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Microvascular fluid exchange and the revised Starling principle

Cardiovascular research, 2010-07, Vol.87 (2), p.198-210 [Peer Reviewed Journal]

2015 INIST-CNRS ;ISSN: 0008-6363 ;EISSN: 1755-3245 ;DOI: 10.1093/cvr/cvq062 ;PMID: 20200043 ;CODEN: CVREAU

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Title:
Microvascular fluid exchange and the revised Starling principle
Author: Levick, J. Rodney ; Michel, C. Charles
Subjects: Animals ; Biological and medical sciences ; Blood Proteins - metabolism ; Body Fluids - metabolism ; Capillary Permeability ; Cardiology. Vascular system ; Edema - metabolism ; Edema - physiopathology ; Endothelium, Vascular - metabolism ; Endothelium, Vascular - physiopathology ; Fluid exchange ; Glycocalyx ; Glycocalyx - metabolism ; Humans ; Inflammation - metabolism ; Inflammation - physiopathology ; Kinetics ; Medical sciences ; Microvessels - metabolism ; Microvessels - physiopathology ; Models, Cardiovascular ; Osmotic Pressure ; Starling principle
Is Part Of: Cardiovascular research, 2010-07, Vol.87 (2), p.198-210
Description: Microvascular fluid exchange (flow Jv) underlies plasma/interstitial fluid (ISF) balance and oedematous swelling. The traditional form of Starling's principle has to be modified in light of insights into the role of ISF pressures and the recognition of the glycocalyx as the semipermeable layer of endothelium. Sum-of-forces evidence and direct observations show that microvascular absorption is transient in most tissues; slight filtration prevails in the steady state, even in venules. This is due in part to the inverse relation between filtration rate and ISF plasma protein concentration; ISF colloid osmotic pressure (COP) rises as Jv falls. In some specialized regions (e.g. kidney, intestinal mucosa), fluid absorption is sustained by local epithelial secretions, which flush interstitial plasma proteins into the lymphatic system. The low rate of filtration and lymph formation in most tissues can be explained by standing plasma protein gradients within the intercellular cleft of continuous capillaries (glycocalyx model) and around fenestrations. Narrow breaks in the junctional strands of the cleft create high local outward fluid velocities, which cause a disequilibrium between the subglycocalyx space COP and ISF COP. Recent experiments confirm that the effect of ISF COP on Jv is much less than predicted by the conventional Starling principle, in agreement with modern models. Using a two-pore system model, we also explore how relatively small increases in large pore numbers dramatically increase Jv during acute inflammation.
Publisher: Oxford: Oxford University Press
Language: English
Identifier: ISSN: 0008-6363
EISSN: 1755-3245
DOI: 10.1093/cvr/cvq062
PMID: 20200043
CODEN: CVREAU
Source: GFMER Free Medical Journals
MEDLINE
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Microvascular fluid exchange and the revised Starling principle

2015 INIST-CNRS ;ISSN: 0008-6363 ;EISSN: 1755-3245 ;DOI: 10.1093/cvr/cvq062 ;PMID: 20200043 ;CODEN: CVREAU

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