TABLE 1.

Main Articles Regarding Glycocalyx Injury in Sepsis and Increased Vascular

References	Type of Study	Study Population	Year	Sample Size	Objectives	Glycocalyx Measurement	Conclusions
Rehm et al (5)	Animal	Guinea pigs: weight 200–250 g	2004	17	Evaluate the impact on the endothelial glycocalyx for the extravasation of colloidal infusion solutions.	Electron microscopy	The endothelial glycocalyx acts as a competent barrier for water and colloids.
Alfieri et al (26)	Animal	Male mice (7–10 wk)	2012	24	Investigate the acute effects of an angiopoietin-1 derivative on microcirculation in a sepsis model, and its association with the inflammatory response.	Intravital microsopy	There is macrocirculation protection in sepsis models following administration of matrilin-1-angiopoietin-1 in endotoxemia-induced vascular dysfunction models through a reduction in inflammation, but without proangiogenic actions.
Mochizuki et al (19)	Animal	Adult dogs (weighing 10–32 kg)	2003	31	Investigate the role of the glycocalyx as a sensor and mechanical trigger of nitric oxide production in response to endothelial shear-stress forces.	Nitrite concentration	Hyaluronic acid glycosaminoglycans within the glycocalyx play a pivotal role in detecting and amplifying the shear force of flowing blood that triggers endothelium-derived nitric oxide.
Van Haaren et al (22)	Animal	Male rats (weigh 200–250 g)	2003	24	Determine the solute transport and endothelial permeability properties of the glycocalyx.	Electron microscopy	Demonstrated the presence of a permeability barrier to solutes on the luminal side of the endothelium in isolated small arteries. There is glycocalyx damage during oxidative stress.
Schmidt et al (25)	Animal	Mice	2012	43	Glycocalyx damage is associated with inflammation and capillary leakage in a sepsis model.	Intravital microscopy	Endothelial glycocalyx breakdown increases the expression of endothelial surface adhesion molecules and favors neutrophil adhesion as well as capillary leakage.
Steppan et al (27)	Human	Adults	2011	150	Evaluate glycocalyx damage in patients with sepsis compared with healthy volunteers and patients following major abdominal surgery.	Inflammatory and glycocalyx injury biomarkers: intercellular adhesion molecule-1, vascular cell adhesion molecule-1, interleukin-6, syndecan-1, heparan sulfate.	Elevated glycocalyx damage biomarkers were found in patients with sepsis and following major abdominal surgery, which could explain the capillary leak syndrome.
Rovas et al (28)	Human	Adults	2019	40	Investigate the associations between glycocalyx dimensions and established parameters of microcirculation dysfunction in sepsis.	Videomicroscopy; sublingual and atomic force microscopy	Glycocalyx damage can occur independently of microcirculatory impairment as measured by classical consensus parameters. Further studies in critically ill patients are needed to unravel the relationship of glycocalyx damage and microvascular impairment, as well as their prognostic and therapeutic importance in sepsis.
Kataoka et al (29)	Animal	BALB/c mice (Japan SLC, Inc, Shizuoka, Japan) (8–10 wk weighing 24–28 g)	2017	26	Evaluate the endothelial glycocalyx in an in vivo sepsis model.	Electron microscopy and intravital microscopy, syndecan-1	Severe sepsis-induced morphologic degradation of the glycocalyx, accompanied by shedding of the syndecan-1 core protein and an increase in leukocyte–endothelial interactions affecting vascular permeability.
Hippensteel et al (30)	Human	Adults	2019	100	Glycocalyx degradation is associated with the volume of IV fluids administered during early sepsis resuscitation.	Heparan sulfate, syndecan-1	Glycocalyx degradation occurs in sepsis and septic shock and is associated with inhospital mortality. The volume of IV fluids administered during sepsis resuscitation is independently associated with the degree of glycocalyx degradation.