Endothelial glycocalyx in acute care surgery - what anaesthesiologists need to know for clinical practice

Abstract

The endothelial glycocalyx (EG) is the thin sugar-based lining on the apical surface of endothelial cells. It has been linked to the physiological functioning of the microcirculation and has been found to be damaged in critical illness and after acute care surgery. This review aims to describe the role of EG in severely injured patients undergoing surgery, discuss specific situations (e.G. major trauma, hemorrhagic shock, trauma induced coagulopathy) as well as specific interventions commonly applied in these patients (e.g. fluid therapy, transfusion) and specific drugs related to perioperative medicine with regard to their impact on EG.EG in acute care surgery is exposed to damage due to tissue trauma, inflammation, oxidative stress and inadequate fluid therapy. Even though some interventions (transfusion of plasma, human serum albumin, hydrocortisone, sevoflurane) are described as potentially EG protective there is still no specific treatment for EG protection and recovery in clinical medicine.The most important principle to be adopted in routine clinical practice at present is to acknowledge the fragile structure of the EG and avoid further damage which is potentially related to worsened clinical outcome.

Keywords: Acute care surgery; Anaesthesia; Endothelial glycocalyx; Fluid therapy; Major trauma; Transfusion.

Fig. 1

Electron microscopy of endothelial glycocalyx in human umbilical vein endothelial cells by cationized ferritin. Black and white arrows demark the endothelial glycocalyx. The bar represents 200 nm. Image was captured using JEOL JEM-1400Plus transmission electron microscope at the Dept. of Histology and Embryology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic. (Courtesy of Dana Cizkova M.D., Ph.D. and Ales Bezrouk Ph.D.)

Fig. 2

Flow chart of literature search and selection

Fig. 3

Endothelial glycocalyx is damaged by primary and secondary injury. This figure demonstrates that secondary injury is more diverse and is better influenced