Hypervolemia increases release of atrial natriuretic peptide and shedding of the endothelial glycocalyxReport as inadecuate

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Critical Care

, 18:538

First Online: 13 October 2014Received: 28 April 2014Accepted: 08 September 2014


IntroductionAcute normovolemic hemodilution ANH and volume loading VL are standard blood-sparing procedures. However, VL is associated with hypervolemia, which may cause tissue edema, cardiopulmonary complications and a prolonged hospital stay. The body reacts to hypervolemia with release of atrial natriuretic peptide ANP from the heart. ANP has been shown to deteriorate the endothelial glycocalyx, a vital part of the vascular permeability barrier. The aim of the present study was to evaluate and compare ANP release and damage to the glycocalyx during ANH and VL.

MethodsANH or VL with 6% hydroxyethyl starch 130-0.4 was administered prior to elective surgery in patients of good cardiopulmonary health n =9 in each group. We measured concentrations of ANP in plasma and of three main constituent parts of the glycocalyx hyaluronan, heparan sulfate and syndecan 1 in serum before and after ANH or VL. Heparan sulfate and syndecan 1 levels in urine were also determined.

ResultsIn contrast to ANH, VL 20 ml-kg induced a significant release of ANP approximately +100%, P <0.05 and increased the serum concentration of two glycocalyx constituents, hyaluronan and syndecan 1 both by about 80%, P <0.05. Elevation of syndecan 1 was also detected in the urine of patients undergoing VL, but no increase was found in patients undergoing ANH. Heparan sulfate levels were not influenced by either procedure.

ConclusionThese data suggest that hypervolemia increases the release of ANP and causes enhanced shedding of the endothelial glycocalyx. This perturbation must be expected to impair the vascular barrier, implying that VL may not be as safe as generally assumed and that it should be critically evaluated.

AbbreviationsANHAcute normovolemic hemodilution

ANPAtrial natriuretic peptide

BSABody surface area

HESHydroxyethyl starch

VLVolume loading

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0538-5 contains supplementary material, which is available to authorized users.

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Author: Daniel Chappell - Dirk Bruegger - Julia Potzel - Matthias Jacob - Florian Brettner - Michael Vogeser - Peter Conzen - Bernh

Source: https://link.springer.com/

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