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The recent publication by Löffel et al1 concerning the Starling principle reveals some important misunderstandings common amongst clinicians about the science. The Authors confuse the Frank Starling Law (of the heart) with Starling’s principle of fluid exchange, often expressed as the Starling equation which I explain here. Jv is the transendothelial solvent filtration rate, A…… Continue reading Misconceptions about the Starling principle as applied to fluid therapy.

I’m delighted to hear from the Publisher that sales of Fluid Physiology in hardback continue to be strong, and that they feel confident to expand our readership by offering a paperback version at a more affordable price. My hope is that this will enable every prescriber of fluid therapy to have their own copy, or…… Continue reading A big Thankyou to purchasers of the Textbook of Fluid Physiology…

The traditional paradigm of lecture theatre gatherings, authoritative Textbooks, accredited congresses and conferences has rapidly dwindled. Today people are choosing Twitter Experts, non-peer reviewed electronic publications, and on-line Presentations without live interactions. Love it or loathe it, there is no going back. Fake News communications are increasingly succeeding in getting published in previously reputable journals;…… Continue reading Medical Education in a post pandemic world

Ernest Henry Starling CMG FRCP FRS (17 April 1866 – 2 May 1927) was very much a clinical scientist and believed that a bottle of intravenous gooey stuff would save Great War victims of wound shock. Research methodology and ethics was pretty rudimentary in the early twentieth century. He seems to have been unclear on…… Continue reading Happy Birthday Ernest Starling, 155 today.

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.