The pointlessness of starch to boost oxygen delivery in surgical patients…

Reiterer C, Kabon B, Zotti O, Obradovic M, Kurz A, Fleischmann E. Effect of goal-directed crystalloid- versus colloid-based fluid strategy on tissue oxygen tension: a randomised controlled trial. Br J Anaesth. 2019;123:768-776. Yet another HES vs LR for GDT in major surgery RCT. Regular readers will understand that modern Starling fluid physiology leads us to…… Continue reading The pointlessness of starch to boost oxygen delivery in surgical patients…

Midodrine again.

Why would a fluid physiologist want to point out that oral pills can be as effective as a drip and a bottle or three of human albumin solution? https://www.ncbi.nlm.nih.gov/pubmed/30312183 Albumin does seem to have a beneficial effect in certain hepatology scenarios, but researchers at the University of Cairo have found a cheaper, simpler and more…… Continue reading Midodrine again.

Why do patients with acute hemorrhage become anemic?

Today’s edition of the New England Journal of Medicine (September 19th 2019, pages 1097-8) carries a two-page explanation of the power and the reach of the humble tweetorial by the outstanding exponent of the art, @Tony_breu of Harvard Medical School. DOI: 10.1056/NEJMp1906790. Tony cites his own first venture into this new route to publication, which…… Continue reading Why do patients with acute hemorrhage become anemic?

An Update on Sodium storage

The latest contribution from Olde Engberink in Amsterdam on the emerging story of sodium storage is Open Access; https://doi.org/10.1007/s00467-019-04305-8 Olde Engberink RHG, Selvarajah V, Vogt L. Clinical impact of tissue sodium storage. Pediatr Nephrol. 2019. And a new diagram for our basic electrolyte physiology teaching for clinicians. Sodium Storage Olde Engberink 2019 The authors conclude…… Continue reading An Update on Sodium storage

Endothelial cells; there are sex differences.

I guess we’d not argue that there are likely to be differences in the microvascular physiology of men and women. Professor Virginia Huxley is the Director of the United States National Center for Gender Physiology and Professor in the Department of Medical Pharmacology and Physiology, Missouri. In a recent paper she wrote; “the incidence and…… Continue reading Endothelial cells; there are sex differences.

Microvascular ion transport through endothelial glycocalyx layer: new mechanism and improved Starling principle

Xi Zhuo Jiang, Yiannis Ventikos,* and Kai H. Luo*  Department of Mechanical Engineering, University College London, London, United Kingdom  Submitted 11 December 2018; accepted in final form 19 April 2019  Am J Physiol Heart Circ Physiol 317: H104–H113, 2019. First published April 26, 2019; doi:10.1152/ajpheart.00794.2018.  Well, I’ve bought a download of this amazing piece of…… Continue reading Microvascular ion transport through endothelial glycocalyx layer: new mechanism and improved Starling principle

Well this is embarrassing…

https://www.youtube.com/watch?v=Qm86qUPS0eI The worst conference presentation I ever made has recently been posted on YouTube by someone called nsicu ru; I probably consented to recording, but did not know it had been so publicly posted. I was the second speaker in a two-presentation morning session, and the first speaker who disapproves of steady state Starling physiology…… Continue reading Well this is embarrassing…

Now on YouTube

FluidPhysiology announces it’s premiere on YouTube, launched yesterday to our twitter followers. The link is; youtu.be/8-w_MO38Umo If you search The Starling Principle or Starling equation or capillary fluid exchange you’ll find many enthusiastic video bloggers, from medical students to professors, explaining the traditional filtration/ reabsorption concept. Some of them have enjoyed many thousands of views…… Continue reading Now on YouTube

Infamy, infamy, why have they got it in for me?

Debates in fluid therapy recommendations can get a bit hot; first it was Colloids versus Crystalloids, then it was Chloride Max versus Chloride Lite solutions. Now I enjoy a good civilised debate, even a Fluid Controversy if that’s what it takes to attract the attention of ticket-buying Conference Delegates, but what I want to talk…… Continue reading Infamy, infamy, why have they got it in for me?