Article Type : Short commentary
Authors : Ahmed NM Ghanem
I read with great interest this recently published article by
Professors Dull, R.O. and Hahn, R.G [1]. The authors are
commended on this review based on evidence from published
studies that represent the current understanding of the condition
and its scientific basis. The authors have faithfully summarized
the evidence based on published reports, including some of the
commonly received errors and misconceptions on the scientific
foundation that identifying and correcting it may help to answer
the vitally important question in the title of the report. The authors
acknowledge that Starling’s law represents the scientific
foundation of the volume-pressure relationship of the vascular
capillary and interstitial fluid compartments. It thus underlies the
rules that govern fluid therapy in shock management. This is the
subject on which both authors are among the top world authority.
My research has demonstrated clearly and completely the
substantial evidence that Starling’s law is wrong, and the correct
replacement is the hydrodynamics of the porous orifice (G) tube
[2]. That has been gathered in a book [3]. This will revolutionize
our understanding of the condition and related issues particularly
on the path-etiology and management of ARDS. Hypovolaemia
and peripheral oedema refer to the condition that affects acutely
ill patients presenting with any shock then suffer clinically with
acute respiratory distress syndrome (ARDS) after fluid therapy in
whom there is massive volumetric overload with hypotension
shock (? Hypovolaemia) and massive fluid creep on the
interstitial fluid space causing generalized oedema. It complicates
fluid therapy for shock resuscitation of burns, sepsis,
haemorrhage, trauma, and acute pancreatitis [4]. It initially
presents as volume kinetic or volumetric overload shock (VOS)
[5]. Among new scientific discoveries in physics, physiology, and
medicine [6].
It has high morbidity and mortality and affects
thousands of patients every year all over the world. Although
there is hypotension shock here it is probably incorrect to assume
hypovolaemia exist. Starling’s law has proved wrong on both of
its forces. However, it continues to dictate the current faulty rules
on fluid therapy in the management of shock. It thus misleads
physicians into giving too much fluid during shock resuscitation
[7]. More than 21 reasons were reported to show that Starling’s
law is wrong [8]. The correct replacement is the hydrodynamic of
the porous orifice (G) tube) that was built on capillary
ultrastructure anatomy of having precapillary sphincter [9]. And a
porous wall [10]. That allow the passage of plasma proteins-hence
nullify the oncotic pressure in Vivo. It follows that the extended
Starling Principle is wrong and a misnomer and all the equa¬tions
are also wrong. Com¬monly received but erroneous concepts and
laws represent fraud in modern science. The clinical significance
is that Starling’s law dictates the faulty rules on fluid therapy
causing many errors and misconceptions that mislead physicians
into giving too much fluid infusions of albumin and crystalloids
for the resuscitation of shock which both cause oedema of ISF
space and vital organs as well as hypervolaemia with hypotension
[11]. This shock is mistaken for septic or any known shock and is
wrongly treated with further huge volume expansion, occurring
with both liberal and conservative approaches of fluid therapy.
This has been recognized as volume kinetic or volumetric
overload shocks (VOS). Volumetric overload inducing VOS is of
2 types; VOS 1 causes the transurethral resection of the prostate
[TURP] syndrome, now being linked to the acute respiratory
distress syndrome [ARDS] that was reported by Ashbaugh, et al.
in 1967 [12]. ARDS is caused by VOS 2 with high morbidity and
mortality and acute kidney injury (AKI) as parts of the multiple
organ dysfunction syndrome (MODS). Volumetric overload
shock induced by persistence to elevate CVP to high level as
based on the faulty Starling’s law. I trust the respected authors, and invite the world authorities, to kindly fulfil their authority and
responsibility by writing an update on the subject that summarises
the results of my recently reported research for the awareness of
the doctors’ readers and the benefit of their patients.
Ethical Approval
Is not applicable. I consent to participate in and consent to publish this article.
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