Extra protein loss not caused by surgical bleeding in patients with ovarian cancer

Rehm, Markus; Haller, M.; Brechtelsbauer, H.; Akbulut, C.; Finsterer, U

doi:10.1111/j.1399-6576.1998.tb05078.x

Cited by 37 publications

(31 citation statements)

References 22 publications

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“…Therefore, if blood loss is compensated for to a large extent using pure crystalline solutions, the colloid osmotic pressure in the blood vessel system will drop significantly. Moreover, during major tumor surgeries, considerable quantities of macromolecules -protein and HES -are lost into the interstitial space, the so-called protein [13] or HES shift [14][15][16]. These are losses of protein or HES that can not be explained by surgical bleeding or urine.…”

Section: Physiology and Effectiveness In Infusion Therapymentioning

confidence: 99%

“…These are losses of protein or HES that can not be explained by surgical bleeding or urine. For example, in ovarian cancer patients, in addition to the protein loss resulting from surgical bleeding (1700 ml, 67 g protein loss), a mean intraoperative protein shift of 49 g occurred [13]. In patients with radical hysterectomy, it was shown that 30% of the applied HES molecules left the vascular bed (mean loss via surgical bleeding: 18 g, mean excretion of HES in urine: 18 g, mean HES shift: 30 g) [16].…”

Section: Physiology and Effectiveness In Infusion Therapymentioning

confidence: 99%

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State of the art in fluid and volume therapy

et al. 2017

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Section: Physiology and Effectiveness In Infusion Therapymentioning

confidence: 99%

Section: Physiology and Effectiveness In Infusion Therapymentioning

confidence: 99%

State of the art in fluid and volume therapy

et al. 2017

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“…This suggests a state of marked extravasation of colloid but can also indicate a stronger incorporation within the glycocalyx. 34 …”

Section: Dimension and Physiological Role Of The Endothelial Glycocalyxmentioning

confidence: 99%

Shedding of the Endothelial Glycocalyx in Patients Undergoing Major Vascular Surgery With Global and Regional Ischemia

et al. 2007

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Background-The astonishing thickness of the endothelial glycocalyx, which rivals that of endothelial cells in the microvasculature, was disclosed in the last 15 years. As already demonstrated, this structure plays a key role in the regulation of inflammation and vascular permeability. Methods and Results-Two components of the glycocalyx, syndecan-1 and heparan sulfate, were measured in arterial blood of 18 patients undergoing surgery of the ascending aorta with cardiopulmonary bypass (nϭ12 with and nϭ6 without deep hypothermic circulatory arrest) and of 14 patients undergoing surgery for infrarenal aortic aneurysm. Basal values of syndecan-1 (1.2 g/dL) and heparan sulfate (590 g/dL) of patients were similar to those of control subjects. Anesthesia and initiation of surgery caused no changes. Global ischemia with circulatory arrest (nϭ12) was followed by transient 42-and 10-fold increases in syndecan-1 and heparan sulfate, respectively, during early reperfusion (0 to 15 minutes). After regional ischemia of heart and lungs (cardiopulmonary bypass; nϭ6), syndecan-1 increased 65-fold, and heparan sulfate increased 19-fold. Infrarenal ischemia was followed by 15-and 3-fold increases, respectively (nϭ14). The early postischemic rises were positively correlated (rϭ0.76, PϽ0.001). Plasma concentrations of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 did not change. Circulating polymorphonuclear granulocytes and the level of postischemic heparan sulfate corresponded negatively. Immunohistochemical imaging and immunoassay of isolated hearts (guinea pig) substantiated syndecan-1 and heparan sulfate as components of the endothelial glycocalyx released into the coronary venous effluent. Electron microscopy revealed shedding of the glycocalyx after ischemia/reperfusion. Conclusions-This study provides the first evidence in humans for shedding of the endothelial glycocalyx during ischemia/reperfusion procedures.

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“…Durch die direkte Messung des Plasmavolumens (Indozyaningrün-Verdünnung) und der Plasmaproteinkonzentration konnte ein medianer Shift von etwa 70 g (mehr als 1/3 des gesamten intravasalen Pools) über die vaskuläre Barriere hinweg in Richtung Interstitium nachgewiesen werden. (Aus[129])Abb. 2 8 Medianer perioperativer Volumenstatus von 13 Patientinnen mitOvarialkarzinom, die sich unter einem "Standardinfusionsregime" (Kristalloid: 1 l/h, Kolloid: bei Blutverlust im Volumenverhältnis 1:1) in kurativer Absicht einer Laparotomie unterzogen.…”

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“…Durch die direkte Messung des Blutvolumens (Double-label-Technik) konnte ein perioperativer Flüssigkeitsshift von annähernd 4 l aus dem Gefäßsystem über die Barriere hinweg in Richtung Interstitium nachgewiesen werden. (Aus[129])…”

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Determinanten des insensiblen Flüssigkeitsverlustes

et al. 2007

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Accurate perioperative fluid balance is the basis of a targeted infusion regimen. However, neither the initial status nor perioperative changes of the fluid compartments can be reliably measured in daily routine. In particular, insensible losses are not consistently assessed, so that substitution therapy is generally empirical. The object of this paper is to communicate the scientific data on this topic. Preoperative fasting (10 h) does not per se cause intravascular hypovolemia. In adults, total basal evaporation by way of the skin and airways and of any wounds during major abdominal interventions is usually less than 1 ml/kg/h. An inconstant fluid and protein shift towards the interstitial space perioperatively seems to be associated with hypervolemia, which suggests it should be preventable. The decisive factor in this context seems to be deterioration of the endothelial glycocalyx, whose further patho-physiological impact is currently only partially known. Clinical studies have revealed a link between fluid restriction and improved outcome after major abdominal surgery.

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Extra protein loss not caused by surgical bleeding in patients with ovarian cancer

Abstract: IPS could be an important quantity in perioperative fluid balance. We assume that different surgical procedures predispose to occurrence of differing amounts of IPS.

Cited by 37 publications

References 22 publications

State of the art in fluid and volume therapy

State of the art in fluid and volume therapy

Shedding of the Endothelial Glycocalyx in Patients Undergoing Major Vascular Surgery With Global and Regional Ischemia

Determinanten des insensiblen Flüssigkeitsverlustes

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