Re-educating the world about the steady-state Starling principle is not going to be quick or easy. Almost every textbook and Review article until very recently has been perpetuating the capillary transendothelial filtration – absorption doctrine of antiquity. In 2004 Adamson et al showed that only filtration occurs at steady state, there is no absorption. The consequence of this basic science fact is beginning to be recognised in the clinical literature. For instance, if manipulating the osmotic pressure of plasma by infusing potentially nephrotoxic and allergenic colloid solutions does not enhance capillary absorption then they cannot preferentially expand the plasma volume, and such biophysical osmotic therapy is futile.

Tom Woodcock invites interested physiologists and clinicians to volunteer to be Starling Ambassadors in their State, Province or Country. Ambassadors will encourage those who teach vascular physiology to our students and those who teach the practice of fluid therapy to our clinical trainees to be up-to-date. Ambassadors may even be able to enlighten those who have yet to meet the steady-state Starling principle.

‘I tremble lest I have mankind for my enemies, so much has wont and custom become second nature. Doctrine once sown strikes deep its root, and respect for antiquity influences all men’.


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