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Tooting, United Kingdom

Thomson R.,Cardiothoracic Intensive Care Unit | Meeran H.,Cardiothoracic Intensive Care Unit | Valencia O.,St Georges NHS Hospital Trust | Al-Subaie N.,Cardiothoracic Intensive Care Unit
Journal of Critical Care | Year: 2014

Objective: The purpose of this study was to assess the effect of goal-directed therapy (GDT), after cardiac surgery, on the incidence of acute kidney injury (AKI). Design: This is a prospective observational study designed to achieve and maintain maximum stroke volume for 8 hours, in patients after cardiac surgery. Setting: This is a single-center study in a 15-bedded cardiothoracic intensive care unit (ICU). Participants: Participants are patients after coronary artery bypass grafting and/or aortic valve surgery. Interventions: Patients in the GDT group received cardiac output monitoring and fluid challenges targeting an increase in stroke volume by at least 10%. Stroke volume maximization was maintained for a period of 8 hours from admission to the ICU. All other aspects of care were dictated by the clinical team. Patients in the standard therapy (ST) group had intravenous fluids in accordance with the routine practice of the unit. Patients were divided into the GDT and ST group dependant on availability of cardiac output monitors and allocation of nursing staff with training in GDT. Patients' data were collected prospectively in both groups. Measurements and main results: One hundred twenty-three patients received GDT compared with 141 patients in the ST group. Both groups received similar volumes of fluid (GDT, 2905 [1367] mL vs 2704 [1393] mL; P = .09). Incidence of AKI was reduced in the GDT group (n = 8 [6.5%] vs n = 28 [19.9%]; P = .002). The median duration of hospital stay was 6 (4) days in the GDT group vs 7 (8) days in the ST, P = .004. Conclusion: Postoperative GDT in patients after cardiac surgery was associated with reduction in the incidence of AKI and a reduction in ICU and hospital duration of stay. © 2014 Elsevier Inc. Source


Hay A.,St Georges NHS Hospital Trust | Pai I.,Royal Surrey County Hospital | Pitkin L.,Royal Surrey County Hospital | Williamson P.,St Georges NHS Hospital Trust | And 2 more authors.
Acta Oto-Laryngologica | Year: 2011

Conclusion. In our experience, fine needle aspiration cytology (FNAC) combined with immunocytochemistry/flow cytometry in the investigation of lymphoma presenting in the neck is highly valuable. In our unit it has a sensitivity of 95.5% and a positive predictive value (PPV) of 96.8% and is the first-line investigation in suspected lymphoma. It enables planning of radiological and haematological investigations and obviates panendoscopy as part of the staging protocol. Objective: Lymphoma commonly presents to otolaryngologists. The aim of our study was to evaluate the accuracy of FNAC in lymphoma presenting in the neck at our institute. Methods: Data were collected retrospectively between 2003 and 2007. Separate searches for cytological and histopathological diagnosis of lymphoma on cervical lymph node biopsies were cross-referenced. Immunocytochemistry stains used were recorded. Results: A total of 121 cases met the inclusion criteria. The FNAC diagnosis of lymphoma was correct on lymph node biopsy in 68.6% (83/121). In 18 (14.9%) cases a false-negative result and in 3 (2.5%) cases a false-positive result was seen. In all, 17 (14.0%) cases were non-diagnostic (11 inadequate and 6 suspicious). In 16/20 (80.0%) cases of wrong diagnosis, immunocytochemistry had not been performed. Flow cytometry and immunocytochemistry were used in 67 cases and the FNAC diagnosis had a sensitivity of 95.5% and a PPV of 96.8% in this group. © 2011 Informa Healthcare. Source

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