1
|
Goury A, Poirson F, Chaput U, Voicu S, Garçon P, Beeken T, Malissin I, Kerdjana L, Chelly J, Vodovar D, Oueslati H, Ekherian JM, Marteau P, Vicaut E, Megarbane B, Deye N. Targeted temperature management using the "Esophageal Cooling Device" after cardiac arrest (the COOL study): A feasibility and safety study. Resuscitation 2017; 121:54-61. [PMID: 28951293 DOI: 10.1016/j.resuscitation.2017.09.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Targeted temperature management (TTM) between 32 and 36°C is recommended after out-of-hospital cardiac arrest (OHCA). We aimed to assess the feasibility and safety of the "Esophageal Cooling Device" (ECD) in performing TTM. PATIENTS AND METHODS This single-centre, prospective, interventional study included 17 comatose OHCA patients. Main exclusion criteria were: delay between OHCA and return of spontaneous circulation (ROSC)>60min, delay between sustained ROSC and inclusion >360min, known oesophageal disease. A TTM between 32 and 34°C was performed using the ECD (Advanced Cooling Therapy, USA) connected to a heat exchanger console (Meditherm III®, Gaymar, France), without cold fluids' use. Primary endpoint was feasibility of inducing, maintaining TTM, and rewarming using the ECD alone. Secondary endpoints were adverse events, focusing on potential digestive damages. Results were expressed as median (interquartiles 25-75). RESULTS Cooling rate to reach the Target Temperature (33°C-TT) was 0.26°C/h [0.19-0.36]. All patients reached the 32-34°C range with a time spent within the range of 26h [21-28] (3 patients did not reach 33°C). Temperature deviation outside the TT during TTM-maintenance was 0.10°C [0.03-0.20]. Time with deviation >1°C was 0h. Rewarming rate was 0.20°C/h [0.18-0.22]. Among the 16 gastrointestinal endoscopy procedures performed, 10 (62.5%) were normal. Minor oeso-gastric injuries (37.5% and 19%, respectively) were similar to usual orogastric tube injuries. One patient experienced severe oesophagitis mimicking peptic lesions, not cooling-related. No patient among the 9 alive at 3-month follow-up had gastrointestinal complains. CONCLUSION ECD seems an interesting, safe, accurate, semi-invasive cooling method in OHCA patients treated with 33°C-TTM, particularly during the maintenance phase.
Collapse
Affiliation(s)
- Antoine Goury
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Florent Poirson
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Ulriikka Chaput
- Hépato-gastro-entérologie, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Sebastian Voicu
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Pierre Garçon
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Thomas Beeken
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Isabelle Malissin
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Lamia Kerdjana
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Jonathan Chelly
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France; Clinical Research Unit-Groupe Hospitalier Sud Île de France, 77000 Melun, France
| | - Dominique Vodovar
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Haikel Oueslati
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Jean Michel Ekherian
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Philippe Marteau
- Hépato-gastro-entérologie, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Hôpital Fernand Widal, AP-HP, Paris Cedex 10, France
| | - Bruno Megarbane
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France; INSERM UMRS-1144, Paris, France
| | - Nicolas Deye
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France; INSERM U942, Hôpital Lariboisière, Paris, France.
| |
Collapse
|
2
|
Kusano M, Ino K, Yamada T, Kawamura O, Toki M, Ohwada T, Kikuchi K, Shirota T, Kimura M, Miyazaki M, Nakamura K, Igarashi S, Tomizawa M, Tamura T, Sekiguchi T, Mori M. Interobserver and intraobserver variation in endoscopic assessment of GERD using the "Los Angeles" classification. Gastrointest Endosc 1999; 49:700-4. [PMID: 10343212 DOI: 10.1016/s0016-5107(99)70285-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND A new endoscopic classification of gastroesophageal reflux disease (GERD) has been proposed, and the term mucosal break has been introduced to describe mucosal damage. This new classification was evaluated by endoscopists with different levels of experience. METHODS Fifty endoscopic photographs for each of 20 randomly selected patients with GERD were assessed retrospectively by three groups of seven endoscopists classified by experience: group 1 (100 to 500 procedures), group 2 (500 to 3000), and group 3 (more than 3000). The new classification was modified by adding grade 0 to describe healed mucosal breaks, so that there were five grades. All photographs were assessed twice at an interval of more than 1 week, and kappa statistics were used to determine observer variation. RESULTS Interobserver variation within group 3 (kappa = 0.39, n = 21) and between groups 3 and 2 (kappa = 0.36, n = 49) was significantly different (p < 0.01) from that between groups 3 and 1 (kappa = 0.26, n = 49). Intraobserver variation in group 1 (kappa = 0.39, n = 7) was significantly different (p < 0.01) from that in group 2 (kappa = 0.51, n = 7) and group 3 (kappa = 0.54, n = 7). CONCLUSIONS Observer variation depends on level of endoscopic experience. Only experienced endoscopists should use the new classification for grading of GERD.
Collapse
Affiliation(s)
- M Kusano
- First Department of Internal Medicine, School of Medicine, Gunma University, Maebashi, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Smedh K, Olaison G, Jönsson KA, Johansson KE, Skullman S, Hallböök O. Interobserver variation of colonoileoscopic findings in Crohn's disease. Scand J Gastroenterol 1995; 30:81-6. [PMID: 7701256 DOI: 10.3109/00365529509093240] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colonoileoscopy is increasingly used to evaluate Crohn's disease, but the reproducibility of endoscopic findings is not clear. METHODS The interobserver variation of endoscopic findings and the influence of experience on assessments were investigated in 82 colonoileoscopies in Crohn's disease. RESULTS In colonic assessment there was excellent agreement for most endoscopic features (kappa values > 0.75; p < 0.001). In ileal assessment agreement was excellent with regard to detection of large ulcers and strictures and endoscopic staging on the basis of ulcer size and stricture (kappa > 0.76; p < 0.001). Observer experience was an important factor in ileal assessments: agreement was excellent for 13 features within experienced pairs, compared with 3 when only 1 of a pair was experienced. In colonic assessment experience was less important. CONCLUSION The study showed that acceptable agreement can be obtained on some well-defined inflammatory lesions in Crohn's disease even when investigator experience is limited. Endoscopic staging on the basis of ulcer size and stricture, being excellently reproducible, can serve as a simple summarizing assessment.
Collapse
Affiliation(s)
- K Smedh
- Dept. of Medico-Surgical Gastroenterology, University Hospital, Linköping, Sweden
| | | | | | | | | | | |
Collapse
|
4
|
Bytzer P, Havelund T, Hansen JM. Interobserver variation in the endoscopic diagnosis of reflux esophagitis. Scand J Gastroenterol 1993; 28:119-25. [PMID: 8441905 DOI: 10.3109/00365529309096057] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The interobserver variation among three experienced endoscopists in the endoscopic diagnosis and grading of reflux esophagitis was investigated in 150 dyspeptic patients. The interobserver variation was analyzed with kappa statistics to correct for the extent of agreement expected by chance alone. The observers diagnosed esophagitis in 22.7%, 32.7%, and 35.3% of the patients, respectively (p < 0.0002). Kappa values for grade-1 esophagitis varied from 0.34 to 0.47, a level generally considered to signify poor agreement, and despite partial agreement on the diagnosis in the individual patient there was almost complete disagreement on the features used to characterize grade 1. Kappa values for diagnosing erosive esophagitis (grades 2-4) were 0.68-0.79. Considering all three observers and all grades of esophagitis (grades 0-4) the overall chance-corrected agreement was 0.55. In patients with low-grade esophagitis without reflux-like dyspepsia and when the observers expressed uncertainty in the diagnosis, the agreement rates were particularly poor. Due to a large chance-corrected interobserver variation, the endoscopic diagnosis grade 1 esophagitis is not reliable and thus may be problematic as a selection criterion for clinical trials. Interobserver variation on the presence of erosive/ulcerative esophagitis is acceptable and comparable to the level for peptic ulcer.
Collapse
Affiliation(s)
- P Bytzer
- Dept. of Medical Gastroenterology S, Odense University Hospital, Denmark
| | | | | |
Collapse
|
5
|
Grant SM, Langtry HD, Brogden RN. Ranitidine. An updated review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in peptic ulcer disease and other allied diseases. Drugs 1989; 37:801-70. [PMID: 2667937 DOI: 10.2165/00003495-198937060-00003] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Ranitidine, a histamine H2-receptor antagonist, is now well established as a potent inhibitor of gastric acid secretion effective in the treatment and prophylaxis of gastrointestinal lesions aggravated by gastric acid secretion. Therapeutic trials involving several thousands of patients with peptic ulcer disease confirm that ranitidine 300mg daily administered orally in single or divided doses is at least as effective as cimetidine 800 to 1000mg daily in increasing the rate of healing of duodenal and gastric ulcers. Similar dosages of ranitidine have been shown to relieve the symptoms of reflux oesophagitis and heal or prevent gastrointestinal damage caused by ulcerogenic drugs. Ranitidine 150mg orally at night maintains ulcer healing in the long term. Ranitidine has also demonstrated good results in the treatment of Zollinger-Ellison syndrome and in the prevention of aspiration pneumonitis when given prior to surgery and to pregnant women at full term. It may also have a place in the management of acute upper gastrointestinal bleeding and in the prevention of stress ulcers in the intensive care setting, although these areas require further investigation. Ranitidine has been used safely in obstetric patients during labour, in children, the elderly, and in patients with renal impairment when given in appropriate dosages. The drug is very well tolerated and is only infrequently associated with serious adverse reactions or clinically significant drug interactions. Even at high dosages, ranitidine appears devoid of antiandrogenic effects. Ranitidine is clearly comparable or superior to most other antiulcer agents in the treatment and prevention of a variety of gastrointestinal disorders associated with gastric acid secretion. With its favourable efficacy and tolerability profiles, ranitidine must be considered a first-line agent when suppression of gastric acid secretion is indicated.
Collapse
Affiliation(s)
- S M Grant
- ADIS Drug Information Services, Auckland, New Zealand
| | | | | |
Collapse
|