Misconceptions About the Starling Principle as Applied to Fluid Therapy.

Published on Sep 1, 2021in Anesthesia & Analgesia4.305
· DOI :10.1213/ANE.0000000000005327
#1Lukas M. Löffel (University of Bern)H-Index: 5
#2Robert G. Hahn (KI: Karolinska Institutet)H-Index: 53
Last. Patrick Y. Wuethrich (University of Bern)H-Index: 12
view all 4 authors...
Background The intraoperative effect of 20% albumin on plasma volume during surgery involving major blood loss has not been explored extensively due to methodological difficulties. Crystalloids poorly expand the plasma volume, and using a colloid might then be a way to avoid fluid overload. As doubts have been raised about synthetic colloids, albumin solutions are currently used more extensively. This study presents a methodological development showing how plasma volume expansion can be studied ...
3 CitationsSource
#1C. Charles Michel (Imperial College London)H-Index: 18
#2Tom WoodcockH-Index: 11
Last. Fitz Roy E Curry (UC Davis: University of California, Davis)H-Index: 59
view all 3 authors...
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...
12 CitationsSource
#1Tom Woodcock (University of Southampton)H-Index: 11
#2Thomas M. Woodcock (Australian School of Advanced Medicine)H-Index: 3
Summary I.V. fluid therapy does not result in the extracellular volume distribution expected from Starling's original model of semi-permeable capillaries subject to hydrostatic and oncotic pressure gradients within the extracellular fluid. Fluid therapy to support the circulation relies on applying a physiological paradigm that better explains clinical and research observations. The revised Starling equation based on recent research considers the contributions of the endothelial glycocalyx layer...
421 CitationsSource
#1A. Fleck (Western Infirmary)H-Index: 1
#2Felicity Hawker (Western Infirmary)H-Index: 1
Last. Calman Kc (Western Infirmary)H-Index: 8
view all 7 authors...
Abstract The rate of loss of albumin to the tissue spaces (measured as transcapillary escape rate) rose by more than 300% in patients with septic shock, and the average increase within 7 h of cardiac surgery was 100%. The transcapillary escape rate in cachectic cancer patients was twice that of a group of healthy individuals. The rate of loss of albumin to the tissue spaces is normally 5%/h, which is more than 10 times the rates of synthesis and catabolism, and these large rate increases indicat...
668 CitationsSource
Cited By0