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Review
. 2024 Feb 26;12(1):16.
doi: 10.1186/s40635-024-00602-1.

Association between intravenous fluid administration and endothelial glycocalyx shedding in humans: a systematic review

Sara Sukudom  1 , Lisa Smart  2   3 , Stephen Macdonald  4   5   6
Affiliations
Review

Association between intravenous fluid administration and endothelial glycocalyx shedding in humans: a systematic review

Sara Sukudom et al. Intensive Care Med Exp. .

Abstract

Introduction: Several studies have demonstrated associations between greater rate/volume of intravenous (IV) fluid administration and poorer clinical outcomes. One postulated mechanism for harm from exogenous fluids is shedding of the endothelial glycocalyx (EG).

Methods: A systematic review using relevant search terms was performed using Medline, EMBASE and Cochrane databases from inception to October 2023. Included studies involved humans where the exposure was rate or volume of IV fluid administration and the outcome was EG shedding. The protocol was prospectively registered on PROSPERO: CRD42021275133.

Results: The search yielded 450 articles, with 20 articles encompassing 1960 participants included in the review. Eight studies were randomized controlled clinical trials. Half of studies examined patients with sepsis and critical illness; the remainder examined perioperative patients or healthy subjects. Almost all reported blood measurements of soluble EG components; one study used in vivo video-microscopy to estimate EG thickness. Four of 10 sepsis studies, and 9 of 11 non-sepsis studies, found a positive relationship between IV fluid rate/volume and measures of EG shedding.

Conclusions: A trend toward an association between IV fluid rate/volume and EG shedding was found in studies of stable patients, but was not consistently observed among studies of septic and critically ill patients.

Keywords: Critical care; Endothelial glycocalyx; Endothelium; Fluid therapy; Sepsis.

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Conflict of interest statement

SM and LS are authors on several included studies. For these studies the risk of bias assessment was performed by SS. The authors declare no other competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection
Fig. 2
Fig. 2
Risk of bias of included studies (n = 20)
See this image and copyright information in PMC

References

    1. Sakr Y, Rubatto Birri PN, Kotfis K, Nanchal R, Shah B, Kluge S, et al. Higher fluid balance increases the risk of death from sepsis: results from a large international audit. Crit Care Med. 2017;45(3):386–394. doi: 10.1097/CCM.0000000000002189. - DOI - PubMed
    1. Silversides JA, Major E, Ferguson AJ, Mann EE, McAuley DF, Marshall JC, et al. Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis. Intensive Care Med. 2017;43(2):155–170. doi: 10.1007/s00134-016-4573-3. - DOI - PubMed
    1. Malbrain M, Van Regenmortel N, Saugel B, De Tavernier B, Van Gaal PJ, Joannes-Boyau O, et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy. Ann Intensive Care. 2018;8(1):66. doi: 10.1186/s13613-018-0402-x. - DOI - PMC - PubMed
    1. Maitland KKS, Opoka RO, Engoru C, Olupot-Olupot P, Akech SO, Nyeko R, Mtove G, Reyburn H, Lang T, Brent B, Evans JA, Tibenderana JK, Crawley J, Russell EC, Levin M, Babiker AG, Gibb DM, on behalf of the FEAST trial group Mortality after fluid Olus in Africal children with severe infection. N Engl J Med. 2011;364(26):2483–2495. doi: 10.1056/NEJMoa1101549. - DOI - PubMed
    1. Maitland K, George EC, Evans JA, Kiguli S, Olupot-Olupot P, Akech SO, et al. Exploring mechanisms of excess mortality with early fluid resuscitation: insights from the FEAST trial. BMC Med. 2013;11:68. doi: 10.1186/1741-7015-11-68. - DOI - PMC - PubMed

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