Abstract
The aim was to explore the body of literature focusing on protective treatments against endothelial glycocalyx degradation in surgery. A comprehensive systematic review of relevant articles was conducted across databases. Inclusion criteria: (1) treatments for the protection of the endothelial glycocalyx in surgery; (2) syndecan-1 used as a biomarker for endothelial glycocalyx degradation. Outcomes analysed: (1) mean difference of syndecan-1 (2) correlation between glycocalyx degradation and inflammation; (3) correlation between glycocalyx degradation and extravasation. A meta-analysis was used to present mean differences and 95% confidence intervals. Seven articles with eight randomised controlled trials were included. The greatest change from baseline values in syndecan-1 concentrations was generally from the first timepoint measured post-operatively. Interventions looked to either dampen the inflammatory response or fluid therapy. Methylprednisolone had the highest mean difference in plasma syndecan-1 concentrations. Ulinastatin showed correlations between alleviation of degradation and preserving vascular permeability. In this systematic review of 385 patients, those treated were more likely than those treated with placebo to exhibit less shedding of the endothelial glycocalyx. Methylprednisolone has been shown to specifically target the transient increase of glycocalyx degradation immediately post-operation and has displayed anti-inflammatory effects. We have proposed suggestions for improved uniformity and enhanced confidence for future randomised controlled trials.
Highlights
The vascular endothelium plays several important roles including haemostatic balance, endothelial integrity, and blood flow regulation [1]
It has differed from the other studies as patients had undergone off-pump CPB, which is of clinical significance as studies have shown differences in plasma syndecan-1 and plasma heparan sulphate concentrations between surgeries [29]
The aim of this systematic review was to investigate treatments listed on large clinical databases to protect against endothelial glycocalyx (EG) degradation in surgery
Summary
The vascular endothelium plays several important roles including haemostatic balance, endothelial integrity, and blood flow regulation [1]. It comprises a single layer of endothelial cells, lining every blood vessel in the body and is understood to be 4000–7000 m2 [2]. These cells play a vital role as a semipermeable membrane to allow the exchange of nutrients and the removal of waste to and from the blood. A key structure involved in these actions is the endothelial glycocalyx (EG), which coats cells’ extracellular matrix. The glycocalyx enables changes by a process known as mechanotransduction
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