The Effects of Resuscitative Fluid Therapy on the Endothelial Surface Layer

Area of Science:

• Critical care medicine
• Vascular biology
• Hemodynamics

Background:

• Resuscitative fluid therapy aims to restore blood volume and tissue perfusion.
• While improving macrohemodynamics, fluid therapy can negatively impact microcirculation and the endothelium.
• The endothelial surface layer (ESL) is crucial for regulating vascular permeability, tone, coagulation, and inflammation.

Purpose of the Study:

• To review the detrimental effects of resuscitative fluid therapy on the endothelial surface layer (ESL).
• To explore how ESL shedding or thinning contributes to critical illness pathophysiology.
• To suggest future research directions for optimizing fluid therapy and preserving ESL integrity.

Main Methods:

• Narrative review of existing literature.
• Critical evaluation of experimental and clinical evidence.
• Analysis of the impact of fluid therapy on ESL structure and function.

Main Results:

• Both critical illness and rapid, large-volume fluid resuscitation can lead to ESL shedding or thinning.
• ESL damage is associated with interstitial edema, inflammation, and microcirculatory dysfunction.
• Evidence from animal models and preliminary human trials suggests restricting crystalloid volume may preserve ESL integrity.

Conclusions:

• Resuscitative fluid therapy poses risks to the endothelial surface layer, potentially exacerbating critical illness.
• Preserving ESL integrity through judicious fluid management may be a key strategy for improving patient outcomes.
• Further research is needed to elucidate the precise mechanisms and clinical implications of ESL dysfunction in fluid resuscitation.