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The Intensive Care Society’s Webinar on Fluids yesterday was Sold Out with record number of delegates and is receiving rave reviews. Ashley Miller’s drawing of the J curve “explains it all as you’ve never seeen it” @PARADicmSHIFT. I reproduce it below. My first attempt at the J curve looked like this in 2012; It makes…… Continue reading Renewed interest in Kinetic diagrams.

The American Journal of Pathology Special edition opens with an overview of nanomechanics; the connections between the luminal surface endothelial glycocalyx and the intra-endothelial cortex, largely composed of actin molecules, is emphasised. The sequelae of endothelial glycocalyx injury include enhanced vascular permeability, tissue oedema, augmented leukocyte adhesion, platelet aggregation, and dysregulated vasodilation. The structure/ function…… Continue reading Glycocalyx Special Edition

A beautifully illustrated report on the cerebral microcirculation of mice provides many answers to the role of precapillary sphincters in cerebral perfusion autoregulation. Grubb, S., Cai, C., Hald, B.O. et al. Precapillary sphincters maintain perfusion in the cerebral cortex. Nat Commun 11, 395 (2020). In previous blogs we considered the possibility of a Bernoulli effect…… Continue reading Precapillary sphincters maintain perfusion in the cerebral cortex.

Last weekend many hundreds of people read my last Post on FluidPhysiology about measuring the endothelial glycocalyx, thankyou so much. Starling physiology has grown to become a Controversy, thanks to the misinterpretations published by Professor Robert Hahn and his colleagues in the past year or so. These prompted Professor Charles Michel, Professor Roy Curry and…… Continue reading Why you need to care about the Glycocalyx Model paradigm.

This month we read an interesting experiment by Sweden’s Robert Hahn, an attempt to quantify the intravascular volume that is not the free-flowing plasma we sample by venesection or by drawing from an intravascular catheter. https://icm-experimental.springeropen.com/articles/10.1186/s40635-020-00317-z We have to thank Fitz-Roy Curry in California for much of our current knowledge about the structure and function of…… Continue reading Can we measure the endothelial glycocalyx?

Our friend @CPV_Physiology raises the interesting question of transport phenomena in nature. In this third post about capillary blood flow velocity I draw to your attention a nice review of the evolution of vascular systems in animals. It is a very reasonable hypothesis that the longest-lived animals have evolved an energy-efficient cardiovascular system that delivers…… Continue reading Why capillary blood flow is Slow in longer-lived species.

To continue on from yesterday’s post, Dr Ghanem replied promptly to my request for more information on his G Tube; The G tube is a tube with narrow orifice and holes in its wall built on a scale to the capillary tube. It was designed and invented by me 39 years ago. It was later…… Continue reading more on Ghanem’s Hypothesis

For nearly a decade I have been encouraging physicians to question the century-old medical school physiology shibboleth concerning fluid volume filtration from followed by absorption to the lumen of an archetypal Capillary; the filtration – absorption model. At steady state, the extended Starling principle holds that the hydrostatic capillary pressure difference declines between arteriole and…… Continue reading Starling’s Law for the Capillary-Interstitial Fluid Transfer is Wrong?

Ernest Henry Starling CMG FRCP FRS, born 17th April 1866. Only by following out the injunction of our great predecessor William Harvey to search out and study the secrets of Nature by way of experiment, can we hope to attain to a comprehension of ‘the wisdom of the body and the understanding of the heart,’ and thereby to…… Continue reading Happy Birthday E.H. Starling

I am delighted to see a pro-con pair of manuscripts published side by side in Acta Anesthesiologica Scandinavica, and would congratulate the Journal Editors for agreeing to this style of presentation. Earlier criticisms of my work by Professor Hahn’s team did not afford me a right to reply. I also thank Imperial College London for…… Continue reading The last word… for now