The role of the glycocalyx in transvascular fluid shifts

Paptistella, Michaela; Chappell, Daniel; Hofmann-Kiefer, Klaus; Kämmerer, T; Conzen, P.; Rehm, Markus

doi:10.1111/j.1778-428x.2010.01143.x

Cited by 7 publications

(5 citation statements)

References 77 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 20 , 21 Coagulopathy, third spacing, and microvascular dysfunction are associated with EG shedding. 15 , 20 – 24 The severity of pathology observed from trauma-related endotheliopathy is associated with the severity of glycocalyx shedding. 25 …”

Section: Shedding and Resuscitationmentioning

confidence: 99%

Resuscitating the Endothelial Glycocalyx in Trauma and Hemorrhagic Shock

Anand

Reyes

Sjöquist

et al. 2023

Annals of Surgery Open

View full text Add to dashboard Cite

The endothelium is lined by a protective mesh of proteins and carbohydrates called the endothelial glycocalyx (EG). This layer creates a negatively charged gel-like barrier between the vascular environment and the surface of the endothelial cell. When intact the EG serves multiple functions, including mechanotransduction, cell signaling, regulation of permeability and fluid exchange across the microvasculature, and management of cell-cell interactions. In trauma and/or hemorrhagic shock, the glycocalyx is broken down, resulting in the shedding of its individual components. The shedding of the EG is associated with increased systemic inflammation, microvascular permeability, and flow-induced vasodilation, leading to further physiologic derangements. Animal and human studies have shown that the greater the severity of the injury, the greater the degree of shedding, which is associated with poor patient outcomes. Additional studies have shown that prioritizing certain resuscitation fluids, such as plasma, cryoprecipitate, and whole blood over crystalloid shows improved outcomes in hemorrhaging patients, potentially through a decrease in EG shedding impacting downstream signaling. The purpose of the following paragraphs is to briefly describe the EG, review the impact of EG shedding and hemorrhagic shock, and begin entertaining the notion of directed resuscitation. Directed resuscitation emphasizes transitioning from macroscopic 1:1 resuscitation to efforts that focus on minimizing EG shedding and maximizing its reconstitution.

show abstract

Section: Shedding and Resuscitationmentioning

confidence: 99%

Resuscitating the Endothelial Glycocalyx in Trauma and Hemorrhagic Shock

Anand

Reyes

Sjöquist

et al. 2023

Annals of Surgery Open

View full text Add to dashboard Cite

show abstract

“…Fluid dynamics within tissues are complex. In recent years the endothelial glycocalyx has been identified as an important consideration in the formation of extravascular fluid, as well as the forces described by Starling ( 3 , 4 ). Starling's original model defined the movement of fluids from the semi-permeable intravascular spaces as being subject to intra- and extravascular colloid osmotic pressure (COP) and hydrostatic forces, specifically the gradients formed between these at the arterial and venous ends of the capillary.…”

Section: Fluid Dynamics In the Lungmentioning

confidence: 99%

Fluid Therapy in Pulmonary Disease: How Careful Do We Need to Be?

Adamantos

2021

Front. Vet. Sci.

View full text Add to dashboard Cite

Intravenous fluid therapy is a vital and life-saving therapeutic in veterinary medicine. In the absence of heart or lung disease, trauma or sepsis there is limited evidence that fluid therapy will have a detrimental effect on lung function. In healthy dogs there is a reasonable level of experimental evidence that supraphysiologic rates of fluid are required before signs of fluid overload are made evident. In cats, however, this may not be the case. There are higher rates of asymptomatic myocardial disease, but even in the absence of that it seems that some cats may be susceptible to fluid overload. Where systemic inflammation already exists the careful homeostatic and protective mechanisms within the lung are deranged and increases in hydrostatic pressure are more likely to result in fluid movement into the lung tissues. Strategies including restricting the use of intravenous crystalloid fluid administration and using blood products for management of severe hemorrhage are of increasing importance in human trauma and seem to be associated with fewer pulmonary complications, and lower mortality. Managing dogs and cats with sepsis and acute respiratory distress syndrome is already challenging, but ensuring adequate vascular expansion needs to be balanced with avoiding excessive volume administration which may negatively impact pulmonary function. While fluids remain crucial to management of these conditions, there will be an ongoing requirement to balance need without providing excess. The use of point of care ultrasound may provide clinicians with a non-invasive and accessible way to do this.

show abstract

“…The endothelial surface layer plays an important role in maintaining the proper functions of coagulation and immune systems. The use of albumin has been shown to maintain the integrity of endothelial surface layer, which could have effect on the volume of blood transfusion and the patients' outcome 4‐7. Maintaining intraoperative hemodynamic stability is very crucial as hemodynamic instability could contribute to coagulopathy and increase risk of blood transfusion.…”

mentioning

confidence: 99%