Resuscitation Fluid Choices to Preserve the Endothelial Glycocalyx

Milford, Elissa M.; Reade, Michael C.

doi:10.1186/s13054-019-2369-x

Cited by 98 publications

(76 citation statements)

References 53 publications

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“…Preservation of this layer by preventing shedding of glycocalyx components, or accelerating repair may be a potential therapeutic target (20). Although no therapeutic agents to abrogate glycocalyx breakdown have yet been investigated in humans with dengue, interest is growing in the potential to translate therapeutics developed for other indications; these include strategies to inhibit heparanase activity [modified heparins, Sulodexide (24)], downregulate MMP activity to reduce proteoglycan shedding [S1P analogs (25,26)], use intravenous fluids (IV) which may accelerate glycocalyx repair (27) [albumin (28), fresh frozen plasma (29)], or avoid bolus administration of IV fluids to prevent further damage to a fragile glycocalyx (30). However, screening of such therapeutic strategies for vascular leak in dengue requires an improvement in vitro models to evaluate glycocalyx integrity.…”

Section: Discussionmentioning

confidence: 99%

Visual and Biochemical Evidence of Glycocalyx Disruption in Human Dengue Infection, and Association With Plasma Leakage Severity

Lam

McBride

et al. 2020

Front. Med.

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Background: Dengue is the most common arboviral infection globally; a minority of patients develop shock due to profound plasma leak through a disrupted endothelial barrier. Understanding of the pathophysiology underlying plasma leak is incomplete, but emerging evidence indicates a key role for degradation of the endothelial glycocalyx. Conclusions: We present the first human in vivo evidence of glycocalyx disruption in dengue, with worse visual glycocalyx damage and higher plasma degradation products associated with more severe plasma leak.

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Section: Discussionmentioning

confidence: 99%

Visual and Biochemical Evidence of Glycocalyx Disruption in Human Dengue Infection, and Association With Plasma Leakage Severity

Lam

McBride

et al. 2020

Front. Med.

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“…Starling originally hypothesized in 1896 that opposing hydrostatic and oncotic pressures in the capillaries of the microcirculation determined fluid flow between the intravascular and interstitial fluid compartments (28). In line with this model administration of colloids became an accepted strategy for management of hypovolaemic shock (37)]. EGL, endothelial glycocalyx layer.…”

Section: Dengue Associated Vascular Leakage In the Context Of The Revmentioning

confidence: 99%

“…fluid reabsorption as dictated by the original Starling model (31,(35)(36)(37). Any fluid that is filtered returns to the circulation via lymphatic channels; in response to increased pressure in local lymphatics, fluid flow toward the thoracic duct increases markedly, but the protein (primarily albumin) content of the returned fluid is low compared to plasma (31).…”

Section: Dengue Associated Vascular Leakage In the Context Of The Revmentioning

confidence: 99%

“…There is however, a situation in which interstitial fluid can flow back up the inter-endothelial clefts and enter the subglycocalyx space. If capillary pressure is severely reduced (e.g., in profound shock) the pressure dynamics within the clefts alter and there is an immediate but transient reversal from filtration to reabsorption (so called autotransfusion) until the capillary pressure rises again and a new steady state condition with reduced filtration becomes established after about 30 min (Figure 2) (35)(36)(37).…”

Section: Dengue Associated Vascular Leakage In the Context Of The Revmentioning

confidence: 99%

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Microvascular Fluid Exchange: Implications of the Revised Starling Model for Resuscitation of Dengue Shock Syndrome

Trieu

Wills

2020

Front. Med.

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Dengue is the most common mosquito-borne viral infection in the world. The most feared complication is a poorly understood vasculopathy that occurs in only a small minority of symptomatic individuals, especially children and young adults, but can result in potentially fatal dengue shock syndrome (DSS). Based mainly on expert opinion, WHO management guidelines for DSS recommend prompt infusion of a crystalloid fluid bolus followed by a tapering crystalloid fluid regimen, supplemented if necessary by boluses of synthetic colloid solutions. However, following publication of a number of major trials undertaken in other, primarily adult, critical care scenarios, use of both synthetic colloid solutions and of fluid boluses for volume expansion have become controversial. Synthetic colloids tend to be used for severe DSS cases in order to boost intravascular oncotic pressure, based on the classic Starling hypothesis in which opposing hydrostatic and oncotic forces determine fluid flow across the microvascular barrier. However, the revised Starling model emphasizes the critical contribution of the endothelial glycocalyx layer (EGL), indicating that it is the effective oncotic pressure gradient across the EGL not endothelial cells per se that opposes filtration. Based on several novel concepts that are integral to the revised Starling model, we review the clinical features of DSS and discuss a number of implications that are relevant for fluid management. We also highlight the need for context-specific clinical trials that address crucially important questions around the management of DSS.

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“…The high molecular weight of the dissolved colloid molecules contributes to oncotic pressure to retain water within the intravascular space (Pachtinger & Drobatz 2008). Colloids may be considered advantageous in the treatment of recurrent hypovolaemia and/or hypoproteinemia, particularly if the glycocalyx integrity is still preserved (Milford & Reade 2019). Colloids can be divided into natural products, such as plasma or albumin, and synthetic products including gelatins, hydroxyethyl starches (HES) and dextrans.…”

Section: Introductionmentioning

confidence: 99%

Current fluid and blood product availability in veterinary setting: a survey of UK small animal practices

Beeston

Charnock

Cook

2020

J of Small Animal Practice

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Objectives To investigate and discuss current fluid and blood products stocked in small animal practices in the UK. Methods An online survey was circulated to small animal veterinary practices across the UK. The survey included questions regarding the level of hospital care provided, the type of fluid and blood component products stocked, the most frequently restocked products, and the available options in the event that blood products were required but not stocked. Results There were 423 responses including 27 duplicates. The remaining 396 respondents represented a spectrum of practices including 19 referral practices. Crystalloids were stocked in all practices. Lactated Ringer's solution was the most frequently re‐stocked product in 355 of 396 (90%) of practices. Where synthetic colloids were stocked, gelatin‐based colloids (155/178 [87%]) were stocked in preference to hydroxyethyl starches (23/178 [13%]). Blood products were stocked by 81 of 396 (20%) of practices. If a blood product was required but not stocked, 31% of practices would use a pet blood banking service, 28% would use their own blood donors, and 21% would refer. Clinical Significance This study provides an insight into the fluid and blood products stocked and used by a selection of veterinary practices within the UK and serves as a baseline for ongoing research and decision‐making in both veterinary practice and industry.

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Resuscitation Fluid Choices to Preserve the Endothelial Glycocalyx

Cited by 98 publications

References 53 publications

Visual and Biochemical Evidence of Glycocalyx Disruption in Human Dengue Infection, and Association With Plasma Leakage Severity

Visual and Biochemical Evidence of Glycocalyx Disruption in Human Dengue Infection, and Association With Plasma Leakage Severity

Microvascular Fluid Exchange: Implications of the Revised Starling Model for Resuscitation of Dengue Shock Syndrome

Current fluid and blood product availability in veterinary setting: a survey of UK small animal practices

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