I had an interesting question today from a correspondent in sunny Spain; is colloid preferable as the bolus challenge in goal-directed therapy? I have always supposed the rationale of increasing stroke volume by fluid challenge is to increase oxygen delivery, though this is rarely mentioned. Goal directed therapy with anything
After the shock of BJA Acceptance of The Revised Starling Principle hypothesis in 2012 came the post-publication anxiety that I had made a terrible mistake and would have to retract because of a glaring logical error. I had been told by someone much more famous than me that patients with
Yesterday we tried something neither of us had done together before; we measured one another central venous pressure. It took less than 4 minutes from offering out an arm to seeing the value displayed in glorious black and white in an App on a tablet computer. I have posted the
Layer upon layer: the functional consequences of disrupting the glycocalyx-endothelial barrier in vivo and in vitro. FitzRoy E. Curry Cardiovasc Res (2017) 113 (6): 559-561. Fitzroy Curry seems to be the world’s go-to opinion on all things glycocalyx, and I was as usual delighted to find my own clinical ramblings being cited
When I first discovered I had been cited on a Wikipedia page I was thrilled and honoured. Great to have been noticed. But then the anonymous friend who gave me this fleeting immortality on the Starling equation page gave up and left it in a slightly disorganised and confused state.
Effect of isotonic versus hypotonic maintenance fluid therapy on urine output, fluid balance, and electrolyte homeostasis: a crossover study in fasting adult volunteers N. Van Regenmortel, T. De Weerdt, A. H. Van Craenenbroeck, E. Roelant, W. Verbrugghe, K. Dams, M. L. N.G. Malbrain, T. Van den Wyngaert, P. G. Jorens Br J Anaesth aex118. DOI: https://doi.org/10.1093/bja/aex118 Published:16 May 2017
Deservedly getting lots of mentions, Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: An international cross-sectional study Great global collaboration. The stand-out for me is that the UK participating units went from being the world’s worst offenders for colloid resuscitation (>80%) to being
Fitz-Roy Curry at UC Davis knows more about vascular permeability than I ever will, and I am pleased to say he has offered some thoughts on Paul Marik’s claims for the Norfolk Protocol. With a little text correcting by myself; “Our lab has little experience with Vitamin C and vascular permeability
Sartor Z, Kesey J, Dissanaike S. The effects of intravenous vitamin C on point-of-care glucose monitoring. J Burn Care Res. 2015;36:50-56. It seems that we should not rely PoC glucose for patients treated with Vitamin C. Risk for insulin therapy stands out. https://www.ncbi.nlm.nih.gov/pubmed/24502221
While it is easy to make the steady-state Starling case against colloids for resuscitation from hypovolaemia, the argument from microvascular flow preservation keeps alive a possible indication for plasma infusions. The endothelial glycocalyx (EG) disintegrates after severe hemorrhagic shock, and there is laboratory evidence that plasma could preserve or restore capillary integrity.