Mitochondrial Oxygen Monitoring During Surgical Repair of Congenital Diaphragmatic Hernia or Esophageal Atresia: A Feasibility Study
| Autor: | Jurgen C. de Graaff, Egbert G. Mik, Sophie A Costerus, Mark A. Wefers Bettink, Dick Tibboel |
|---|---|
| Přispěvatelé: | Pediatric Surgery, Anesthesiology |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
030204 cardiovascular system & hematology
Pediatrics surgery 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine In vivo 030225 pediatrics medicine Surgical repair Protoporphyrin IX business.industry lcsh:RJ1-570 Congenital diaphragmatic hernia lcsh:Pediatrics Brief Research Report Hypoxia (medical) medicine.disease Pathophysiology Oxygen tension mitochondria monitoring chemistry Atresia Anesthesia Pediatrics Perinatology and Child Health medicine.symptom neonate business oxygen |
| Zdroj: | Frontiers in Pediatrics, Vol 8 (2020) Frontiers in Pediatrics Frontiers in Pediatrics, 8:532. Frontiers Media S.A. |
| ISSN: | 2296-2360 |
| DOI: | 10.3389/fped.2020.00532/full |
| Popis: | Current monitoring techniques in neonates lack sensitivity for hypoxia at cellular level. The recent introduction of the non-invasive Cellular Oxygen METabolism (COMET) monitor enables measuring in vivo mitochondrial oxygen tension (mitoPO2), based on oxygen-dependent quenching of delayed fluorescence of 5-aminolevulinic acid (ALA)-enhanced protoporphyrin IX. The aim is to determine the feasibility and safety of non-invasive mitoPO2 monitoring in surgical newborns. MitoPO2 measurements were conducted in a tertiary pediatric center during surgical repair of congenital diaphragmatic hernia or esophageal atresia. Intraoperative mitoPO2 monitoring was performed with a COMET monitor in 11 congenital diaphragmatic hernia and four esophageal atresia neonates with the median age at surgery being 2 days (IQR 1.25–5.75). Measurements were done at the skin and oxygen-dependent delayed fluorescence was measurable after at least 4 h application of an ALA plaster. Pathophysiological disturbances led to perturbations in mitoPO2 and were not observed with standard monitoring modalities. The technique did not cause damage to the skin, and seemed safe in this respect in all patients, and in 12 cases intraoperative monitoring was successfully completed. Some external and potentially preventable factors—the measurement site being exposed to the disinfectant chlorohexidine, purple skin marker, or infrared light—seemed responsible for the inability to detect an adequate delayed fluorescence signal. In conclusion, this is the first study showing it is possible to measure mitoPO2 in neonates and that the cutaneous administration of ALA to neonates in the described situation can be safely applied. Preliminary data suggests that mitoPO2 in neonates responds to perturbations in physiological status. |
| Databáze: | OpenAIRE |
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