@rombarthelemy @BakkeHK Sorry, that was just a general comment on the psychological effect, not trying to argue against #albumin; quite the opposite!
Very interesting article and thank you for sharing it! Do you have any thoughts on timing and benefit, purely in terms of #glycocalyx damage?
Is the benefit of albumin constant regardless of the degree of existing glycocalyx damage? Or is there a point where, if the disruption is severe enough, it stops being effective?
@razvan @BakkeHK Not at all. The purpose of using #albumin in #SepticShock is precisely to prevent or mitigate #glycocalyx damage. If oncontic pressure gradient was the purpose, any synthetic colloid would do the job (actually, they won’t, because of the altered endothelial layer, as you suggested)
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00697-1
https://link.springer.com/article/10.1007/s00134-022-06740-y
The endothelial glycocalyx comprises a complex layer of membrane-bound proteoglycans, secreted glycosaminoglycans, glycoproteins, glycolipids and bound plasma proteins such as albumin and antithrombin associated with the endothelial surface. The glycocalyx plays an important role in vascular homeostasis, regulating vascular permeability and cell adhesion, and acts as a mechanosensor for hemodynamic shear stresses; it also has antithrombotic and anti-inflammatory functions. Plasma proteins such as albumin are physiologically bound within the glycocalyx, thus contributing to stability of the layer. Albumin is the major determinant of plasma colloid osmotic pressure. In addition, albumin transports sphingosine-1-phosphate which has protective endothelial effects, acts as a free radical scavenger, and has immunomodulatory and anti-inflammatory effects. This review examines the physiological function of the endothelial glycocalyx and the role of human albumin in preserving glycocalyx integrity and the microcirculation.
Howard Smith MD, AM
Razvan Azamfirei
Romain Barthélémy
Universität Freiburg
Søren Grubb