Effects of different mean arterial pressure targets on plasma volume, ANP and glycocalyx—A randomized trial

Damén, Tor; Saadati, Sofia; Forssell-Aronsson, Eva; Hesse, Camilla; Bentzer, Peter; Ricksten, Sven Erik; Nygren, Andreas

doi:10.1111/aas.13710

Cited by 8 publications

(6 citation statements)

References 28 publications

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“…In addition, general anaesthesia with complete sedation and analgesia can inhibit systemic inflammation to a large extent (Chaiyakulsil et al., 2018; Sasaki et al., 2017; Vos et al., 2015). Intraoperative mean arterial blood pressure is kept very stable to ensure organ perfusion (Damén et al., 2021). The prognosis of patients in the three groups was similar, and all patients were discharged from the hospital smoothly.…”

Section: Discussionmentioning

confidence: 99%

Effect of different levels of stroke volume variation on the endothelial glycocalyx of patients undergoing colorectal surgery: A randomized clinical trial

Liu

Chen

Gao

et al. 2021

Experimental Physiology

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New Findings What is the central question of this study?Massive infusion can destroy the endothelial glycocalyx. We compared the serum concentrations of endothelial glycocalyx components and atrial natriuretic peptide and the outcomes of patients with different levels of stroke volume variation (SVV). What is the main finding and its importance?With a decrease in SVV, the serum concentrations of endothelial glycocalyx components and atrial natriuretic peptide increased, whereas the oxygenation index decreased. When the intraoperative SVV was maintained at 7−10%, the patients had better postoperative recovery and shorter postoperative hospital stays. Therefore, it is advisable to maintain the SVV between 7 and 10%. Abstract Dynamic haemodynamic parameters, such as stroke volume variation (SVV), can be used for blood volume monitoring. However, studies have determined the SVV threshold but not the optimal level. The endothelial glycocalyx (EG) plays an important role in maintaining vascular permeability. Moreover, rapid and massive infusion can lead to the degradation, shedding and destruction of the EG. We aimed to explore the effects of different SVV values (11–14, 7–10 or 3–6%) on the EG in 54 patients who were scheduled for elective colorectal tumour surgery and to identify the optimal peri‐operative fluid therapy strategy. The concentrations of EG degradation products (heparin sulphate, hyaluronic acid and syndecan‐1) and atrial natriuretic peptide were higher when the SVV was maintained between 3 and 6% after fluid therapy compared with pre‐infusion (P < 0.05). Comparison of postoperative complications and hospitalization time among the three SVV levels was not statistically significant (P > 0.05). The postoperative hospitalization time in patients with SVV of 7–10% was shorter than that in patients with SVV of 3–6%. Infusion of a large volume of fluid, with increasing EG degeneration and atrial natriuretic peptide concentrations, might be related to postoperative outcomes.

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Section: Discussionmentioning

confidence: 99%

Effect of different levels of stroke volume variation on the endothelial glycocalyx of patients undergoing colorectal surgery: A randomized clinical trial

Liu

Chen

Gao

et al. 2021

Experimental Physiology

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“…The increases in BV in the two groups were greater than expected. The explanation of this phenomenon is that a decrease in blood pressure during the induction of anesthesia increased the plasma volume [ 17 , 18 ]. The calculated increase in plasma volume without fluid infusion during the induction of anesthesia was 10–15% [ 17 ], corresponding to a 310 to 460 mL increase in plasma volume.…”

Section: Discussionmentioning

confidence: 99%

Intra-operative intravascular effect of the difference in colloid solutions during acute normovolemic hemodilution

et al. 2021

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Background Acute normovolemic hemodilution (ANH) is used to reduce the risk of peri-operative allogeneic blood transfusion. Although crystalloid and/or colloid solutions have been used for volume replacement during ANH, no studies have examined the differences among solutions on the volume status, electrolytes, acid-base balance, and hemodynamic status during surgery with ANH. Methods We retrospectively compared the effect of Ringer’s lactate with 3% dextran-40 (Saviosol®, DEX group) and 6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (Voluven®, HES group) on blood hemoglobin serum electrolytes and estimated blood volume before induction of anesthesia (baseline), after ANH and after blood transfusion following surgery in patients undergoing open gynecological surgery (n = 111 and 67, respectively). The primary outcomes were the changes in hemoglobin and electrolytes after ANH. Results There were no differences in hemoglobin or electrolytes between the two groups at baseline. Postoperative hemoglobin was significantly higher (11.0 ± 1.5 g/dL vs 9.9 ± 1.3 g/dL) (mean ± SD) in the DEX group than in the HES group (p = 0.03). Postoperative potassium was significantly decreased from the baseline both in the DEX group (137.9 ± 2.5 mmol/L vs 136.3 ± 2.7 mmol/L) and in the HES group (138.3 ± 2.0 mmol/L vs 137.8 ± 2.5 mmol/L) (p < 0.001 for both); however, it was significantly higher than in the DEX group after surgery (p < 0.001). Estimated blood volume after surgery was significantly increased after ANH in both groups; however, it was larger in the HES group than in the DEX group. Conclusions Postoperative hemoglobin and potassium were significantly higher, and estimated blood volume was significantly smaller in the DEX than in the HES group.

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“…[ 3 ] However, not all studies support this viewpoint. [ 19 , 20 ] Oscillatory shear stress caused by intravenous infusion may directly induce glycocalyx degradation, [ 10 ] indicating that the rate of intravenous infusion can also affect the glycocalyx integrity. However, recent studies showed no difference between intravenous infusion at a faster versus slower rate.…”

Section: Common Factors Of Fluid Resuscitation Affecting the Glycocalyxmentioning

confidence: 99%

Resuscitation fluids as drugs: targeting the endothelial glycocalyx

Wang

Zhang²,

Liu³

et al. 2022

Chinese Medical Journal

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Fluid resuscitation is an essential intervention in critically ill patients, and its ultimate goal is to restore tissue perfusion. Critical illnesses are often accompanied by glycocalyx degradation caused by inflammatory reactions, hypoperfusion, shock, and so forth, leading to disturbed microcirculatory perfusion and organ dysfunction. Therefore, maintaining or even restoring the glycocalyx integrity may be of high priority in the therapeutic strategy. Like drugs, however, different resuscitation fluids may have beneficial or harmful effects on the integrity of the glycocalyx. The purpose of this article is to review the effects of different resuscitation fluids on the glycocalyx. Many animal studies have shown that normal saline might be associated with glycocalyx degradation, but clinical studies have not confirmed this finding. Hydroxyethyl starch (HES), rather than other synthetic colloids, may restore the glycocalyx. However, the use of HES also leads to serious adverse events such as acute kidney injury and bleeding tendencies. Some studies have suggested that albumin may restore the glycocalyx, whereas others have suggested that balanced crystalloids might aggravate glycocalyx degradation. Notably, most studies did not correct the effects of the infusion rate or fluid volume; therefore, the results of using balanced crystalloids remain unclear. Moreover, mainly animal studies have suggested that plasma may protect and restore glycocalyx integrity, and this still requires confirmation by high-quality clinical studies.

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Effects of different mean arterial pressure targets on plasma volume, ANP and glycocalyx—A randomized trial

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 8 publications

References 28 publications

Effect of different levels of stroke volume variation on the endothelial glycocalyx of patients undergoing colorectal surgery: A randomized clinical trial

Effect of different levels of stroke volume variation on the endothelial glycocalyx of patients undergoing colorectal surgery: A randomized clinical trial

Intra-operative intravascular effect of the difference in colloid solutions during acute normovolemic hemodilution

Resuscitation fluids as drugs: targeting the endothelial glycocalyx

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