Tom Woodcock
University of Southampton
Oncotic pressureInternal medicineStarling equationHealth careCardiologyIntensive care medicineLawExtracellular fluidMultidisciplinary approachFrank–Starling law of the heartObservational studyIntensive care unitConflict of interestMEDLINEAnesthesiologyContext (language use)EdemaIntensive carePain medicinePerioperativeAnesthesiaFamily medicineMechanicsInformed consentMedicine
Publications 33
Ernest Starling first presented a hypothesis about the absorption of tissue fluid to the plasma within tissue capillaries in 1896. In this Chapter we trace the evolution of Starling’s hypothesis to a principle and an equation, and then look in more detail at the extension of the Starling principle in recent years. In 2012 Thomas Woodcock and his son proposed that experience and experimental observations surrounding clinical practices involving the administration of intravenous fluids were better...
#1Ellis Muggleton (TUM: Technische Universität München)H-Index: 6
#2Johannes Janson (TUM: Technische Universität München)
Last. Tom WoodcockH-Index: 12
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We know that plasma albumin concentration begins to fall as soon as the surgical patient is positioned on the operating table and before induction of anaesthesia. A recent study found that after adopting a seated position from reclined posture, fluid accumulates in the legs of healthy volunteers according to first order exponential function lasting around 45 minutes, followed by a linear accumulation. This is likely a consequence of increased capillary pressures in the legs driving exponential h...
#1C. Charles Michel (Imperial College London)H-Index: 18
#2Tom WoodcockH-Index: 12
Last. Fitz Roy E Curry (UC Davis: University of California, Davis)H-Index: 60
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The Starling Principle states that fluid movements between blood and tissues are determined by differences in hydrostatic and colloid osmotic (oncotic) pressures between plasma inside microvessels and fluid outside them. The Revised Starling Principle recognizes that, because microvessels are permeable to macromolecules, a balance of pressures cannot halt fluid exchange. In most tissues, steady oncotic pressure differences between plasma and interstitial fluid depend on low levels of steady filt...
#1Gregory J. Martin (Emory University)H-Index: 7
#2David A. Kaufman (NYU: New York University)H-Index: 8
Last. Timothy E. Miller (Duke University)H-Index: 29
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Background: Optimal fluid therapy in the perioperative and critical care settings depends on understanding the underlying cardiovascular physiology and individualizing assessment of the dynamic patient state. Methods: The Perioperative Quality Initiative (POQI-5) consensus conference brought together an international team of multidisciplinary experts to survey and evaluate the literature on the physiology of volume responsiveness and perioperative fluid management. The group used a modified Delp...
#1Jonathan Lacey (UCL: University College London)H-Index: 4
#2Jo Corbett (University of Portsmouth)H-Index: 26
Last. Hugh Montgomery (UCL: University College London)H-Index: 80
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AbstractBackground: Dehydration appears prevalent, costly and associated with adverse outcomes. We sought to generate consensus on such key issues and elucidate need for further scientific enquiry....
#1Tom Woodcock (University Hospital Southampton NHS Foundation Trust)H-Index: 12
### Key points As the evidence base is limited, we must take a rational approach to fluid therapy, but reason has to be based on familiarity with state-of-the-art physiological science. For about a decade, now it has been clear that most capillaries do not reabsorb filtered fluid, with the corollary that interstitial fluid is in a vital steady-state circulation at about 5–10 ml min−1, and capillary filtration rate can increase to 100 ml min−1 or more with rapid 1 litre fluid bolus. Applying a pa...
#1Tom WoodcockH-Index: 12
While extreme fluid deprivation and fluid overdose resulting from negligence or misinformed prescription are undoubtedly harmful, observations and experiments do not point to fluid therapy as a significant determinant of patient outcomes from major surgery. Therapy maintaining fluid balance less than 2 l is probably optimal. There are two interdependent fluid circulations (blood and interstitial fluid) serving the needs of cells and intracellular fluid. Filtration rate (Jv) of fluid from the blo...
#2P. BarkerH-Index: 1
#3P. E. CreaseyH-Index: 1
Last. Tom WoodcockH-Index: 12
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Summary Diabetes affects 10–15% of the surgical population and patients with diabetes undergoing surgery have greater complication rates, mortality rates and length of hospital stay. Modern management of the surgical patient with diabetes focuses on: thorough pre-operative assessment and optimisation of their diabetes (as defined by a HbA1c < 69 mmol.mol−1); deciding if the patient can be managed by simple manipulation of pre-existing treatment during a short starvation period (maximum of one mi...
#1Wojciech Dąbrowski (Medical University of Lublin)H-Index: 7
#2Tom WoodcockH-Index: 12
Last. Manu L N G MalbrainH-Index: 67
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Fluid therapy is one of the most important treatments in patients with traumatic brain injury (TBI) as both hypo- and hypervolaemia can cause harm. The main goals of fluid therapy for patients with TBI are to optimize cerebral perfusion and to maintain adequate cerebral oxygenation. The avoidance of cerebral oedema is clearly essential. The current weight of evidence in the published literature suggests that albumin therapy is harmful and plasma substitutes have failed to demonstrate superiority...
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