title: The endothelial glycocalyx and perioperative lung injury.
abstract: OBJECTIVE
  Ventilator-induced lung injury is a major contributor to perioperative lung injury. The end-expiratory lung volume, regional lung overdistension, and tidal recruitment are known to be the main factors causing subsequent alveolar damage and inflammation. The alveolar-capillary membrane including the endothelial glycocalyx as an integral part of the vascular endothelium seems to play a major role in different kinds of lung injury.
  
  
  RESULTS
  Recent studies underline the pivotal importance of the endothelial glycocalyx in lung injury. The glycocalyx regulates and modulates plasma endothelial cell interactions. Several triggers are known to deteriorate the gylcocalyx such as fluid overload, ischemia, and TRALI. The clinical manifestation is inflammation, capillary leak, and edema formation. Breakdown of the endothelial gylcocalyx is of gaining importance in the context of one-lung ventilation, known to be a major risk factor for postoperative lung injury. Studies suggest that volatile anesthetics may have a protective influence on the endothelial glycocalyx of pulmonary capillaries and reduce ischemia-reperfusion injury. This might be of clinical relevance for postoperative outcome.
  
  
  CONCLUSIONS
  This review focuses on the involvement of the pulmonary endothelial glycocalyx in the context of perioperative lung injury. The pathophysiological mechanisms and trigger factors of glycocalyx deterioration are discussed, and prevention strategies are taken into consideration.
authors.affiliation: Department of Anaesthesiology, University Hospital of Munich, LMU Munich, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Brettner
authors.forename: Vera
authors.initials: V
authors.lastname: von Dossow
authors.forename: Daniel
authors.initials: D
authors.lastname: Chappell
mesh_terms: D002199:Capillary Permeability; D004727:Endothelium / Q000098:blood supply / Q000166:cytology / Q000293:injuries*; D019276:Glycocalyx / Q000473:pathology*; D006801:Humans; D015994:Incidence; D008168:Lung / Q000098:blood supply / Q000166:cytology / Q000473:pathology*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D055397:Ventilator-Induced Lung Injury / Q000453:epidemiology / Q000209:etiology / Q000473:pathology* / Q000517:prevention & control