RESUMO
BACKGROUND: A mismatch between oxygen delivery (DO2) and consumption (VO2) is associated with increased perioperative morbidity and mortality. Hyperlactatemia is often used as an early screening tool, but this non-continuous measurement requires intermittent arterial line sampling. Having a non-invasive tool to rapidly detect inadequate DO2 is of great clinical relevance. The respiratory exchange ratio (RER) can be easily measured in all intubated patients and has been shown to predict postoperative complications. We therefore aimed to assess the discriminative ability of the RER to detect an inadequate DO2 as reflected by hyperlactatemia in patients having intermediate-to-high risk abdominal surgery. METHODS: This historical cohort study included all consecutive patients who underwent intermediate-to-high risk surgery from January 1st, 2014, to April 30th, 2019 except those who did not have RER and/or arterial lactate measured. Blood lactate levels were measured routinely at the beginning and end of surgery and RER was calculated at the same moment as the blood gas sampling. The present study tested the hypothesis that RER measured at the end of surgery could detect hyperlactatemia at that time. A receiver operating characteristic (ROC) curve was constructed to assess if RER calculated at the end of the surgery could detect hyperlactatemia. The chosen RER threshold corresponded to the highest value of the sum of the specificity and the sensitivity (Youden Index). RESULTS: Among the 996 patients available in our study cohort, 941 were included and analyzed. The area under the ROC curve was 0.73 (95% CI: 0.70 to 0.76; p < 0.001), with a RER threshold of 0.75, allowing to discriminate a lactate > 1.5 mmol/L with a sensitivity of 87.5% and a specificity of 49.5%. CONCLUSION: In mechanically ventilated patients undergoing intermediate to high-risk abdominal surgery, the RER had moderate discriminative abilities to detect hyperlactatemia. Increased values should prompt clinicians to investigate for the presence of hyperlactatemia and treat any potential causes of DO2/VO2 mismatch as suggested by the subsequent presence of hyperlactatemia.
Assuntos
Hiperlactatemia , Estudos de Coortes , Humanos , Ácido Láctico , Complicações Pós-Operatórias/diagnósticoRESUMO
Assessing the impact of mining activity on the availability of environmental pollutants is crucial for informing health policies in anticipation of future production scenarios of critical minerals essential for the transition to a net-zero carbon society. However, temporal and spatial monitoring is often sparse, and measurements may not extend far enough back in time. In this study, we utilize variations of chemical elements contained in tree-rings collected in local villages from an area heavily affected by copper mining in the Atacama Desert since the early 20th century to evaluate the temporal distribution of pollutants and their relationship with local drivers. By combining time-varying data on local drivers, such as copper production and the dry tailings deposit area, we show how the surge in copper production during the 1990s, fueled by trade liberalization and increased international demand, led to a significant increment in the availability of metal(loid)s related to mining activities on indigenous lands. Our findings suggest that the environmental legislation in Chile may be underestimating the environmental impact of tailing dams in neighboring populations, affecting the well-being of Indigenous Peoples from the Atacama mining hotspot region. We argue that future changes in production rates driven by international demand could have negative repercussions on the environment and local communities. Therefore, mining emissions and the management of tailing dams should be carefully considered to anticipate their potential negative effects on human and ecosystem health.
Assuntos
Cobre , Poluentes Ambientais , Humanos , Cobre/análise , Ecossistema , Poeira/análise , Monitoramento Ambiental , Meio AmbienteRESUMO
Indigenous communities from northern Chile have historically been exposed to the impacts of massive copper industrial activities conducted in the region. Some of the communities belonging to the Alto El Loa Indigenous Development Area are located less than 10â¯km from the "Talabre'' tailings dam, which contains residues from copper production and other metals that can be toxic to human health (e.g., As, Sb, Cd, Mo, Pb). Given the increasing demand of copper production to achieve net-zero emission scenarios and concomitant expansions of the tailings, the exposure to toxic metals is a latent risk to local communities. Despite the impact that copper production could generate on ancestral communities from northern Chile, studies and monitoring are limited and the results are often not made accessible for local communities. Here, we evaluate such risks by characterizing metal concentrations in dust collected from roofs and windows of houses from the Alto El Loa area. Our results showed that As, Sb, Cd, Cu, Mo, Ag, S, and Pb concentrations in these matrices can be connected to local copper mining activities. Additionally, air transport models indicate that high concentrations of toxic elements (As, Sb, and Cd) can be explained by the atmospheric transport of particles from the tailings in a NE direction up to 50â¯km away. Pollution indices and Health Risk Assessment suggested a highly contaminated region with a health risk for its inhabitants. Our analysis on a local scale seeks to make visible the case of northern Chile as a critical territory where actions should be taken to mitigate the effects of mining in the face of this new scenario of international demand for the raw materials necessary for the transition to a net-zero carbon global society.