Resuscitation fluids as drugs: targeting the endothelial glycocalyx.
10.1097/CM9.0000000000001869
- VernacularTitle:Resuscitation fluids as drugs: targeting the endothelial glycocalyx
- Author:
Guangjian WANG
1
;
Hongmin ZHANG
;
Dawei LIU
;
Xiaoting WANG
Author Information
1. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China.
- Collective Name:Chinese Critical Ultrasound Study Group
- Publication Type:Review
- MeSH:
Animals;
Colloids;
Crystalloid Solutions/therapeutic use*;
Fluid Therapy;
Glycocalyx;
Humans;
Hydroxyethyl Starch Derivatives;
Isotonic Solutions;
Microcirculation;
Resuscitation
- From:
Chinese Medical Journal
2022;135(2):137-144
- CountryChina
- Language:English
-
Abstract:
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.
