Evaluation of resuscitation fluids on endothelial glycocalyx, venular blood flow, and coagulation function after hemorrhagic shock in rats

Abstract

Our findings support the concept of cardiovascular and microvascular stabilization by infused FFP, in which the increase in microvascular perfusion associated with restored EG is essential for an optimal resuscitation strategy.

Plasma syndecan-1 and heparan sulfate correlate with microvascular glycocalyx degradation in hemorrhaged rats after different resuscitation fluids

“…Using electron microscopy images of venules, Kozar et al (32) reported similar data in a more severe model of hemorrhagic shock. Different studies suggested at least partial recovery of the damaged glycocalyx by treatment with plasma and other blood-derived resuscitation fluids, but not by treatment with crystalloids (32,59,60). These data suggested that fluid resuscitation could prompt further changes in the glycocalyx after an initial hemorrhage-induced degradation.…”

Application of pulsed arterial resuscitation in a rabbit model of hemorrhagic shock

“…[18,19] However, a sudden influx of liquid into the blood vessels will cause the infused blood to be retained in the venous system as the blood is in a state of stasis in the capillaries, which will cause a constant increase in the intravascular hydrostatic pressure. [13,[20][21][22] In turn, this results in more intravascular liquid penetrating into the extravascular space through the blood vessel walls, which already show increased permeability due to the ischemic and hypoxic injury. Consequently, this process can cause edema of the internal organs, especially pulmonary edema.…”

Validation of acute traumatic coagulopathy in an ovine model of trauma and haemorrhage

“…Restoration of plasma volume with crystalloid and/or synthetic colloid solutions produces a diffuse microvascular bleeding tendency due to dilution of clotting factors, accelerated endothelial glycocalyx degradation and direct interactions with fibrin polymerization (178,183,204). The induction of acidosis to a pH of less than 7.2 via intravenous administration of hydrochloric acid or ischemia-reperfusion injury has been shown to reduce the enzymatic activity of coagulation proteases, producing a coagulopathy that cannot be readily reversed with simple correction of the acidosis (192)(193)(194).…”

“…However only 3 models have evaluated aspects of the proposed pathophysiologic mechanisms, and as a result animal models are yet to significantly contribute to the improved mechanistic understanding of ATC (40,177,178).…”

“…There is some evidence to suggest that fresh frozen plasma (FFP) may have a protective and restorative effect on the endothelial glycocalyx (137,178), a…”