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Administration of 500 ml of normal saline does not result in immediate damage to the endothelial glycocalyx determinable by sublingual microcirculation assessment


Authors: J. Pouska 1,2;  D. Astapenko 3,4;  V. Tégl 1,2,5;  J. Beneš 1,2,5;  V. Černý 3,4,6-9
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Plzeň 1;  Klinika anesteziologie, resuscitace a intenzivní medicíny, Lékařská fakulta v Plzni, Univerzita Karlova 2;  Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Hradec Králové 3;  Lékařská fakulta v Hradci Králové, Univerzita Karlova 4;  Biomedicínské centrum, Lékařská fakulta v Plzni, Univerzita Karlova 5;  Klinika anesteziologie, perioperační a intenzivní medicíny, Univerzita J. E. Purkyně, Masarykova nemocnice, Ústí nad Labem 6;  Institut postgraduálního vzdělávání ve zdravotnictví 7;  Centrum pro výzkum a vývoj, Fakultní nemocnice Hradec Králové 8;  Dept. of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Kanada 9
Published in: Anest. intenziv. Med., 29, 2018, č. 6, s. 322-327
Category:

Overview

Objective:

Assessment of endothelial glycocalyx alteration after infusion of 500 ml of normal saline by perfused boundary region (PBR) parameter in twelve healthy volunteers.

Hypothesis:

Endothelial glycocalyx will be significantly altered by infusion of 500 ml of normal saline.

Design:

Non-randomized, prospective, double-centre study.

Settings:

Two ICUs in University Hospitals.

Materials and methods:

Twelve healthy volunteers without acute illness were recruited. 500 ml of normal saline was infused to each participant. We collected basic haemodynamic data as well as perfused boundary region as a marker of endothelial glycocalyx integrity before and after the fluid administration. Student T-test (paired) with p-value of 0.05 was used for the statistical analysis.

Results:

After administration of 500 ml of normal saline there was non-significant change in PBR (2.00±0.21 vs. 2.21±0.36, p = 0.089). Concerning the macrohaemodynamics, there was a significant drop in the heart rate after the infusion (74±10 vs. 68±10, p = 0.003).

Conclusion:

Our study did not confirm alteration of the endothelial glycocalyx after intravenous administration of 500 ml of normal saline to healthy volunteers. There was a significant decrease of heart rate after the infusion but no other changes were observed.

keywords

microcirculation – intravenous infusion – endothelial glycocalyx


Sources

1. Jacob M, Chappell D. Reappraising Starling: The physiology of the microcirculation. Curr Opin Crit Care. 2013;19:282–289. doi:10.1097/MCC.0b013e3283632d5e.

2. Cerny V, Astapenko D, Brettner F, et al. Targeting the endothelial glycocalyx in acute critical illness as a challenge for clinical and laboratory medicine. Crit Rev Clin Lab Sci. 2017;54:343–357. doi:10.1080/10408363.2017.1379943.

3. Murphy LS, Wickersham N, McNeil JB, et al. Endothelial glycocalyx degradation is more severe in patients with non-pulmonary sepsis compared to pulmonary sepsis and associates with risk of ARDS and other organ dysfunction. Ann Intensive Care. 2017;7:102. doi:10.1186/s13613-017-0325-y.

4. Vincent JL, Weil MH. Fluid challenge revisited. Crit Care Med. 2006;34:1333–1337. doi:10.1097/01.CCM.0000214677.76535.A5.

5. Oberleithner H, Peters W, Kusche-Vihrog K, et al. Salt overload damages the glycocalyx sodium barrier of vascular endothelium. Pflugers Arch Eur J Physiol. 2011;462:519–528. doi:10.1007/s00424-011-0999-1.

6. Chappell D, Bruegger D, Potzel J, et al. Hypervolemia increases release of atrial natriuretic peptide and shedding of the endothelial glycocalyx. Crit Care. 2014;18:1–8. doi:10.1186/s13054-014-0538-5.

7. Cerny V, Astapenko D, Burkovskiy I, et al. Glycocalyx in vivo measurement. Jünger M, Krüger-Genge A, Jung F, eds. Clin Hemorheol Microcirc. 2017;67:1–5. doi:10.3233/CH-179235.

8. Lee DH, Dane MJC, Van Den Berg BM, et al. Deeper penetration of erythrocytes into the endothelial glycocalyx is associated with impaired microvascular perfusion. PLoS One. 2014;9:1–8. doi:10.1371/journal.pone.0096477.

9. Cecconi M, Hofer C, Teboul JL, et al. Fluid challenges in intensive care: the FENICE study: A global inception cohort study. Intensive Care Med. 2015;41:1529–1537. doi:10.1007/s00134-015-3850-x.

10. Ukor IF, Hilton AK, Bailey MJ, Bellomo R. The haemodynamic effects of bolus versus slower infusion of intravenous crystalloid in healthy volunteers. J Crit Care. 2017;41:254–259. doi:10.1016/j.jcrc.2017.05.036.

11. Rehm M, Bruegger D, Christ F, et al. Shedding of the endothelial glycocalyx in patients undergoing major vascular surgery with global and regional ischemia. Circulation. 2007;116:1896–1906. doi:10.1161/CIRCULATIONAHA.106.684852.

12. Zeng Y, Tarbell JM. The adaptive remodeling of endothelial glycocalyx in response to fluid shear stress. Vinci MC, ed. PLoS One. 2014;9:e86249. doi:10.1371/journal.pone.0086249.

13. Powell M, Mathru M, Brandon A, et al. Assessment of endothelial glycocalyx disruption in term parturients receiving a fluid bolus before spinal anesthesia: a prospective observational study. Int J Obstet Anesth. 2014;23:330–334. doi:10.1016/j.ijoa.2014.06.001.

14. Puskarich MA, Cornelius DC, Tharp J, et al. Plasma syndecan-1 levels identify a cohort of patients with severe sepsis at high risk for intubation after large-volume intravenous fluid resuscitation. J Crit Care. 2016;36:125–129. doi:10.1016/j.jcrc.2016.06.027.

15. Self WH, Semler MW, Wanderer JP, et al. Balanced Crystalloids versus Saline in Noncritically Ill Adults. N Engl J Med. 2018;378:819–828. doi:10.1056/NEJMoa1711586.

16. Mccluskey SA, Karkouti K, Wijeysundera D, et al. Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality: A propensity-matched cohort study. Anesth Analg. 2013;117:412–421. doi:10.1213/ANE.0b013e318293d81e.

17. Kusche-Vihrog K, Schmitz B, Brand E. Salt controls endothelial and vascular phenotype. Pflugers Arch Eur J Physiol. 2015;467:499–512. doi:10.1007/s00424-014-1657-1.

18. Vlahu CA, Lemkes BA, Struijk DG, et al. Damage of the Endothelial Glycocalyx in Dialysis Patients. J Am Soc Nephrol. 2012;23:1900–1908. doi:10.1681/ASN.2011121181.

19. Ince C, Boerma EC, Cecconi M, et al. Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2018:1–19. doi:10.1007/s00134-018-5070-7.

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