Oxidation of Intravenous Lipid in Infants and Children With Systemic Inflammatory Response Syndrome and Sepsis

Caresta, Elena; Pierro, Agostino; Chowdhury, Moti; Peters, Mark; Piastra, Marco; Eaton, Simon

doi:10.1203/01.pdr.0000252441.91671.e5

Cited by 14 publications

(5 citation statements)

References 45 publications

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“…Plasma and CSF malondialdehyde (MDA) levels, a marker of lipid peroxidation, were measured by the high-performance liquid chromatography. Plasma MDA was measured as previously described using 25 μl plasma [6]. For CSF, 100 μl CSF was incubated with 2.5 μl (0.2% w/v) butylated hydroxytoluene in ethanol plus 375 μl 1% (v/v) phosphoric acid for 10 min, and 345 μl 0.22% thiobarbituric acid and incubated for 60 min at 100 °C for 60 min.…”

Section: Lipid Peroxidation Marker Measurementsmentioning

confidence: 99%

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Lipid Peroxidation and Antioxidant Consumption as Early Markers of Neurosurgery-Related Brain Injury in Children

et al. 2019

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Background and Aims Lipid peroxidation represents a marker of secondary brain injury both in traumatic and in nontraumatic conditions-as in major neurosurgical procedures-eventually leading to brain edema amplification and further brain damage. Malondialdehyde (MDA), a lipid peroxidation marker, and ascorbate, a marker of antioxidant status, can represent early indicators of this process within the cerebrospinal fluid (CSF). We hypothesized that changes in cerebral lipid peroxidation can be measured ex vivo following neurosurgery in children. Methods Thirty-six children (M:F = 19/17, median age 32.9 months; IQR 17.6-74.6) undergoing neurosurgery for brain tumor removal were admitted to the pediatric intensive care unit (PICU) in the postoperative period with an indwelling intraventricular catheter for intracranial pressure monitoring and CSF drainage. Plasma and CSF samples were obtained for serial measurement of MDA, ascorbate, and cytokines. Results An early brain-limited increase in lipid peroxidation was measured, with a significant increase from baseline of MDA in CSF (p = 0.007) but not in plasma. In parallel, ascorbate in CSF decreased (p = 0.05). Systemic inflammatory response following brain surgery was evidenced by plasma IL-6/IL-8 increase (p 0.0022 and 0.0106, respectively). No correlation was found between oxidative response and tumor site or histology (according to World Health Organization grading). Similarly, lipid peroxidation was unrelated to the length of surgery (mean 321 ± 73 min), or intraoperative blood loss (mean 20.9 ± 16.8% of preoperative volemia, 44% given hemotransfusions). Median PICU stay was 3.5 days (IQL range 2-5.5 d.), and postoperative ventilation need was 24 h (IQL range 20-61.5 h). The elevation in postoperative MDA in CSF compared with preoperative values correlated significantly with postoperative ventilation need (P = 0.05, r2 0168), while no difference in PICU stay was recorded. Conclusions Our results indicate that lipid peroxidation increases consistently following brain surgery, and it is accompanied by a decrease in antioxidant defences; intraventricular catheterization offers a unique chance of oxidative process monitoring. Further studies are needed to evaluate whether monitoring post-neurosurgical oxidative stress in CSF is of prognostic utility.

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Section: Lipid Peroxidation Marker Measurementsmentioning

confidence: 99%

“…After cooling, the MDAthiobarbituric acid derivative was extracted with 400 μl butanol. To an autosampler vial, 250 μl butanol phase was transferred, butanol evaporated off under N2 at 80 °C, and the MDAthiobarbituric acid derivative redissolved in 150 μl buffer and analyzed by HPLC as for plasma [6].…”

Section: Lipid Peroxidation Marker Measurementsmentioning

confidence: 99%

Lipid Peroxidation and Antioxidant Consumption as Early Markers of Neurosurgery-Related Brain Injury in Children

et al. 2019

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“…However, the expected change in _ VCO 2 is not necessarily equal to the change in _ VO 2 . For example, when the metabolic rate is increased as a result of injury or sepsis, fat metabolism tends to increase and the RQ decreases [12][13][14].…”

Section: Metabolism Of Comentioning

confidence: 99%

Monitoring CO2 in shock states

Danin

Siegenthaler

Levraut

et al. 2014

J Clin Monit Comput

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The primary end point when treating acute shock is to restore blood circulation, mainly by reaching macrocirculatory parameters. However, even if global haemodynamic goals can be achieved, microcirculatory perfusion may remain impaired, leading to cellular hypoxia and organ damage. Interestingly, few methods are currently available to measure the adequacy of organ blood flow and tissue oxygenation. The rise in tissue partial pressure of carbon dioxide (CO2) has been observed when tissue perfusion is decreased. In this regard, tissue partial pressure of CO2 has been proposed as an early and reliable marker of tissue hypoxia even if the mechanisms of tissue partial pressure in CO2 rise during hypoperfusion remain unclear. Several technologies allow the estimation of CO2 content from different body sites: vascular, tissular (in hollow organs, mucosal or cutaneous), and airway. These tools remain poorly evaluated, and some are used but are not widely used in clinical practice. The present review clarifies the physiology of increasing tissue CO2 during hypoperfusion and underlines the specificities of the different technologies that allow bedside estimation of tissue CO2 content.

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“…Parenteral lipid emulsions (ILE) supplies essential fatty acids and energy and are calorie dense so that the volume required for nutrition can be reduced, which is important considering the frequent need of fluid restriction among patients in the PICU. Even infants with systemic inflammatory response syndrome (SIRS) and sepsis have the capacity to oxidize intravenously administered ILE without increased lipid peroxidation, provided a limited glucose supply is given simultaneously (100). When PICU patients are parenterally fed, it is advisable to provide approximately 30% of the nonprotein calories as ILE (90).…”

Section: Fat Metabolism and Requirementmentioning

confidence: 99%