Endothelial Glycocalyx

[Boujee]

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Hey guys I'm havin a hard time understanding the "clinical" relevance of the endothelial glycocalyx during perioperative fluid administration...

So there is an oncotic gradient within the membrane itself providing an opposing force to the intravascular hydrostatic pressure with an end result of "less" fluid shifts into the interstitium than previously thought...

Also, by expanding the intravascular space we can disrupt this boundary and cause a shift of fluid into the interstitial space causing edema and its deleterious effects...this is through the release of ANP...

Ok guys this is what i can summarize about my recent reading...my question is: how does this new knowledge change our management?

Thank you in advance for any insight...

 

[coprolalia]

It doesn't. You read a review paper. This subject is far from solved. When you don't give fluids then you have to give pressors to maintain end-organ perfusion. And, there are trade-offs to that too with no clear evidence that the latter is better.

Point is, excessive crystalloids probably "wash off" the endothelial glycocalyx. We probably aren't using enough colloid. That's the take-home message of that review article.

-copro