Lung Ultrasound and Electrical Impedance Tomography During Ventilator-Induced Lung Injury.

OBJECTIVES: Lung damage during mechanical ventilation involves lung volume and alveolar water content, and lung ultrasound (LUS) and electrical impedance tomography changes are related to these variables. We investigated whether these techniques may detect any signal modification during the development of ventilator-induced lung injury (VILI). DESIGN: Experimental animal study. SETTING: Experimental Department of a University Hospital. SUBJECTS: Forty-two female pigs (24.2 ± 2.0 kg). INTERVENTIONS: The animals were randomized into three groups (n = 14): high tidal volume (TV) (mean TV, 803.0 ± 121.7 mL), high respiratory rate (RR) (mean RR, 40.3 ± 1.1 beats/min), and high positive-end-expiratory pressure (PEEP) (mean PEEP, 24.0 ± 1.1 cm H2O). The study lasted 48 hours. At baseline and at 30 minutes, and subsequently every 6 hours, we recorded extravascular lung water, end-expiratory lung volume, lung strain, respiratory mechanics, hemodynamics, and gas exchange. At the same time-point, end-expiratory impedance was recorded relatively to the baseline. LUS was assessed every 12 hours in 12 fields, each scoring from 0 (presence of A-lines) to 3 (consolidation). MEASUREMENTS AND MAIN RESULTS: In a multiple regression model, the ratio between extravascular lung water and end-expiratory lung volume was significantly associated with the LUS total score (p < 0.002; adjusted R2, 0.21). The variables independently associated with the end-expiratory difference in lung impedance were lung strain (p < 0.001; adjusted R2, 0.18) and extravascular lung water (p < 0.001; adjusted R2, 0.11). CONCLUSIONS: Data suggest as follows. First, what determines the LUS score is the ratio between water and gas and not water alone. Therefore, caution is needed when an improvement of LUS score follows a variation of the lung gas content, as after a PEEP increase. Second, what determines the end-expiratory difference in lung impedance is the strain level that may disrupt the intercellular junction, therefore altering lung impedance. In addition, the increase in extravascular lung water during VILI development contributed to the observed decrease in impedance.

End-tidal to arterial PCO2 ratio: a bedside meter of the overall gas exchanger performance.

BACKGROUND: The physiological dead space is a strong indicator of severity and outcome of acute respiratory distress syndrome (ARDS). The "ideal" alveolar PCO2, in equilibrium with pulmonary capillary PCO2, is a central concept in the physiological dead space measurement. As it cannot be measured, it is surrogated by arterial PCO2 which, unfortunately, may be far higher than ideal alveolar PCO2, when the right-to-left venous admixture is present. The "ideal" alveolar PCO2 equals the end-tidal PCO2 (PETCO2) only in absence of alveolar dead space. Therefore, in the perfect gas exchanger (alveolar dead space = 0, venous admixture = 0), the PETCO2/PaCO2 is 1, as PETCO2, PACO2 and PaCO2 are equal. Our aim is to investigate if and at which extent the PETCO2/PaCO2, a comprehensive meter of the "gas exchanger" performance, is related to the anatomo physiological characteristics in ARDS. RESULTS: We retrospectively studied 200 patients with ARDS. The source was a database in which we collected since 2003 all the patients enrolled in different CT scan studies. The PETCO2/PaCO2, measured at 5 cmH2O airway pressure, significantly decreased from mild to mild-moderate moderate-severe and severe ARDS. The overall populations was divided into four groups (~ 50 patients each) according to the quartiles of the PETCO2/PaCO2 (lowest ratio, the worst = group 1, highest ratio, the best = group 4). The progressive increase PETCO2/PaCO2 from quartile 1 to 4 (i.e., the progressive approach to the "perfect" gas exchanger value of 1.0) was associated with a significant decrease of non-aerated tissue, inohomogeneity index and increase of well-aerated tissue. The respiratory system elastance significantly improved from quartile 1 to 4, as well as the PaO2/FiO2 and PaCO2. The improvement of PETCO2/PaCO2 was also associated with a significant decrease of physiological dead space and venous admixture. When PEEP was increased from 5 to 15 cmH2O, the greatest improvement of non-aerated tissue, PaO2 and venous admixture were observed in quartile 1 of PETCO2/PaCO2 and the worst deterioration of dead space in quartile 4. CONCLUSION: The ratio PETCO2/PaCO2 is highly correlated with CT scan, physiological and clinical variables. It appears as an excellent measure of the overall "gas exchanger" status.

Urban pollution.

Air pollution represents a health risk for people living in urban environment. Urban air consists in a complex mixture of chemicals and carcinogens and its effects on health can be summarized in acute respiratory effects, neoplastic nonneoplastic (e.g. chronic bronchitis) chronic respiratory effects, and effects on other organs and systems. Air pollution may be defined according to origin of the phenomena that determine it: natural causes (natural fumes, decomposition, volcanic ash) or anthropogenic causes which are the result of human activities (industrial and civil emissions). Transport is the sector that more than others contributes to the deterioration of air quality in cities. In this context, in recent years, governments of the territory were asked to advance policies aimed at solving problems related to pollution. In consideration of the many effects on health caused by pollution it becomes necessary to know the risks from exposure to various environmental pollutants and to limit and control their effects. Many are the categories of "outdoor" workers, who daily serve the in urban environment: police, drivers, newsagents, etc.

Environmental and biological monitoring of arsenic in outdoor workers exposed to urban air pollutants.

The aim of this study is to evaluate personal exposure to As in urban air in two groups of outdoor workers (traffic policemen and police drivers) of a big Italian city through: (a) environmental monitoring of As obtained by personal samples and (b) biological monitoring of total urinary As. The possible influence of smoking habit on urinary As was evaluated. We studied 122 male subjects, all Municipal Police employees: 84 traffic policemen and 38 police drivers exposed to urban pollutants. Personal exposure to As in air was significantly higher in traffic policemen than in police drivers (p=0.03). Mean age, length of service, alcohol drinking habit, number of cigarettes smoked/day and BMI were comparable between the groups of subjects studied. All subjects were working in the same urban area where they had lived for at least 5 yrs. Dietary habits and consumption of water from the water supply and/or mineral water were similar in traffic policemen and in police drivers. The values of total urinary As were significantly higher in traffic policemen (smokers and non smokers) than in police drivers (smokers and non smokers) (p=0.02). In the subgroup of non-smokers the values of total urinary As were significantly higher in traffic policemen than in police drivers (p=0.03). In traffic policemen and in police drivers total urinary As values were significantly correlated to the values of As in air (respectively r=0.9 and r=0.8, p<0.001). This is the first research in literature studying the exposure to As in outdoor workers occupationally exposed to urban pollutants, such as traffic policemen and police drivers. Personal exposure to As in the air, as well as the urinary excretion of As, is significantly higher in traffic policemen compared to drivers. These results can provide information about exposure to As in streets and in car for other categories of outdoor workers similarly exposed.

Luteinizing hormone (LH) levels in male workers exposed to urban stressors.

The aim of the study is to evaluate if occupational exposure to urban stressors could cause alterations in luteinizing hormone (LH) plasma levels in male traffic policemen vs. administrative staff of Municipal Police.After excluding the subjects with the main confounding factors, male traffic police and administrative staff of Municipal Police were matched by age, working life, body mass index (BMI), alcohol drinking habit, cigarette smoking habit and habitual consumption of Italian coffee.In 166 male traffic police mean LH values were significantly higher compared to 166 male administrative employees. The distribution of LH values in traffic police and in administrative employees was statistically significant.Our results suggest that recent exposure to urban stressors (chemical, physical and psycho-social) can alter the plasma concentration of LH. In agreement with our previous research, levels of plasma LH may be used as early biological markers, valuable for the group, used in occupational set before the appearance of the disease.