Chest
-
The clinical assessment of intravascular volume status and volume responsiveness is one of the most difficult tasks in critical care medicine. Furthermore, accumulating evidence suggests that both inadequate and overzealous fluid resuscitation are associated with poor outcomes. The objective of this study was to determine the predictive value of passive leg raising (PLR)- induced changes in stroke volume index (SVI) as assessed by bioreactance in predicting volume responsiveness in a heterogenous group of patients in the ICU. A secondary end point was to evaluate the change in carotid Doppler fl ow following the PLR maneuver. ⋯ Monitoring the hemodynamic response to a PLR maneuver using bioreactance provides an accurate method of assessing volume responsiveness in critically ill patients. In addition, the study suggests that changes in carotid blood fl ow following a PLR maneuver may be a useful adjunctive method for determining fluid responsiveness in hemodynamically unstable patients.
-
Exposure to hazardous heavy metals such as cadmium and lead has been associated with several chronic diseases. Heavy metal exposure may contribute to increased oxidative stress and inflammation in the lungs, resulting in tissue destruction manifesting clinically as obstructive lung disease (OLD). We aimed to evaluate the association between serum cadmium and lead concentration and OLD. ⋯ In a large representative sample of the US population, we demonstrated a significant association between OLD and serum cadmium and lead concentrations. Cadmium appeared to partially mediate the association between smoking and OLD. A dose-response effect between increasing cadmium concentration and progressively worsening lung function was observed in smokers.
-
The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) suppress ambient particulate matter, 10 μm (PM(10) )-induced inflammatory response in vitro. The aim of this study was to determine the effect of statins on PM(10) -induced lung inflammation in vivo. ⋯ Lovastatin attenuates the PM(10) -induced recruitment and activation of alveolar macrophages and polymorphonuclear leukocytes, reduces local proinflammatory cytokine production, and promotes the clearance of PM(10) particles from lung tissues to regional lymph nodes. These novel pleiotropic properties of statins are most likely to contribute to the downregulation of PM(10) -induced lung inflammation.