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. Lyophilised plasma seems to be…… Continue reading Plasma and Vitamin C for shock resuscitation.
I was surprised to learn of the work of Dr Corinne Becker at the Lymphoedema Centre, and with a little searching discovered that many surgeons are now offering autologous lymph node transplant for the treatment of lymphoedema. Students of the steady state Starling principle will understand the rationale; contrary to standard medical school physiology teaching,…… Continue reading Lymph nodes reabsorb lymphatic fluid; a surgical application of an important principle.
Yesterday I did some teaching for NHS HRA Research Ethics Committees in London. I took the opportunity to present the Paul Marik story and covered the pros and cons of offering this treatment “on the NHS” as even-handedly as I could. Then I asked for a show of hands on who would demand a “proper” UK-based…… Continue reading Law (English) and Ethics of withholding Vitamin C for treatment of sepsis.
I was recently amazed to be engaged in a Twitter kerfuffle which generated more than 10,000 Impressions within 24 hours. Passions were running high, libellous comments were being broadcast, and old friendships seemed to be at breaking point. The issue? The ethics of preserving endothelial (im)permeability. This Post reflects my current perspective on things; I…… Continue reading Vitamin C and the ethics of Borrowing data.
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 low volume hyperoncotic resuscitation have…… Continue reading Low volume resuscitation – PEGged?
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 plasma concentration of albumin, and…… Continue reading Hypoalbuminaemia in surgical practice; recent insights from the Karolinska.
I’m looking forward to meeting senior trainee anaesthetists at the University Hospital of South Manchester on Monday March 13th, when I will share with them my reasons for creating fluidphysiology.org and the perils of open access publishing/ blogging etc. We might even talk a bit of fluid physiology.