The Michel–Weinbaum steady-state Starling principle has important consequences for clinical practice. The hope that biophysical intravascular colloid therapy with albumin or plasma substitutes can deliver plasma volume support without causing oedema is in vain. The rational approach is to use isotonic salt solutions to support the ECF volume, while care is taken to avoid harmful capillary hypertension. In current practice, a judicious infusion of norepinephrine or phenylephrine is widely used to limit Jv when fluids alone are not enough. Future therapies may be aimed at stabilizing the endothelial barrier.

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