Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 223: The Glycocalyx with Marius Fassbinder
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Feb 28, 2022 Dr. Marius Fassbinder, an attending anesthesiologist with a focus on fluid management, dives into the fascinating world of the endothelial glycocalyx. He explains its critical role in fluid dynamics and how it influences clinical practices. Discover the surprising factors that can damage this vital structure, the nuances of fluid therapy, and why classic models like Starling's may need an update. Fassbinder also shares insights on using colloids versus crystalloids, offering practical recommendations for clinicians.
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Starling's Classic Model Needs Refinement
- The original Starling model posited filtration at the arterial end and reabsorption at the venous end driven by oncotic pressure differences.
- Later data show little reabsorption in most tissues, challenging the high-filtration/high-reabsorption model.
Glycocalyx Is A Protein-Trapping Sugar Mesh
- The endothelial glycocalyx is a sugar-rich mesh lining the vessel lumen that traps plasma proteins like albumin.
- It creates a non-circulating fluid layer beneath it and retains proteins via negative charge, shaping transvascular fluid behavior.
A Large, Recruitable Subglycocalyx Volume
- The glycocalyx thickness ranges from ~0.2 to 8 µm and overlies a fluid-filled, non-circulating intravascular space.
- That subglycocalyx reservoir can total around 1.7 L in adults and is recruitable by raising intravascular oncotic pressure.
