Final proof Starling’s law wrong and G tube hydrodynamic is the correct replacement: New results and critical analytical criticisms of landmark articles

Substantial evidence demonstrating Starling’s law is wrong currently exists. This article presents the final definitive proof that Starling’s law is wrong, and the correct replacement is the hydrodynamic of the G tube. The presented evidence is based on reported and new results of the G tube hydrodynamic and critical analytical criticism of landmark and contemporary impactful articles. The objectives of this article are to affirm applicability to capillary; crossing the editors’ barrier to convince the hardest of critics that the new theory is correct. The new results presented here further affirm this and the critical analytical criticisms reveal many errors that has misled authors into reporting erroneous results and conclusions affirming Starling’s law and its equations are wrong. The new results show the difference between the hydrostatic pressure and the two components of dynamic pressure: Flow and Side pressures. The side pressure is a negative pressure gradient exerted on the wall of G tube built on a scale to capillary ultrastructure of precapillary sphincter and the wide intercellular cleft pores in its wall. This affirms Starling’s law and its equation are wrong and its correct replacement is the magnetic field like phenomenon of the G tube that explain the fast capillary interstitial fluid transfer necessary for viability of cells at rest and during strenuous exercise.

Fluid Therapy (FT) Complications: Volumetric Overload (VO) in the patho-Aetiology of VO Shocks (VOS) and the Acute Respiratory Distress Syndrome (ARDS)

Fluid therapy (FT) was introduced during WW2. Ever since its complications have been frequently reported but notably some serious complications have been overlooked. The role of volumetric overload (VO) in inducing VU shocks (VOS) and causing the acute respiratory distress syndrome (ARDS) has remained overlooked, unrecognized, and underestimated till recently. The role of FT complications in inducing VOS and causing ARDS is hard to detect because VOS is a shock that complicates another existing shock seamlessly and un-noticed. The author attributes this to the faulty rules on FT dictated by the wrong Starling’s law that causes many errors and misconceptions of FT which mislead physicians into giving too much fluid during shock resuscitation. The research findings on the wrong Starling’s law and how it has been corrected based on the hydrodynamic of the porous orifice (G) tube and the newly recognized VOS and the new patho-aetiology and therapy of ARDS are summarized here. Other authors in support of this contention are quoted. The errors on current FT and its corrections are given. Finally, a new prospective cohort study on FT and ARDS is recommended and a call for new guidelines on FT is urgently needed.

Twenty-one Reasons Affirming Starling’s Law on the Capillary-interstitial Fluid Transfer Wrong and the Correct Replacement is the Hydrodynamic of the Porous Orifice (G) Tube

Many reasons why Starling’s law wrong and the correct replacement is the hydrodynamic of porous orifice (G) tube exist. Starling’s hypothesis is based on Poiseuille’s work in which the hydrostatic pressure causes filtration. The oncotic pressure force of plasma proteins causes re-absorption. Starling’s law is wrong on both forces. The capillary has a pre-capillary sphincter and pores that allow the passage of plasma proteins. This makes the capillary a porous orifice (G) tube with different hydrodynamic; side pressure causes suction not filtration. The pores nullify the oncotic force in vivo. There is evidence to show that the osmotic chemical composition of various body fluids is identical to plasma proteins. The interstitial fluid (ISF) space has a negative pressure of -7 cm water. Evidence on Albumin versus Saline for fluid resuscitation shows no significant difference. This affirms that the oncotic force does not exist in vivo that partly prove Starling’s law wrong. Inadequacy in explaining the capillary–ISF transfer, has previously called for reconsideration of Starling’s hypothesis. Physics and physiological research demonstrate that pressure does not cause filtration across the wall of G tube, it causes suction. In G tube negative side pressure gradient causing suction maximum near the inlet and turns positive maximum near the exit causing filtration. Physiological study completed the evidence that Starling’s law is wrong as the capillary works as G tube not Poiseuille’s tube. Both absorption and filtration are autonomous functions of G tube thus fit to replace Starling’s law. The clinical significance is discussed.

What is Misleading Physicians into Giving Too Much Fluid during Resuscitation of Shock and Surgery that Induces ARDS and/or AKI?

Introduction and Objective: Evidence demonstrates that there are many errors and misconceptions on fluid therapy. Starling’s law underlies it all. This report gives the complete evidence that Starling’s law is wrong on both forces and the correct replacement is hydrodynamic of the G tube. New physiological evidence is provided with clinical relevance and significance. Material and Methods: The physics proof is based on G tube hydrodynamic. The physiological proof is based on a study of the hind limb of sheep: running plasma and later saline through the artery compared to that through the vein as regards the formation of oedema. The clinical significance is based on 2 studies one prospective and a 23 case series on volumetric overload shocks (VOS). The recent clinical studies on albumin and hydroxyethyl starch versus saline and also that on plasma proteins partly affirm that Starling’s law is wrong. My physics and physiological research completes this evidence. Results: Hydrodynamics of G tube showed that proximal, akin to arterial, pressure induces suction “absorption”, not “filtration”. In Poiseuille’s tube side pressure is all positive causing filtration based on which Starling proposed his hypothesis. The physiological evidence proves that the capillary works as G tube not Poiseuille’s tube: Oedema occurred when fluids are run through the vein but not through the artery. There was no difference using saline or plasma proteins, neither in physiological nor in clinical studies. The wrong Starling’s law dictates the faulty rules on fluid therapy misleading physicians into giving too much fluid during shock resuscitation and surgery inducing VOS and ARDS. Conclusion: Hydrodynamic of the G tube challenges the role attributed to arterial pressure as filtration force in Starling’s law. A literature review shows that oncotic pressure does not work either. The new hydrodynamic of G tube is proposed to replace Starling’s law which is wrong on both forces. The physiological proof and relevance to clinical importance on the pathogenesis of clinical syndromes are discussed.

The Correct Replacement for the Wrong Starling’s law is the Hydrodynamic of the Porous Orifice (G) Tube: The Complete Physics and physiological Evidence with Clinical Relevance and Significance

Introduction and objective: To report the complete evidence that Starling’s law is wrong and the correct replacement is the hydrodynamic of the G tube. New physiological evidence is provided with clinical relevance and significance. Material and methods: The physics proof is based on G tube hydrodynamic. Physiological proof is based on study of the hind limb of sheep: running plasma and later saline through the artery compared to that through the vein as regards the formation of oedema. The clinical significance is based on 2 studies one prospective and a 23 case series on volumetric over load shocks (VOS). Results: Hydrodynamic of G tube showed that proximal, akin to arterial, pressure induces suction “absorption” not “filtration”. In Poiseuille’s tube side pressure is all positive causing filtration based on which Starling proposed his hypothesis, The physiological evidence proves that the capillary works as G tube not Poiseuille’s tube: Oedema occurred when fluids are run through the vein but not through the artery. There was no difference using saline or plasma proteins. The wrong Starling’s law dictates the faulty rules on fluid therapy inducing VOS and causing ARDS. Conclusion: Hydrodynamic of the G tube challenges the role attributed to arterial pressure as filtration force in Starling’s law. A literature review shows that oncotic pressure does not work either. The new hydrodynamic of G tube is proposed to replace Starling’s law which is wrong on both forces. The physiological proof and relevance to clinical importance on the pathogenesis of clinical syndromes are discussed.