Starling's forces are fundamental to our understanding of physiology. Based on his findings, hydrostatic pressure and oncotic pressure are crucial factors in the movement of intravascular and extravascular fluid. However, new literatures on endothelial glycocalyx, a layer of protective glycoprotein within the vasculature that was first discovered in the 1980s, are reshaping our standard models of Starling's forces. This article examines the nature of the endothelial glycocalyx and why understanding it may change the way we resuscitate patients with sepsis.
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and Adjunct Clinical Faculty, Graduate and Undergraduate Program, New York University College of Nursing, New York.
Correspondence: Leon Chen, MSc, AGACNP-BC, CCRN, CPEN, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (email@example.com).
The author acknowledges Eugene Oswald, MSN, AGPCNP-BC, from NYU Langone Medical Center's Emergency Department for editorial work.
The author has disclosed that he has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.