Speed of intravenous fluid on glycocalyx integrity and central blood volume in a porcine septic shock model.

backgroundIt is unclear whether the rate of intravenous fluid (IVF) administration in sepsis influences glycocalyx breakdown. This study aimed to measure the effect of rapid versus slow fluid bolus in a septic pig model on the integrity of the glycocalyx by measuring the serum levels of heparan sulfate and syndecan-1, breakdown products of the glycocalyx. Because endothelial glycocalyx is composed of apical cell membrane-bound proteoglycans such as syndecan-1, covalently bound with long linear glycosaminoglycans such as heparan sulfate, shedding of these different glycocalyx components is closely related. Additionally, we measured central blood volume (blood volume in the heart and lungs) to determine the effect of fluid administration rate on intravascular volume. Plasma membrane type-1 matrix metalloproteinase (MT1-MMP) levels (indicating vascular shear stress) were compared between groups to assess whether fast IVF boluses generate greater endothelial shearing forces than slow boluses.

methodsA porcine septic shock model using lipopolysaccharide-induced endotoxemia was used. We randomized 22 piglets to receive two fluid boluses of 20 mL/kg each 30 min apart; 11 received the fluid bolus over 5 min and 11 over 20 min. We monitored the central blood volume index (CBVI) using ultrasound dilution. Measurements of glycocalyx degradation markers, heparan sulfate and syndecan-1, MT1-MMP, and CBVI were obtained at the onset of septic shock and every 30 min for four measurements. Study variables were summarized as mean (standard deviation) by fast versus slow IVF groups across measurement time points. To assess the mean trends in outcomes (syndecan-1, heparan sulfate, MT1-MMP, CBVI) between the two speeds of IVF administration over time, a linear mixed-effects model with a first-order autoregressive within-subject correlation structure was applied.

resultsSerum heparan sulfate and syndecan-1 levels showed no significant differences (P = 0.405 and 0.571, respectively). Baseline-adjusted mean central blood volumes over the four measurements were greater in the slow IVF versus fast group; however, the difference fell short of statistical significance (P = 0.073), indicating a nonsignificant trend toward greater central blood volume with slower infusion. Although MT1-MMP levels increased with time, there was no between-group difference in the MT1-MMP levels.

conclusionsThere was no difference in glycocalyx degradation or vascular shear stress between an IVF bolus given over 5 min compared with 20 min. Central blood volumes trended greater in the slow IVF group compared with the fast IVF group.