Double-barrier concept means primarily the endothelial surface layer constitutes the vascular barrier.
The osmotic gradient is generated within the intact endothelial surface layer.
The endothelial cell line is of lower priority.
2. Fluid shifting
Type 1 shift, occuring always, is a physiological, nearly protein-free shift.
It is only pathologic if the capacity of the lymphatic system is transgressed.
The pathologic type 2 shift is based on vascular barrier dysfunction.
Type 2 shift contains protein close to plasma concentrations.
3. Cardiac output
The metabolic demands of the body are met by varying cardiac output.
Stroke volume variation or pulse pressure variation is suitable for predicting fluid responsiveness.
Cardiac output should be normalized with volumetric parameters in mind.
4. Colloid solutions
Colloids are beneficial in reaching hemodynamic stability during hypovolemia.
Low-molecular hydroxyethyl starch (130 kDa) seems not to harm renal function.
Gelatins may cause renal injury.
Use of albumin for volume resuscitation is neither harmful nor beneficial.