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- W2079461344 abstract "Editor—I would like to thank the authors for their immensely informative article on transvascular fluid exchange.1Woodcock TE Woodcock TM Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy.Br J Anaesth. 2012; 108: 384-394Abstract Full Text Full Text PDF PubMed Scopus (481) Google Scholar It is apparent that advances in this area of science are now starting to explain many of the clinically observed phenomena in critically ill patients, such as the broad equivalence of crystalloids and colloids, and the failure of albumin infusions to improve tissue oedema. A phenomenon familiar to many of us is the turning point when a sick patient in intensive care exhibits spontaneous diuresis, thereby excreting their iatrogenic excess body water—at this stage, we ‘know’ that the patient will get better. Do the authors think that this occurrence represents the juncture at which tissue compliance returns to normal, and the increased hydrostatic pressure drives fluid back into the circulation? Certainly, the components of the inflammatory response that control these changes hold great promise as targets for future therapies. Despite the admirable explanation of the revised Starling equation in this article, I am not sure I agree with the conclusion that a rational use of colloids should be restricted to euvolaemic or hypervolaemic haemodilution. This statement is based on the premise that patients who are profoundly hypovolaemic will have an equivalent plasma expansion with either class of fluid, that is, they are below the J-point on the graph provided (Fig. 4 in the original article). Above the J-point, colloids do stay in the circulation for longer, and I would argue that this applies to fluid optimization in the perioperative period, where patients are only moderately hypovolaemic. Thus, over several days of flow-guided optimization, the total volume of colloids used will be less compared with crystalloids for the same effect. However, the long debated question remains as to whether the advantage of less tissue oedema outweighs the other adverse effects (and cost) associated with colloids. None declared." @default.
- W2079461344 created "2016-06-24" @default.
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- W2079461344 date "2012-06-01" @default.
- W2079461344 modified "2023-09-30" @default.
- W2079461344 title "Fluid physiology, tissue compliance, and colloids" @default.
- W2079461344 cites W2128082929 @default.
- W2079461344 doi "https://doi.org/10.1093/bja/aes150" @default.
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