The endothelial glycocalyx (EG) is the thin sugar-based lining on the apical surface of endothelial cells. It has been linked to the physiological functioning of the microcirculation and has been found to be damaged in critical illness and after acute care surgery. This review aims to describe the role of EG in severely injured patients undergoing surgery, discuss specific situations (e.G. major trauma, hemorrhagic shock, trauma induced coagulopathy) as well as specific interventions commonly applied in these patients (e.g. fluid therapy, transfusion) and specific drugs related to perioperative medicine with regard to their impact on EG.EG in acute care surgery is exposed to damage due to tissue trauma, inflammation, oxidative stress and inadequate fluid therapy. Even though some interventions (transfusion of plasma, human serum albumin, hydrocortisone, sevoflurane) are described as potentially EG protective there is still no specific treatment for EG protection and recovery in clinical medicine.The most important principle to be adopted in routine clinical practice at present is to acknowledge the fragile structure of the EG and avoid further damage which is potentially related to worsened clinical outcome.

Biomedical centrum Faculty of Medicine in Plzen Charles University Prague Czech Republic

Centrum for Research and Development University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Anaesthesia Pain Management and Perioperative Medicine Dalhousie University Halifax NS Canada

Department of Anaesthesiology and Intensive Care Medicine University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Anaesthesiology and Intensive Care Medicine University Hospital Plzen Pilsen Czech Republic

Department of Computer Science Dalhousie University Halifax NS Canada

Department of Microbiology and Immunology Dalhousie University Halifax NS Canada

Department of Pharmacology Dalhousie University Halifax NS Canada

Department of Pharmacy East West University A 2 Jahurul Islam Avenue Dhaka Bangladesh

Department of Physiology and Biophysics Dalhousie University Halifax NS Canada

Departments of Anaesthesiology Perioperative and Intensive care medicine J E Purkinje 21 University Masaryk Hospital Usti nad Labem Socialni pece 3316 12A 400 11 Usti nad Labem Czech Republic

Faculty of Medicine in Hradec Kralove Charles University Prague Czech Republic

Faculty of Medicine in Plzen Charles University Prague Czech Republic

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Individualizing Fluid Management in Patients with Acute Respiratory Distress Syndrome and with Reduced Lung Tissue Due to Surgery-A Narrative Review