Reperfusion injury after hemorrhage: a collective review.

Abstract

To review current knowledge of hemorrhagic shock and reperfusion injury. Patients with hemorrhagic shock require optimal resuscitation and cessation of ongoing bleeding. Often our resuscitative measures, while necessary, cause a wide range of detrimental physiologic effects. Research continues to answer questions regarding measurable endpoints and optimal fluids used in resuscitation. Elucidation and understanding of the complex metabolic pathways involved in reperfusion injury are areas of intense current investigative effort. A literature review was performed using MEDLINE and key words related to experimental and clinical studies concerning shock and reperfusion. Experimental studies have shown that resuscitation with colloid and crystalloid show no difference in outcomes in critically ill patients. Laboratory studies are showing promising results with immunomodulation of response to injury. However, no clinical trials have shown significance yet. It is unlikely that a single treatment modality or "magic bullet" will be able to substantially block such a complex regulated process unless performed before feedback mechanisms known to be in place. Ongoing translational research will inevitably have a major impact on patient care.