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The Extended Starling principle needs clinical validation.

Robert G Hahn^1,2, Randal O Dull³, Joachim Zdolsek⁴

¹Research Unit, Södertälje Hospital, Södertälje, Sweden.

Acta Anaesthesiologica Scandinavica

|April 10, 2020

Summary

This summary is machine-generated.

The Revised Starling principle, based on animal studies, challenges human fluid dynamics. Clinical observations in humans do not align with its proposals regarding the endothelial glycocalyx and fluid exchange.

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Area of Science:

Physiology
Microcirculation
Fluid Dynamics

Background:

The Revised (or

Purpose of the Study:

To evaluate the clinical validity of the Revised Starling principle.
To investigate discrepancies between the Revised Starling principle and human physiological observations.

Main Methods:

Review of experimental and clinical observations in humans.
Analysis of fluid therapy studies and microcirculatory proposals.

Main Results:

Human clinical observations poorly align with the Revised Starling principle's microcirculatory proposals.
The role of the endothelial glycocalyx in fluid reabsorption and capillary leakage presents inconsistencies with the principle.
The principle's focus on steady-state conditions neglects the dynamic nature of human circulation, including vasomotion.

Conclusions:

The Revised Starling principle requires significant clinical validation.
Human microcirculatory observations suggest limitations in the current understanding of the Revised Starling principle.
Dynamic circulatory factors like vasomotion are crucial for understanding human fluid exchange and necessitate consideration beyond steady-state models.