or tumor. The results were classified as malignant, benign disease, normal or inadequate sample. The frequency of definitive lymph node sampling in those patients with and without calcified granulomatous mediastinal/hilar nodal inflammation was compared using a chi squared test with significant p value <.05. Institutional review board approval was attained. RESULTS: All 38 patients (20 female, mean age 59) undergoing EBUS-TBNA were included. In total, 66 lymph nodes (mean size=12.8mm) and 4 masses were biopsied. Definitive lymph node sampling was achieved in 29/38 (76%) (excluding n=3 necrosis). The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of EBUS-TBNA for malignancy was 79%, 100%, 100%, 85% and 90% respectively. On pre-EBUS CT chest, 23 (61%) had calcified granulomatous inflammation (13 (34%) mediastinal/hilar lymph node involvement). The prevalence of cancer was similar in those with and without calcified granulomatous inflammation (35% and 40%). There was a trend towards a reduction in frequency of definitive lymph node sampling in those patients with (8/13) and without (21/25) mediastinal/hilar nodal calcified granulomatous inflammation, however this was not statistically different (p=0.12).
Kidney International, Jun 1, 2005
Regional citrate versus systemic heparin anticoagulation for continuous renal replacement in crit... more Regional citrate versus systemic heparin anticoagulation for continuous renal replacement in critically ill patients. Background. We determined the effect of regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill subjects suffering from acute renal failure who were not at high risk for hemorrhagic complications. Methods. Between April 1999 and June 2002, 30 critically ill subjects requiring continuous renal replacement therapy and using 79 hemofilters were randomly assigned to receive regional citrate or systemic heparin anticoagulation. Results. The median hemofilter survival time was 124.5 hours (95% CI 95.3 to 157.4) in the citrate group, which was significantly longer than the 38.3 hours (95% CI 24.8 to 61.9) in the heparin group (P < 0.001). Increasing illness severity score, male gender, and decreasing antithrombin-III levels were independent predictors of an increased relative hazard of hemofilter failure. After adjustment for illness severity, antithrombin-III levels increased significantly more over the period of study in the citrate as compared to the heparin group (P = 0.038). Moreover, after adjustment for antithrombin-III levels and illness severity score, the relative risk of hemorrhage with citrate anticoagulation was significantly lower than that with heparin (relative risk of 0.14; 95% CI 0.02 to 0.96, P = 0.05). Conclusion. Compared with systemic heparin anticoagulation, regional citrate anticoagulation significantly increases hemofilter survival time, and significantly decreases bleeding risk in critically ill patients suffering from acute renal failure and requiring continuous renal replacement therapy. Acute renal failure (ARF) is a common complication of critically ill patients with mortality rates in excess of 40% [1-6]. The use of continuous renal replacement therapy (CRRT) in the management of acute renal failure in critically ill patients has become accepted, and based on two North American surveys, it has been estimated that one
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine
Journal of Bronchology & Interventional Pulmonology
The International Journal of Artificial Organs, 2008
Background Acetaminophen (paracetamol) overdose is a leading cause of acute liver failure (ALF). ... more Background Acetaminophen (paracetamol) overdose is a leading cause of acute liver failure (ALF). When patients fulfill the King's College criteria for acetaminophen-induced ALF (AALF), they have a poor prognosis for survival without liver transplantation. Recent advances in artificial liver support have used albumin as a binding and scavenging molecule in ALF. One method, single-pass albumin dialysis (SPAD), involves dialyzing blood against an albumin-containing solution across a high-flux membrane to remove albumin-bound toxins. Herein, we describe our protocol for SPAD and report its use in a case of AALF as a bridge to native liver recovery. Case A 41-year-old female with no documented history of liver disease presented with acute acetaminophen toxicity and developed hepatic encephalopathy, coagulopathy and lactic acidosis. The patient met King's College criteria for liver transplantation, based on pH and INR, but was deemed not suitable as a candidate due to psychosocial...
Kidney International, 2005
Regional citrate versus systemic heparin anticoagulation for continuous renal replacement in crit... more Regional citrate versus systemic heparin anticoagulation for continuous renal replacement in critically ill patients. Background. We determined the effect of regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill subjects suffering from acute renal failure who were not at high risk for hemorrhagic complications. Methods. Between April 1999 and June 2002, 30 critically ill subjects requiring continuous renal replacement therapy and using 79 hemofilters were randomly assigned to receive regional citrate or systemic heparin anticoagulation. Results. The median hemofilter survival time was 124.5 hours (95% CI 95.3 to 157.4) in the citrate group, which was significantly longer than the 38.3 hours (95% CI 24.8 to 61.9) in the heparin group (P < 0.001). Increasing illness severity score, male gender, and decreasing antithrombin-III levels were independent predictors of an increased relative hazard of hemofilter failure. After adjustment for illness severity, antithrombin-III levels increased significantly more over the period of study in the citrate as compared to the heparin group (P = 0.038). Moreover, after adjustment for antithrombin-III levels and illness severity score, the relative risk of hemorrhage with citrate anticoagulation was significantly lower than that with heparin (relative risk of 0.14; 95% CI 0.02 to 0.96, P = 0.05). Conclusion. Compared with systemic heparin anticoagulation, regional citrate anticoagulation significantly increases hemofilter survival time, and significantly decreases bleeding risk in critically ill patients suffering from acute renal failure and requiring continuous renal replacement therapy. Acute renal failure (ARF) is a common complication of critically ill patients with mortality rates in excess of 40% [1-6]. The use of continuous renal replacement therapy (CRRT) in the management of acute renal failure in critically ill patients has become accepted, and based on two North American surveys, it has been estimated that one
Journal of Parenteral and Enteral Nutrition, 2013
Background-Critically ill patients commonly experience skeletal muscle wasting that may predict c... more Background-Critically ill patients commonly experience skeletal muscle wasting that may predict clinical outcome. Ultrasound is a noninvasive method that can measure muscle quadriceps muscle layer thickness (QMLT) and subsequently lean body mass (LBM) at the bedside. However, currently the reliability of these measurements are unknown. The objectives of this study were to evaluate the intra-and interreliability of measuring QMLT using bedside ultrasound. Methods-Ultrasound measurements of QMLT were conducted at 7 centers on healthy volunteers. Trainers were instructed to perform measurements twice on each patient, and then a second trainee repeated the measurement. Intrarater reliability measured how consistently the same person measured the subject according to intraclass correlation (ICC). Interrater reliability measured how consistently trainer and trainee agreed when measuring the same subject according to the ICC. Results-We collected 42 pairs of within operator measurements with an ICC of .98 and 78 pairs of trainer-to-trainee measurements with an ICC of .95. There were no statistically significant differences between the trainer and trainee results (trainer and trainee mean = −0.028 cm, 95% CI = −0.067 to −0.011, P = .1607). Conclusions-Excellent intra-and interrater reliability for ultrasound measurements of QMLT in healthy volunteers was observed when performed by a range of providers with no prior
Journal of Neurosurgery, 1991
✓ A 42-year-old woman suffered a severe intracerebral and intraventricular hemorrhage from a rupt... more ✓ A 42-year-old woman suffered a severe intracerebral and intraventricular hemorrhage from a ruptured anterior cerebral artery aneurysm. Evacuation of the frontal hematoma and clipping of the aneurysm was performed but the intraventricular blood clot persisted, causing ventricular dilatation and high intracranial pressure (ICP) 24 hours after surgery despite external ventricular drainage. Over this period of time the patient's clinical condition improved from Grade V to Grade IVb (World Federation of Neurological Surgeons classification). The intraventricular hematoma was lysed with a total of 8 mg recombinant tissue plasminogen activator injected directly into the ventricles on the 1st and 2nd postoperative days, resulting in rapid normalization of ventricular size and ICP. The patient has since made a substantial recovery and has been able to return home.
Journal of Critical Care, 1990
is staff nurse and Ms. Chan is manager of the Renal Unit at the General Hospital (Grey Nuns) of E... more is staff nurse and Ms. Chan is manager of the Renal Unit at the General Hospital (Grey Nuns) of Edmonton.
Critical Care Medicine, 1993
Critical Care, 2012
Introduction: Cardiac complications are potentially life-threatening following emergency repair o... more Introduction: Cardiac complications are potentially life-threatening following emergency repair of ruptured abdominal aortic aneurysms (rAAA). Our objectives were to describe the incidence, risk factors, cardiac outcomes and mortality associated with elevated cardiac-specific troponin (cTnI) following repair of rAAA. We hypothesized that early post-operative cTnI elevation (>0.15 mcg/L) in rAAA patients would identify a high-risk subgroup for cardiovascular complications and adverse outcomes. Methods: This was a retrospective population-based cohort study of all referrals for emergency repair of rAAA in central and northern Alberta, from 1 January 2002 to 31 December 2009. Demographic, clinical, physiologic and laboratory data were extracted, along with cardiac-specific investigations and events in the 72 hours following rAAA repair. Results: In total, 55% of patients (n = 77/141) had elevated cTnI, of which 12% (n = 9) had ST segment elevation, 23% (n = 18) had ST segment depression, 5% (n = 4) had other ECG changes, and 61% (n = 47) had no diagnostic ECG changes. Those with positive cTnI were more likely to have coronary artery disease (45.5% vs. 23.4%, P = 0.01) and higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (24.9 vs. 21.4, n = 0.016). cTnI positive patients were more likely to receive vasoactive support (58.4% vs. 14.1%, P < 0.001), had longer intensive care unit (ICU) lengths of stay (8 (3 to 11) vs. 4 (2 to 9) days, P = 0.02) and higher adjusted in-hospital mortality (40.3% vs. 14.1%; OR 4.23; 95% CI, 1.47 to 12.1; P = 0.007). Conclusions: Elevated cTnI early after rAAA repair is an independent predictor for post-operative complications and death.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2012
Purpose The optimal timing for starting renal replacement therapy (RRT) in patients with acute ki... more Purpose The optimal timing for starting renal replacement therapy (RRT) in patients with acute kidney injury (AKI) is unknown. Defining current practice is necessary to design interventional trials. We describe the current Canadian practice regarding the timing of RRT initiation for AKI. Methods An observational study of patients undergoing RRT for AKI was undertaken at 11 intensive care units (ICUs) across Canada. Data were captured on Electronic supplementary material The online version of this article (
Blood Purification, 2009
Background: Extracorporeal support with single-pass albumin dialysis (SPAD) may remove protein-bo... more Background: Extracorporeal support with single-pass albumin dialysis (SPAD) may remove protein-bound toxins in acute liver failure. We evaluated the clinical, physiological and laboratory parameters of SPAD in acetaminophen-induced acute liver failure (AALF). Methods: Retrospective case-control studies of AALF patients were used. Results: We identified 13 AALF patients (6 SPAD-treated, 7 controls). The average age was 38 years, 92% were female, none had cirrhosis and the Model for End-Stage Liver Disease (MELD) scores were 43. Eleven patients (85%) fulfilled the King’s College criteria for a liver transplant. SPAD-treated patients received 21 sessions (total: 147 h, mean 3.5 runs or 24.5 h/patient). There were no complications. No significant changes in clinical, physiological or biochemical parameters occurred during SPAD. Compared with the controls, there were no significant differences in ICU or 1-year survival, liver recovery or referral for a liver transplant. Conclusion: SPAD ...
BMC Nephrology, 2013
BackgroundCurrent data describing the epidemiology of acute kidney injury (AKI) following repair ... more BackgroundCurrent data describing the epidemiology of acute kidney injury (AKI) following repair of ruptured abdominal aortic aneurysm (rAAA) are limited and long-term outcomes are largely unknown. Our objectives were to describe the incidence rate, risk factors, clinical course and long-term outcomes of AKI following rAAA repair.MethodsRetrospective population-based cohort study of all referrals undergoing emergency repair of rAAA in Northern Alberta from January 1, 2002 to December 31 2009. Demographic, clinical, physiologic and laboratory data were extracted. AKI was defined and classified according to the AKIN criteria.ResultsIn total, 140 patients survived to receive emergent rAAA repair. Post-operative AKI occurred in 75.7% of patients (n = 106), 78.3% (n = 83) of which occurred during the initial 24 hours of ICU admission. AKIN stage 1, 2, and 3 occurred in 47 (33.6%), 36 (25.7%) and 23 (16.4%), respectively, with 19 patients receiving renal replacement therapy (RRT). Several...
BMJ Open Respiratory Research
IntroductionThe Stather Canadian Outcomes registry for chest ProcedurEs (SCOPE registry) is a Can... more IntroductionThe Stather Canadian Outcomes registry for chest ProcedurEs (SCOPE registry) is a Canadian multicentre registry of chest procedures.Methods and analysisThe SCOPE registry is designed as a multicentre prospective database of specific bronchoscopic or other pulmonary procedures. Each procedure of interest will be associated with a registry module, and data capture designed to evaluate effectiveness of procedures on relevant patient outcomes. Participating physicians will be asked to enter data for all procedures performed in a given module. The anonymised dataset will be housed in a web-based electronic secure database. Specific modules included will be based on participating physician suggestions, capacity and consensus of the steering committee and relevance of hypotheses/research potential.Ethics and disseminationThe central registry is under approval from the Conjoint Health Research Ethics Board at the University of Calgary. We aim for registry data to lead to publica...
Canadian Respiratory Journal, 2015
I n the past two decades, there has been increased interest in the use of noninvasive ventilation... more I n the past two decades, there has been increased interest in the use of noninvasive ventilation (NIV) as a treatment for acute respiratory failure (1-3). NIV can provide ventilatory support with similar physiological benefits as invasive mechanical ventilation, including reduced work of breathing and improved gas exchange (4). NIV has advantages including the need for less sedation, reduced risk for ventilator-associated pneumonia, and shorter durations of ventilation and intensive care unit (ICU) stay (5). Consequently, the use of NIV has increased internationally (6) within ICUs, emergency departments (EDs) (7,8) and postanesthetic care units (9), as well as medical wards and palliative care units (10,11). However, the frequency of NIV use varies among sites and countries (1,2,12-17), and may be underutilized in some diagnoses (18). The quality of evidence supporting the use of NIV in various etiologies of acute respiratory failure varies. A recent Canadian clinical practice guideline (19) highlighted the varying strength of evidence to GC Digby, SP Keenan, CM Parker, et al. Noninvasive ventilation practice patterns for acute respiratory failure in Canadian tertiary care centres: A descriptive analysis.
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Papers by Daniel Stollery