Oxidative Stress and Neonatal Respiratory Extracorporeal Membrane Oxygenation

Abstract

Oxidative stress is a frequent condition in critically ill patients, especially if exposed to extracorporeal circulation, and it is associated with worse outcomes and increased mortality. The inflammation triggered by the contact of blood with a non-endogenous surface, the use of high volumes of packed red blood cells and platelets transfusion, the risk of hyperoxia and the impairment of antioxidation systems contribute to the increase of reactive oxygen species and the imbalance of the redox system. This is responsible for the increased production of superoxide anion, hydrogen peroxide, hydroxyl radicals, and peroxynitrite resulting in increased lipid peroxidation, protein oxidation, and DNA damage. The understanding of the pathophysiologic mechanisms leading to redox imbalance would pave the way for the future development of preventive approaches. This review provides an overview of the clinical impact of the oxidative stress during neonatal extracorporeal support and concludes with a brief perspective on the current antioxidant strategies, with the aim to focus on the potential oxidative stress-mediated cell damage that has been implicated in both short and long-term outcomes.

Towards Biohybrid Lung Development—Fibronectin-Coating Bestows Hemocompatibility of Gas Exchange Hollow Fiber Membranes by Improving Flow-Resistant Endothelialization

“…In order to exert flow conditions, we established a BioStat mock circulation, which was designed to simulate BHL relevant, clinical settings [28], imitating various pO 2 and pCO 2 blood levels as seen in patients suffering from different lung diseases, or rather different flow dynamics during disease dependent BHL application, e.g., veno-venous or rather veno-arterial [41] cannulation, providing the important pre-translational test platform for BHL assessment under these disease-like conditions. However, the set-up used in this study ensured constant arterial blood parameters under the applied flow conditions, to exclude any detrimental effects on the EC monolayer behavior, e.g., glycocalyx degradation, as seen for example in ischemia and reperfusion injury [42] or rather ROS (reactive oxygen species) production, which occurs during hyperoxemia and adversely triggers pro-inflammatory cell responses or even induces apoptosis [43].…”

Interprofessional Consensus Regarding Design Requirements for Liquid-Based Perinatal Life Support (PLS) Technology

“…Of these, the elimination of urinary excreted substances would be most likely technical feasible with current medical technology ( 36 ). Technical challenges lie within the objective to minimize activation of coagulation and inflammation induced by foreign surfaces ( 37 ), and in appropriate sizing.…”

Iron Homeostasis Disruption and Oxidative Stress in Preterm Newborns

“…Finally, procedures that require massive blood products exposure, as in the case of exchange transfusion or extracorporeal membrane oxygenation, further increases the neonatal exposure to hemolysis, oxidative stress and, hence, the risk of mortality [117,118].…”