CURRENT PERSPECTIVES IN SHOCK RESEARCH

Focal hypoperfusion and ischemia together with the deterioration of ce ll function are characteristic features of hypovolemia after trauma an d hemorrhage as well as for severe infections and sepsis in ICU patien ts. The interaction of polymorphonuclear leukocytes (PMNL) with the mi crovascular endothelium is the central issue in the pathogenesis of sh ock, and is followed by the liberation of potent vasoactive mediators into the circulation. With regard to outcome, only such therapeutic co ncepts will be of impact to the care of the critically ill patient, wh ich go beyond the normalization of macrohemodynamic parameters and enh ancement of systemic oxygen transport capacity. On the basis of the re cent insights into the pathogenesis of shock research has been focusse d on the restitution of microvascular blood now by monoclonal antibodi es or receptor antagonists directed against the early mediators of sho ck (endotoxin, tumor necrosis factor and interleukins, pla telet-activ ating factor, oxygen free radicals and nitric oxide (NO)). Moreover, b olus infusion of hyperosmolar saline-colloid solution (small-volume re suscitation) produces an instantaneous mobilization of fluid from the endothelium, which is swollen during shock as result of low-flow and h ypoxia. The impact of these new therapeutic concepts can only be evalu ated through further controlled, prospective clinical trials.