Jacob M, Bruegger D, Rehm M, Welsch U, Conzen P, Becker BF: Contrasting effects of colloid and crystalloid resuscitation fluids on cardiac vascular permeability

Clinic of Anesthesiology, Ludwig-Maximilians University Munich, Germany.
Anesthesiology (Impact Factor: 5.88). 06/2006; 104(6):1223-31. DOI: 10.1097/00000542-200606000-00018
Source: PubMed


Fluid extravasation may lead to myocardial edema and consequent reduction in ventricular function. Albumin is presumed to interact with the endothelial glycocalyx. The authors' objective was to compare the impact of different resuscitation fluids (human albumin, hydroxyethyl starch, saline) on vascular integrity.
In an isolated perfused heart model (guinea pig), Krebs-Henseleit buffer was augmented with colloids (one third volume 5% albumin or 6% hydroxyethyl starch 130/0.4) or crystalloid (0.9% saline). Perfusion pressure and vascular fluid filtration (epicardial transudate formation) were assessed at different flow rates. After global, stopped-flow ischemia (37 degrees C, 20 min), hearts were reperfused with the same resuscitation fluid additives. In a second series, the authors applied the respective perfusates after enzymatic digestion of the endothelial glycocalyx (heparinase, 10 U over 15 min).
Both 5% albumin and 6% hydroxyethyl starch decreased fluid extravasation versus saline (68.4 +/- 5.9, 134.8 +/- 20.5, and 436.8 +/- 14.7 microl/min, respectively, at 60 cm H(2)O perfusion pressure; P < 0.05), the corresponding colloid osmotic pressures being 2.95, 5.45, and 0.00 mmHg. Digestion of the endothelial glycocalyx decreased coronary integrity in both colloid groups. After ischemia, a transient increase in vascular leak occurred with Krebs-Henseleit buffer containing hydroxyethyl starch and saline, but not with albumin. The authors observed no difference between intravascular and bulk interstitial colloid concentration in the steady state. Notwithstanding, electron microscopy revealed an intact endothelial glycocalyx and no interstitial edema in the albumin group.
Ex vivo, albumin more effectively prevented fluid extravasation in the heart than crystalloid or artificial colloid. This effect was partly independent of colloid osmotic pressure and may be attributable to an interaction of albumin with the endothelial glycocalyx.

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    • "Albumin supplementation significantly attenuated pronounced shedding of the glycocalyx as well as interstitial edema and the increased adhesion of leukocytes observed after a cold ischemia. Interestingly, experimental studies suggest that concentrations of albumin significantly lower than the physiological value may be sufficient to protect vascular integrity [139]. "
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    ABSTRACT: The glycocalyx of the endothelium is an intravascular compartment that creates a barrier between circulating blood and the vessel wall. The glycocalyx is suggested to play an important role in numerous physiological processes including the regulation of vascular permeability, the prevention of the margination of blood cells to the vessel wall, and the transmission of shear stress. Various theoretical models and experimental approaches provide data about changes to the structure and functions of the glycocalyx under various types of inflammatory conditions. These alterations are suggested to promote inflammatory processes in vessels and contribute to the pathogenesis of number of diseases. In this review we summarize current knowledge about the modulation of the glycocalyx under inflammatory conditions and the consequences for the course of inflammation in vessels. The structure and functions of endothelial glycocalyx are briefly discussed in the context of methodological approaches regarding the determination of endothelial glycocalyx and the uncertainty and challenges involved in glycocalyx structure determination. In addition, the modulation of glycocalyx structure under inflammatory conditions and the possible consequences for pathogenesis of selected diseases and medical conditions (in particular, diabetes, atherosclerosis, ischemia/reperfusion, and sepsis) are summarized. Finally, therapeutic strategies to ameliorate glycocalyx dysfunction suggested by various authors are discussed.
    Full-text · Article · Apr 2014 · Mediators of Inflammation
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    • "For these reasons, it is not surprising that prior attempts have been made to measure electrical potentials on and around acupuncture points. A total of four studies within the English literature reported that the electrical potential at acupuncture points were, on average, 5 to 100 mV more positive than adjacent skin areas [8, 16, 17, 35]. The non-English literature also agreed with this relative direction in potential [17, 36]. "
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    Full-text · Article · Dec 2012 · Evidence-based Complementary and Alternative Medicine
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    • "Lopes et al. [31], in their work revealed that there is reduced morbidity and hospital stay by GDT and this was associated with a reduced interleukin-6 response. Other studies on perioperative changes of the vascular barrier suggest that the endothelial glycocalyx plays a key role [28] [32]. "
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    Full-text · Article · Jan 2012 · Egyptian Journal of Anaesthesia
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