Vascular permeability and loss of glycocalix in sepsis: the role of fluid resuscitation

Fluid resuscitation with crystalloids is the first step of hemodynamic management of sepsis, with the primary goal of restoring adequate tissue perfusion. However, its efficacy is not clear, given that about ¾ of the administered volume is lost into the interstitial space [1]. Whereas the optimal dose is not established, a positive fluid balance may be an independent predictor of mortality [2]. The precise mechanisms are unknown. Larger fluid volumes may increase the transvascular pressure gradient of extravasation, thereby exacerbating tissue edema. Alternatively, fluids may directly contribute to vascular permeability. This short overview explores the complex relationship between fluids and vascular permeability in sepsis.