Oxidative and Nitrosative Stress in Critical Illness and Injury

Abstract

The study of mediators and pathways of oxidative stress and nitrosative stress have been underway for decades, but the role of free radicals in the pathogenesis and treatment of disease remains incompletely understood. Recent years have seen a rapid escalation in research concerning the links between cellular mechanisms of disease and the clinical management of injury and illness. Reactive oxygen species and reactive nitrogen species are now understood to play a significant role in disordered cellular processes as well as having key regulatory roles in normal cellular physiology and healing. This chapter is focused on oxidative and nitrosative stress as it translates to the practice of pediatric critical care. The first part of this chapter reviews some fundamental concepts of oxidative and nitrosative regulation and stress. The roles of reactive oxygen and nitrogen species in select aspects of normal cellular homeostasis and physiologic function including endothelial function, immune system regulation and mitochondrial respiration are presented in the second part. The final section of this chapter discusses the role of these free radicals in select disease states chosen for their particular relevance to pediatric critical care.