Plasma and Vitamin C for shock resuscitation.

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.

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Low volume resuscitation – PEGged?

Really grateful to the correspondent who pointed me to interesting work being done on “cell impermeants” at Virginia Commonwealth University using the hydrogel PEG-20k. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476060/ http://journals.lww.com/jtrauma/Abstract/publishahead/Low_Volume_Resuscitation_Using_Polyethylene.99474.aspx I was previously unaware of the therapeutic potential for polyethylene glycol and remain uncertain about the “cell impermeant” rationale. Low volume hypertonic and/ or

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Hypoalbuminaemia in surgical practice; recent insights from the Karolinska.

Jan Wernerman’s respected team at the Karolinska are publishing interesting data from their investigations into perioperative and inflammatory hypoalbuminaemia. Followers of fluidphysiology.org understand that albumin has two vital circulations; in steady state conditions most of our albumin is within the extravascular circulation of interstitial fluid. Acute dehydration can increase the

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