Mark Wefers Bettink

Chapter 11 192 the monitoring technique might be of additional value for an anesthesiologist during challenging operations. The goal of an anesthesiologist, safeguarding oxygen supply and thereby organ function during an operation, may benefit from direct cellular oxygen monitoring. Future perspectives In our experimental work we should link the change of mitochondrial function in vivo (COMET) and ex vivo (mitochondrial function in platelets in own serum) to the elevation of mtDNA. Measuring the changes of in vivo and ex vivo mitochondrial dysfunction over time may show which method of monitoring mitochondrial function is more sensitive to measure these changes earlier. We should measure the effect of treatment of mitochondrial dysfunction on organ function or changes biomarkers associated with outcome like lactate concentration. Further work is needed to determine if a decline and elevation of mitochondrial function in sepsis is part of an pathophysiological pattern in sepsis or may even be a different phenotype of the disease. The COMET monitor is sufficiently capable of measuring mitochondrial oxygenation and respiration on the ICU. There is no knowledge of normal values of mitochondrial respiration in the age group mostly affected by sepsis, namely the age group of 60 and over. Although finding a sufficiently linked control group to the sepsis group is challenging, I strongly believe the next studies with the COMET monitor should include at least an healthy control group and possibly also an IC control group. As an example for an IC study I suggest measuring mitochondrial function as early as reasonably possible on the ICU in combination with a more longitudinal approach. In this longitudinal approach it would be nice to measure mitochondrial respiration multiple times per day for a couple of days. In the described longitudinal approach, measuring mitochondrial respiration during the different phases of sepsis will help with determining the role of mitochondria in the pathophysiology of sepsis. The COMET monitor could be of additional value in the current field of cellular monitoring of oxygenation and mitochondrial function. At the moment we are finishing our ongoing studies of monitoring of cellular oxygenation in patients under anesthesia and using the decline of mitoPO 2 from baseline as a possible individual transfusion target. In the future monitoring of cellular oxygenation could help anesthesiologist during the stabilization of patients in major operations like multi trauma patients, transplantation of major organs or thoracic surgery.