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Educational Objectives: The Endothelial Glycocalyx: A New Target in Critical Illness Can Ince PhD 2:15-2:30 Wednesday, February 15 Discuss the morphology, composition and physiology of the endothelial glycocalyx Present methods of assessing the presence of the glycocalyx Discuss the how the glycocalyx is compromised, its pathophysiological consequences and the factors which contribute to its shedding. Content Description: The endothelial glycocalyx is an intraluminal layer of about 0.2µm covering the endothelial cells of blood vessels. It is a compressible gel-like layer consisting of a web-like structure of membrane-bound glycoproteins and proteoglycans. The endothelial glycocalyx exerts a wide array of protective effects for the vasculature via inhibition of coagulation and leucocyte adhesion, contributing to anti-oxidant compounds, contributing to the vascular permeability barrier and by mediating shear stress-induced NO release. Demonstrating its presence and its compromise has been technically very challenging which why its presence and significance has only recently come to light. Its compromise is detected under vital or electron microscopy or by the presence of components of the shredded glycocalyx in plasma. Its degradation is partially sensitive to reactive oxygen species and disease states associated with activation of oxidative stress such as diabetes and sepsis as well probably a host of other diseased states where inflammatory activation and oxidative stress are present. The appreciation of its presence and physiological function has led to a re-appraisal of the view of fluid resuscitation as a means of treating hypovolemia and maintaining intraluminal volume. In this respect there has been a reappraisal of the understanding of Starlings principle in describing the effects of colloids. It is clear that future will be focused on protective strategies aimed at the glycocalyx as well as novel fluid taking the importance the glycocalyx into account. Methods under development using high resolution vital microscopy to assess the presence of the glycocalyx at the bedside may prove useful in this respect. Suggested Reading: Nieuwdorp M, Meuwese MC, van Lieshout MHP, Levi M, Meijers JCM, Ince C, Vink H, Kastelein JJP, Erik SG Stroes ESG (2009) TNF· inhibition dampens endotoxin-induced endothelial glycocalyx perturbation and inflammatory effects in vivo. Atherosclerosis. 202(1):296-303. Nieuwdorp M, Meuwese MC, Hans L Mooij HL, Ince C, BroekhuizenLN, Kastelein JP, Stroes ESG, Vink H (2008) Measuring endothelial glycocalyx dimensions in humans: a novel tool to monitor vascular vulnerability. J of Applied Physiol 104(3):845-52 Nieuwdorp M, Mooij HL, Kroon J, Atasever B, Spaan JA, Ince C, Holleman F, Diamant M, Heine RJ, Hoekstra JB, Kastelein JJ, Stroes ES, Vink H. (2006) Endothelial glycocalyx damage coincides with microalbuminuria in type 1 diabetes. Diabetes. Apr;55(4):1127-32 Vink H and Duling BR. Identification of distinct luminal domains for macromolecules, erythrocytes, and leukocytes within mammalian capillaries. Circ Res 79: 581-589, 1996. 29
Chappell D, Jacob M, Hofmann-Kiefer K, Bruegger D, Rehm M, Conzen P, Welsch U, Becker B (2007) Hydrocortisone Preserves the Vascular Barrier by Protecting the Endothelial Glycocalyx Anesthesiology 107:776 – 84 Zuurbier C, Vink H, Koeman A, Demirci C, Ince C (2005) Short-term hyperglycemia increases endothelial glycocalyx permeability and decreases lineal density of capillaries with flowing RBC's. J Appl Physiol 99(4):1471-6. Woodcock TE, Woodcock TM (2012) Revised Starling equation and the glycocalyx modelof transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. Brit J Anaesthesia doi:10.1093/bja/aer515 Levick JR, Michel CR (2010) Microvascular fluid exchange and the revised Starling principle. Cardiovas Res 87, 198–210 Xavier Marechal X, Favory R, Joulin O, Montaigne D, Hassoun S, Decoster S, Zerimech F, Neviere R (2008) Endothelial glycocalyx damage during endotoxemia coincides with microcirculatory dysfunction and vascular oxidative stress Shock 29: 572-576. 30
Page 2 and 3: CRRT 2012 SEVENTEENTH INTERNATIONAL
Page 4 and 5: FACULTY DISCLOSURES CRRT 2012 Facul
Page 6 and 7: CRRT 2012 ORGANIZING COMMITTEE USA
Page 8 and 9: CRRT 2012 FACULTY Patrick Honoré,
Page 10 and 11: ACKNOWLEDGEMENTS CRRT 2012 ACKNOWLE
Page 12 and 13: PLENARY SESSIONS CRRT 2012 PROGRAM/
Page 18 and 19: WORKSHOPS CRRT 2012 PROGRAM/INDEX T
Page 20 and 21: WORKSHOPS CRRT 2012 PROGRAM/INDEX W
Page 22 and 23: POSTER ABSTRACTS C
Page 24 and 25: POSTER ABSTRACTS C
Page 26 and 27: NURSING FORUM LUNCHEON Communicatio
Page 28 and 29: Nutritional Support in ICU Patients
Page 32 and 33: SPECIAL LECTURE Engineering Critica
Page 34 and 35: Nishimura R, Ornato JP, Page RL, Ri
Page 36 and 37: Do Vasoactive Drugs and Fluids Impr
Page 38 and 39: Blood Transfusions are Important fo
Page 40 and 41: Thinking Outside of the Box: A Nove
Page 42 and 43: Nursing Forum 2 Luncheon Benchmarki
Page 44 and 45: 4. Mori K, Lee HT, Rapoport D, Drex
Page 46 and 47: Differential Diagnosis of AKI: Can
Page 48 and 49: Myocardial Stunning and Brain Edema
Page 50 and 51: 4. Udy A, Roberts JA, Lipman J. Wha
Page 52 and 53: CRRT and ECMO: Techniques and Outco
Page 54 and 55: Management of Severe Heart Failure:
Page 56 and 57: Avoiding Anticoagulation for CRRT:
Page 58 and 59: Improving Outcomes from</st
Page 60 and 61: The Changing Face of AKI: Snapshots
Page 62 and 63: Alkaline Phosphatase Peter Pickkers
Page 64 and 65: creatinine (Cr) was measured using
Page 66 and 67: Surveillance and Early Recognition
Page 68 and 69: therapy admitted to general intensi
Page 70 and 71: A01 Assessing the Microcirculation
Page 72 and 73: A01 Assessing the Microcirculation
Page 74 and 75: C03 Critical Care Pharmacology: Vas
Page 76 and 77: D04 Biomarkers 1: Principles and Ap
Page 78 and 79: 6. Ferguson JW, Dover AR, Chia S, C
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G07 Fluids and Solutions in the Cri
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A09 Vascular Access /Membrane and C
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A09 Vascular Access /Membrane and C
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C11 Critical Care Management: Nutri
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D12 Biomarkers 2: Application in AK
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Educational Objectives: E13 Liver a
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G15 Fluids and Solutions in the Cri
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Educational Objectives: 1) Discuss
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B18 Fluid Management Ravindra L. Me
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C19 Acid Base and Electrolyte Probl
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D20 Extracorporeal Techniques for S
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the mediatordelivery hypothesis. In
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F22 Ensuring Patient Safety and Qua
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H24 Patient Centered Care in the IC
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B26 Starting and Stopping RRT for A
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C27 Acid Base and Electrolyte Probl
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D28 Extracorporeal Techniques for S
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E29 Heart Failure and Cardio-Renal
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F30 Ensuring Patient Safety and Qua
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H32 Withdrawing & Withholding Suppo
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Patel SS, Holley JL. Withholding an
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