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Resuscitation fluids as drugs: targeting the endothelial glycocalyx
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 microcircul...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8769111/ https://www.ncbi.nlm.nih.gov/pubmed/34985018 http://dx.doi.org/10.1097/CM9.0000000000001869 |
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author | Wang, Guangjian Zhang, Hongmin Liu, Dawei Wang, Xiaoting |
author_facet | Wang, Guangjian Zhang, Hongmin Liu, Dawei Wang, Xiaoting |
author_sort | Wang, Guangjian |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8769111 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-87691112022-01-20 Resuscitation fluids as drugs: targeting the endothelial glycocalyx Wang, Guangjian Zhang, Hongmin Liu, Dawei Wang, Xiaoting Chin Med J (Engl) Review Article 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. Lippincott Williams & Wilkins 2022-01-20 2022-01-04 /pmc/articles/PMC8769111/ /pubmed/34985018 http://dx.doi.org/10.1097/CM9.0000000000001869 Text en Copyright © 2022 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) |
spellingShingle | Review Article Wang, Guangjian Zhang, Hongmin Liu, Dawei Wang, Xiaoting Resuscitation fluids as drugs: targeting the endothelial glycocalyx |
title | Resuscitation fluids as drugs: targeting the endothelial glycocalyx |
title_full | Resuscitation fluids as drugs: targeting the endothelial glycocalyx |
title_fullStr | Resuscitation fluids as drugs: targeting the endothelial glycocalyx |
title_full_unstemmed | Resuscitation fluids as drugs: targeting the endothelial glycocalyx |
title_short | Resuscitation fluids as drugs: targeting the endothelial glycocalyx |
title_sort | resuscitation fluids as drugs: targeting the endothelial glycocalyx |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8769111/ https://www.ncbi.nlm.nih.gov/pubmed/34985018 http://dx.doi.org/10.1097/CM9.0000000000001869 |
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