What is the Role of the Endothelial Glycocalyx in Fluid Therapy?

Kendon Kuo, DVM, MS, DACVECC, assistant clinical professor at the Auburn University College of Veterinary Medicine, explains how veterinarians are continuing to explore how a damaged glycocalyx can impact fluid therapy.

"So, the glycocalyx is a relatively old idea that's becoming kind of rediscovered. And so, the more we kind of learn about fluids, the more we learn that we don't know exactly what's happening. And so, the glycocalyx is kind of this fuzzy layer that lines our blood vessels and it has a lot of different functions, but as far as fluid therapy goes we're thinking in different diseases that glycocalyx might be injured and that might change how fluids work. And so, you know fluids like, hetastarch, vetstarch, ideally they should hang out in the vascular space and kind of pull fluid in and keep fluids there, but we're discovering you know perhaps that glycocalyx is being damaged. And as a result, those fluids actually kind of leak out.

And so, in diseases where the glycocalyx could be damaged, things like colloids might not work as expected. And so, really it's changing how we think about fluids, how we approach fluids, and there's been some good studies showing that if you give too much fluids that will damage the glycocalyx. And so, it really kind of makes us take pause and say you know should we bolus these fluids, should we give this bolus over a slower period of time? All those are questions that I wish I had answers for, but, I think we're just at the of the iceberg at this point."