The endothelial glycocalyx and fluid therapy in critical care and perioperative medicine


Authors: D. Astapenko 1,2;  J. Pouska 3,4;  V. Černý 1,2,5,8;  J. Beneš 3,4,9
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Hradec Králové 1;  Lékařská fakulta v Hradci Králové, Univerzita Karlova 2;  Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Plzeň 3;  Klinika anesteziologie, resuscitace a intenzivní medicíny, Lékařská fakulta v Plzni, Univerzita Karlova 4;  Klinika anesteziologie, perioperační a intenzivní medicíny, Masarykova nemocnice Ústí nad Labem, Univerzita J. E. Purkyně v Ústí nad Labem 5;  Institut postgraduálního vzdělávání ve zdravotnictví 6;  Centrum pro výzkum a vývoj, Fakultní nemocnice Hradec Králové 7;  Dept. of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Kanada 8;  Biomedicínské centrum, Lékařská fakulta v Plzni, Univerzita Karlova 9
Published in: Anest. intenziv. Med., 28, 2017, č. 5, s. 289-296
Category: Intensive Care Medicine - Review Article

Overview

The endothelial glycocalyx represents a key component of the endothelial barrier on its intraluminal side. It is vital for the maintenance of vascular integrity in physiological conditions and most probably also in pathophysiological conditions. Due to its sugar-based structure, it is highly vulnerable and in the context of critical conditions of patients, the development of endothelial dysfunction is always linked to a certain degree of damage of the glycocalyx. The current state of knowledge favours determining a presumption of a relationship between the function of the glycocalyx and volume replacement therapy. Attempts to minimize damage (and to allow spontaneous recovery) are the only available rational concepts of maintaining integrity of the endothelium and reaching the maximal effect of infusion therapy. This narrative review article brings a summary of this topic and discusses arguments for consideration of the significance of the glycocalyx in the decision-making in fluid therapy.

Keywords:
endothelial glycocalyx – fluid therapy – microcirculation


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Labels
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
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