1
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Dull RO, Hahn RG, Dull GE. Anesthesia-induced Lymphatic Dysfunction. Anesthesiology 2024; 141:175-187. [PMID: 38739769 DOI: 10.1097/aln.0000000000005002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
General anesthetics adversely alters the distribution of infused fluid between the plasma compartment and the extravascular space. This maldistribution occurs largely from the effects of anesthetic agents on lymphatic pumping, which can be demonstrated by macroscopic fluid kinetics studies in awake versus anesthetized patients. The magnitude of this effect can be appreciated as follows: a 30% reduction in lymph flow may result in a fivefold increase of fluid-induced volume expansion of the interstitial space relative to plasma volume. Anesthesia-induced lymphatic dysfunction is a key factor why anesthetized patients require greater than expected fluid administration than can be accounted for by blood loss, urine output, and insensible losses. Anesthesia also blunts the transvascular refill response to bleeding, an important compensatory mechanism during hemorrhagic hypovolemia, in part through lymphatic inhibition. Last, this study addresses how catecholamines and hypertonic and hyperoncotic fluids may mobilize interstitial fluid to mitigate anesthesia-induced lymphatic dysfunction.
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Affiliation(s)
- Randal O Dull
- Departments of Anesthesiology, Pathology, and Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Robert G Hahn
- Department of Anesthesiology and Intensive Care, Karolinska Institute at Danderyds Hospital, Stockholm, Sweden
| | - Gabriella E Dull
- Department of Nursing, Banner University Medical Center, Tucson, Arizona
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2
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Hill DM, Reger M, Todor LA, Boyd AN, Cogle S, DeWitt A, Drabick Z, Faris J, Zavala S, Adams B, Alexander KM, Carter K, Gayed RM, Gutenschwager DW, Hall A, Hansen M, Krantz EN, Pham F, Quan AN, Smith L, Tran N, Walroth TA, Mueller SW. An Appraisal of Pharmacotherapy-Pertinent Literature Published in 2021 and 2022 for Clinicians Caring for Patients With Thermal or Inhalation Injury. J Burn Care Res 2024; 45:614-624. [PMID: 38285011 DOI: 10.1093/jbcr/irae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Indexed: 01/30/2024]
Abstract
Studies focusing on pharmacotherapy interventions to aid patients after thermal injury are a minor focus in burn injury-centered studies and published across a wide array of journals, which challenges those with limited resources to keep their knowledge current. This review is a renewal of previous years' work to facilitate extraction and review of the most recent pharmacotherapy-centric studies in patients with thermal and inhalation injury. Twenty-three geographically dispersed, board-certified pharmacists participated in the review. A Medical Subject Heading-based, filtered search returned 2336 manuscripts over the previous 2-year period. After manual review, 98 (4%) manuscripts were determined to have a potential impact on current pharmacotherapy practice. The top 10 scored manuscripts are discussed. Only 17% of those reviewed were assessed to likely have little effect on current practice. The overall impact of the current cohort was higher than previous editions of this review, which is encouraging. There remains a need for investment in well-designed, high-impact, pharmacotherapy-pertinent research for patients sustaining thermal or inhalation injuries.
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Affiliation(s)
- David M Hill
- Department of Pharmacy, Regional One Health, Memphis, TN 38139, USA
| | - Melissa Reger
- Department of Pharmacy, Community Regional Medical Center, Fresno, CA 93721, USA
| | - Lorraine A Todor
- Department of Pharmacy, Regional One Health, Memphis, TN 38139, USA
| | - Allison N Boyd
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN 46202, USA
| | - Sarah Cogle
- Pharmacy Clinical Programs, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Alexandra DeWitt
- Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA 70112, USA
| | - Zachary Drabick
- Department of Pharmacy, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Janie Faris
- Department of Pharmacy, Parkland Health & Hospital System, Dallas, TX 35235, USA
| | - Sarah Zavala
- Department of Pharmacy, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
| | - Beatrice Adams
- Department of Pharmacy, Tampa General Hospital, Tampa, FL 33606, USA
| | - Kaitlin M Alexander
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL 32610, USA
| | - Kristen Carter
- Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA
| | - Rita M Gayed
- Department of Pharmacy and Medical Nutrition, Grady Burn Center, Atlanta, GA 71644, USA
| | | | - Alexandria Hall
- Department of Pharmacy, Harborview Medical Center, Seattle, WA 98104, USA
| | - Meaghan Hansen
- Department of Pharmacy, UPMC Mercy, Pittsburgh, PA 15219, USA
| | - Erica N Krantz
- Department of Pharmacy, Ascension Via Christi, Wichita, KS 67214, USA
| | - Felix Pham
- Department of Pharmacy, Torrance Memorial Medical Center, Torrance, CA 90505, USA
| | - Asia N Quan
- Department of Pharmacy, The Arizona Burn Center Valleywise Health, Phoenix, AZ 85008, USA
| | - Lisa Smith
- Department of Pharmacy, Doctors Hospital, Augusta, GA 30909, USA
| | - Nicolas Tran
- Department of Pharmacy, Tampa General Hospital, Tampa, FL 33606, USA
| | - Todd A Walroth
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN 46202, USA
| | - Scott W Mueller
- Department of Pharmacy, University of Colorado Health, Aurora, CO 80045, USA
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3
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Astapenko D, Zrzavecky M, Gorskaja D, Hyspler R, Ticha A, Radochova V, Lehmann C, Malbrain MLNG, Cerny V, Hahn RG. Modulation of the capillary leakage by exogenous albumin in a rat model of endothelial glycocalyx damage. Clin Hemorheol Microcirc 2024; 86:509-517. [PMID: 38073383 DOI: 10.3233/ch-232027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Endothelial glycocalyx (EG) plays a crucial role in maintaining the plasma proteins within the intravascular space. OBJECTIVE We studied whether exogenous albumin protects the EG in an experimental model of EG enzymatic damage in rats. METHODS Rats were divided into three groups of 10 animals that received (1) Evans blue (2) Evans blue + hyaluronidase, or (3) Evans blue + hyaluronidase + 20% human albumin via the tail vein. Spectrophotometric analysis was performed 2 h later to quantify the leakage of Evans blue-labeled albumin into the heart, lungs, brain, kidneys, liver, small intestine, spleen, and skeletal muscle. RESULTS Administration of hyaluronidase numerically increased the capillary leakage of Evans blue in all examined tissues. Co-administration of albumin decreased the leakage of albumin in all tissues except the heart. In the lungs, the ratio between the absorbance and dry organ weight decreased from 5.3 ± 2.4 to 1.7 ± 0.5 (mean ± SD) (P < 0.002), and in the liver, the absorbance decreased from 2.2 ± 0.7 to 1.5 ± 0.4 (P < 0.011). CONCLUSION Exogenous albumin decreased the capillary leakage of albumin which was interpreted as a sign of maintained EG integrity.
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Affiliation(s)
- David Astapenko
- Department of Anesthesiology, Resuscitation, and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
- Faculty of Health Studies, Technical University in Liberec, Liberec, Czech Republic
| | - Marek Zrzavecky
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Diana Gorskaja
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Radomir Hyspler
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Alena Ticha
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Vera Radochova
- Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Christian Lehmann
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- Medical Data Management, Medaman, Geel, Belgium
- International Fluid Academy, Lovenjoel, Belgium
| | - Vladimir Cerny
- Department of Anesthesiology, Resuscitation, and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
- Faculty of Health Studies, Technical University in Liberec, Liberec, Czech Republic
- Department of Anesthesiology and Resuscitation, University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovakia
| | - Robert G Hahn
- Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden
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4
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Zdolsek JH, Zdolsek M, Hahn RG. Recruitment of efferent lymph during infusion of 20 % albumin. Microvasc Res 2023; 148:104539. [PMID: 37156370 DOI: 10.1016/j.mvr.2023.104539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/02/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Intravenous infusion of hyper-oncotic 20 % albumin expands the plasma volume by approximately twice the infused volume. We investigated whether the recruited fluid stems from accelerated flow of efferent lymph, which would add protein to the plasma, or from reversed transcapillary solvent filtration, where the solvent is expected to be low in protein. METHODS We analyzed data from 27 intravenous infusions of 20 % albumin (3 mL/kg; approximately 200 mL) over 30 min given to 27 volunteers and patients. Twelve of the volunteers were also given a 5 % solution and served as controls. The pattern of blood hemoglobin, colloid osmotic pressure, and the plasma concentrations of two immunoglobulins (IgG and IgM) were studied over 5 h. RESULTS A decrease of the difference between the plasma colloid osmotic pressure and plasma albumin occurred during the infusions and was almost four times greater for 5 % albumin than for 20 % albumin at 40 min (P < 0.0036), which indicates that non-albumin protein enriched the plasma when 20 % was infused. Moreover, the difference between the infusion-derived dilution of the blood plasma based on hemoglobin and the two immunoglobulins amounted to -1.9 % (-6 to +0.2) for 20 % albumin and to -4.4 % (25th-75th percentile range - 8.5 to +0.2) during experiments with 5 % albumin (P < 0.001). This supports that the plasma was enriched by immunoglobulins, probably via the lymph, when 20 % was infused. CONCLUSIONS Between half and two-thirds of the extravascular fluid that was recruited during infusion of 20 % albumin in humans consisted of protein-containing fluid consistent with efferent lymph.
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Affiliation(s)
- Joachim H Zdolsek
- Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Markus Zdolsek
- Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Robert G Hahn
- Research Unit, Södertälje Hospital, Södertälje, Sweden, Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden.
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5
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Weinberg L, Yanase F, Tosif S, Riedel B, Bellomo R, Hahn RG. Trajectory of plasma syndecan-1 and heparan sulphate during major surgery: A retrospective observational study. Acta Anaesthesiol Scand 2023; 67:4-11. [PMID: 36112130 PMCID: PMC10087164 DOI: 10.1111/aas.14150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/01/2022] [Accepted: 09/10/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Surgical trauma-induced inflammation during major surgery may disrupt endothelial integrity and affect plasma concentrations of glycocalyx constituents, such as syndecan-1 and heparan sulphate. To date, no studies have focused on their perioperative temporal changes. METHODS As part of a trial, we obtained plasma and urine specimens sampled during the perioperative period in 72 patients undergoing major abdominal surgery. The plasma concentration of syndecan-1 and heparan sulphate was measured on five occasions, from baseline to the second postoperative day. Plasma and urinary creatinine and urinary syndecan-1 concentrations were measured before surgery and on the first postoperative morning. RESULTS We observed three different temporal patterns of plasma syndecan-1 concentration. Group 1 'low' (64% of patients) showed only minor changes from baseline despite a median heparan sulphate increase of 67% (p < .005). Group 2 'increase' (21% of patients) showed a marked increase in median plasma syndecan-1 from 27 μg/L to 118 μg/L during the first postoperative day (p < .001) with a substantial (+670%; p < .005) increase in median plasma heparan sulphate from 279 to 2196 μg/L. Group 3 'high' (14% of patients) showed a constant elevation of plasma syndecan-1 to >100 μg/L, but low heparan sulphate levels. The plasma C-reactive protein concentration did not differ across the three groups and 90% of colon surgeries occurred in Group 1. Treatment with dexamethasone was similar across the three groups. Surgical blood loss, duration of surgery and liver resection were greatest in Group 2. CONCLUSION Changes in syndecan-1 and heparan sulphate after surgery appear to show three different patterns, with the greatest increases in those patients with greater blood loss, more liver surgery and longer operations. These observations suggest that increases in syndecan-1 and heparan sulphate reflect the degree of surgical injury.
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Affiliation(s)
- Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Melbourne, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, Australia
| | - Fumitaka Yanase
- Department of Intensive Care, Austin Hospital, Melbourne, Australia.,Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Shervin Tosif
- Department of Anaesthesia, Austin Hospital, Melbourne, Australia
| | - Bernhard Riedel
- Department of Critical Care, The University of Melbourne, Melbourne, Australia.,Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Rinaldo Bellomo
- Department of Critical Care, The University of Melbourne, Melbourne, Australia.,Department of Intensive Care, Austin Hospital, Melbourne, Australia
| | - Robert G Hahn
- Karolinska Institute at Danderyd's Hospital (KIDS), Stockholm, Sweden.,Department of Research, Södertälje Hospital, Södertälje, Sweden
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6
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Dull RO, Hahn RG. The glycocalyx as a permeability barrier: basic science and clinical evidence. Crit Care 2022; 26:273. [PMID: 36096866 PMCID: PMC9469578 DOI: 10.1186/s13054-022-04154-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022] Open
Abstract
Preclinical studies in animals and human clinical trials question whether the endothelial glycocalyx layer is a clinically important permeability barrier. Glycocalyx breakdown products in plasma mostly originate from 99.6–99.8% of the endothelial surface not involved in transendothelial passage of water and proteins. Fragment concentrations correlate poorly with in vivo imaging of glycocalyx thickness, and calculations of expected glycocalyx resistance are incompatible with measured hydraulic conductivity values. Increases in plasma breakdown products in rats did not correlate with vascular permeability. Clinically, three studies in humans show inverse correlations between glycocalyx degradation products and the capillary leakage of albumin and fluid.
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7
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Zdolsek M, Hahn RG. Kinetics of 5% and 20% albumin: A controlled crossover trial in volunteers. Acta Anaesthesiol Scand 2022; 66:847-858. [PMID: 35491239 PMCID: PMC9541965 DOI: 10.1111/aas.14074] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/27/2022]
Abstract
Background Albumin for intravenous infusion is marketed in two concentrations, 20% and 5%, but how they compare with regard to plasma volume expansion over time is unclear. Methods In a prospective crossover study, 12 volunteers received 3 ml kg−1 of 20% albumin and, on another occasion, 12 ml kg−1 of 5% albumin over 30 min. Hence, equivalent amounts of albumin were given. Blood was collected on 15 occasions over 6 h. Mass balance and volume kinetics were used to estimate the plasma volume expansion and the capillary leakage of albumin and fluid based on measurements of blood hemoglobin, plasma albumin, and the colloid osmotic pressure. Results The greatest plasma volume expansion was 16.0 ± 6.4% (mean ± SD) with 20% albumin and 19.0 ± 5.2% with 5% albumin (p < .03). The volume expansion with 20% albumin corresponded to twice the infused volume. One third of the 5% albumin volume quickly leaked out of the plasma, probably because of the higher colloid osmotic pressure of the volunteer plasma (mean, 24.5 mmHg) than the albumin solution (19.1 mmHg). At 6 h, the capillary leakage amounted to 42 ± 15% and 47 ± 11% of the administered albumin with the 20% and 5% preparations, respectively (p = .28). The corresponding urine outputs were 547 (316–780) ml and 687 (626–1080) ml (median and interquartile range; p = .24). Conclusion The most important difference between the fluids was a dehydrating effect of 20% albumin when the same albumin mass was administered.
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Affiliation(s)
- Markus Zdolsek
- Department of Biomedical and Clinical Sciences (BKV) Linköping University Linköping Sweden
| | - Robert G. Hahn
- Research Unit Södertälje Hospital, Södertälje, Sweden, and Karolinska Institutet at Danderyds Hospital (KIDS) Danderyd Sweden
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8
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Farrugia A, Mori F. Therapeutic solutions of human albumin - The possible effect of process-induced molecular alterations on clinical efficacy and safety. J Pharm Sci 2022; 111:1292-1308. [PMID: 35276228 DOI: 10.1016/j.xphs.2022.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 12/14/2022]
Abstract
Human albumin solutions were developed as therapeutic during the Second World War to address blood loss due to battlefield injury. This indication was based on the recognition that albumin provided most of the oncotic capacity of human plasma. For the succeeding sixty years, this formed the basis for the use of albumin in traumatology and emergency medicine. In more recent times, the pharmacological properties arising from albumin's complex structure have become a focus of attention by clinical researchers. In particular, albumin, through anti-inflammatory and anti-oxidant properties, has been proposed as an agent for the treatment of sepsis, cirrhosis and other inflammatory states. Some evidence for these indications has accrued from a number of small clinical trials and observational studies. These studies have not been confirmed in other large trials. Together with other investigators, we have shown that the process of plasma fractionation results in alterations in the structure of albumin, including those parts of the molecule involved in anti-oxidant and anti-inflammatory effects. Albumin products from diverse manufacturers show heterogeneity in their ability to address these effects. In this article, we review the historical development of albumin solutions, pointing out the variations in fractionation chemistries which different manufacturers have adopted. We suggest ways by which the manufacturing processes have contributed to variations in the physico-chemical properties of molecule. We review the outcomes of clinical studies assessing the role of albumin in ameliorating conditions such as sepsis and cirrhosis, and we speculate as to the extent which heterogeneity in the products may have contributed to variable clinical outcomes. Finally, we argue for a change in the perception of the plasma product industry and its regulatory overseers. Historically, albumin has been viewed as a generic commodity, with different preparations being interchangeable in their clinical application. We suggest that this implied biosimilarity is not necessarily applicable for different albumin solutions. The use of albumin, in indications other than its historical role as a plasma expander, can only be validated by clinical investigation of each separate albumin product.
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Affiliation(s)
- Albert Farrugia
- Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Perth, Australia.
| | - Filippo Mori
- Kedrion S.p.A., Research and Innovation Department, Via di Fondovalle, Loc., Bolognana 55027, Gallicano (LU), Italy
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9
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Cartotto R, Burmeister DM, Kubasiak JC. Burn Shock and Resuscitation: Review and State of the Science. J Burn Care Res 2022; 43:irac025. [PMID: 35218662 DOI: 10.1093/jbcr/irac025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Indexed: 12/31/2022]
Abstract
Burn shock and acute fluid resuscitation continue to spark intense interest and debate among burn clinicians. Following a major burn injury, fluid resuscitation of burn shock is life-saving, but paradoxically can also be a source of increased morbidity and mortality because of the unintended consequence of systemic edema formation. Considerable research over the past two decades has been devoted to understanding the mechanisms of edema formation, and to develop strategies to curb resuscitation fluids and limit edema development. Recognition of burn endotheliopathy - injury to the endothelium's glycocalyx layer- is one of the most important recent developments in our understanding of burn shock pathophysiology. Newer monitoring approaches and resuscitation endpoints, along with alternative resuscitation strategies to crystalloids alone, such as administration of albumin, or plasma, or high dose ascorbic acid, have had mixed results in limiting fluid creep. Clear demonstration of improvements in outcomes with all of these approaches remains elusive. This comprehensive review article on burn shock and acute resuscitation accompanies the American Burn Association's State of the Science meeting held in New Orleans, LA on November 2-3, 2021 and the Proceedings of that conference published in this journal.
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Affiliation(s)
- Robert Cartotto
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, and University of Toronto, Canada
| | - David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland and United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas USA
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10
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Richards JE, Samet RE, Grissom TE. Scratching the Surface: Endothelial Damage in Traumatic Hemorrhagic Shock. Adv Anesth 2021; 39:35-51. [PMID: 34715980 DOI: 10.1016/j.aan.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Justin E Richards
- Department of Anesthesiology, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Suite T1R77, Baltimore, MD 21201, USA
| | - Ron E Samet
- Department of Anesthesiology, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Suite T1R77, Baltimore, MD 21201, USA
| | - Thomas E Grissom
- Department of Anesthesiology, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Suite T1R77, Baltimore, MD 21201, USA.
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11
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Li Y, Jiang L, Song T, Wang Y, Su B. A call for better understanding the role of albumin in mediating VE-cadherin phosphorylation and endothelial barrier dysfunction in septic patients. Crit Care 2021; 25:232. [PMID: 34210346 PMCID: PMC8252191 DOI: 10.1186/s13054-021-03637-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 02/08/2023] Open
Affiliation(s)
- Yupei Li
- Department of Nephrology, Med-X Center for Manufacturing, West China Hospital, Sichuan University, Guoxue Alley No. 37, Chengdu, 610041, Sichuan Province, China.,Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, 610207, Sichuan Province, China
| | - Luojia Jiang
- Department of Nephrology, Med-X Center for Manufacturing, West China Hospital, Sichuan University, Guoxue Alley No. 37, Chengdu, 610041, Sichuan Province, China
| | - Tao Song
- College of Polymer Science and Engineering, Sichuan University, Chengdu, 610065, Sichuan Province, China
| | - Yiran Wang
- College of Polymer Science and Engineering, Sichuan University, Chengdu, 610065, Sichuan Province, China
| | - Baihai Su
- Department of Nephrology, Med-X Center for Manufacturing, West China Hospital, Sichuan University, Guoxue Alley No. 37, Chengdu, 610041, Sichuan Province, China. .,Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, 610207, Sichuan Province, China. .,The First People's Hospital of Shuangliu District, Chengdu, 610200, Sichuan Province, China.
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12
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Hahn RG, Zdolsek M, Zdolsek J. Plasma concentrations of syndecan-1 are dependent on kidney function. Acta Anaesthesiol Scand 2021; 65:809-815. [PMID: 33595099 DOI: 10.1111/aas.13801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Elevated plasma concentrations of syndecan-1 and heparan sulfate in studies of trauma, sepsis, and major surgery are commonly assumed to indicate acute glycocalyx degradation. We explored a possible role of the kidneys for these elevations. METHODS Plasma and urine concentrations of syndecan-1, heparan sulfate, and biomarkers of inflammation were measured over 5 hours in 15 hospital patients treated for post-burn injury. The renal clearances of syndecan-1 and heparan sulfate (CLR ) were calculated and their influence on the plasma concentration predicted by simulation. RESULTS The urine/plasma concentration ratio was 0.9 (0.3-3.0) for syndecan-1 and 2.8 (2.0-4.3) for heparan sulfate. The CLR varied 250-fold for syndecan-1 and 10-fold for heparan sulfate. Multiple linear regression analysis showed that CLR for syndecan-1 was positively associated with the creatinine clearance (P < .0032) and the urine flow (P < .015). CLR for heparan sulfate increased with interleukin-6 (P < .003) and the urine flow (P < .01). Simulations suggested that a change in CLR from the mean of the highest 3 to the lowest three values would double plasma syndecan-1 within 4 hours and cause a 7-fold rise after 24 hours. A similar change in CLR for heparan sulfate would triple the plasma level within 24 hours, even if no increased shedding of the glycocalyx takes place. CONCLUSIONS The renal elimination of syndecan-1 and heparan sulfate varied greatly. A change in kidney function, which is common after trauma and major surgery, might alone induce several-fold changes in their plasma concentrations.
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Affiliation(s)
- Robert G. Hahn
- Research Unit Södertälje Hospital Södertälje Sweden
- Karolinska Institutet at Danderyds Hospital (KIDS) Stockholm Sweden
| | - Markus Zdolsek
- Department of Biomedical and Clinical Sciences (BKV) Linköping University Linköping Sweden
| | - Joachim Zdolsek
- Department of Biomedical and Clinical Sciences (BKV) Linköping University Linköping Sweden
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13
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Hahn RG, Patel V, Dull RO. Human glycocalyx shedding: Systematic review and critical appraisal. Acta Anaesthesiol Scand 2021; 65:590-606. [PMID: 33595101 DOI: 10.1111/aas.13797] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The number of studies measuring breakdown products of the glycocalyx in plasma has increased rapidly during the past decade. The purpose of the present systematic review was to assess the current knowledge concerning the association between plasma concentrations of glycocalyx components and structural assessment of the endothelium. METHODS We performed a literature review of Pubmed to determine which glycocalyx components change in a wide variety of human diseases and conditions. We also searched for evidence of a relationship between plasma concentrations and the thickness of the endothelial glycocalyx layer as obtained by imaging methods. RESULTS Out of 3,454 publications, we identified 228 that met our inclusion criteria. The vast majority demonstrate an increase in plasma glycocalyx products. Sepsis and trauma are most frequently studied, and comprise approximately 40 publications. They usually report 3-4-foldt increased levels of glycocalyx degradation products, most commonly of syndecan-1. Surgery shows a variable picture. Cardiac surgery and transplantations are most likely to involve elevations of glycocalyx degradation products. Structural assessment using imaging methods show thinning of the endothelial glycocalyx layer in cardiovascular conditions and during major surgery, but thinning does not always correlate with the plasma concentrations of glycocalyx products. The few structural assessments performed do not currently support that capillary permeability is increased when the plasma levels of glycocalyx fragments in plasma are increased. CONCLUSIONS Shedding of glycocalyx components is a ubiquitous process that occurs during both acute and chronic inflammation with no sensitivity or specificity for a specific disease or condition.
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Affiliation(s)
- Robert G. Hahn
- Research UnitSödertälje Hospital Södertälje Sweden
- Karolinska Institute at Danderyds Hospital (KIDS) Stockholm Sweden
| | - Vasu Patel
- Department of Internal Medicine Northwestern Medicine McHenry Hospital McHenry IL USA
| | - Randal O. Dull
- Department of Anesthesiology, Pathology, Physiology, Surgery University of ArizonaCollege of Medicine Tucson AZ USA
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