Endpoints of resuscitation for the victim of trauma

Useful resuscitation endpoints must serve both to diagnose the need for and to ensure the ongoing adequacy of resuscitation. To this end, traditional measures of organ perfusion are now widely appreciated to be grossly inadeq uate. Useful endpoints or milestones range from the global, to the regional , to the cellular specific. Understanding the basic principles of perfusion -related dysoxia in trauma and hemorrhage and its potential rapid transitio n to involve inflammatory and immune responses on cellular oxygen utilizati on will aid the clinician in choosing and appropriately interpreting endpoi nt monitoring data. There also appears to be an optimal window of opportuni ty for monitoring to help mitigate the development of more complicated infl ammatory states. This article reviews the underlying need for endpoint sele ction (both global and regional, biochemical and functional) and monitoring during resuscitation of the polytrauma patient. At this juncture it appear s that early use of a blend of global markers such as lactate and base defi cit coupled with an available sensitive regional monitor such as gastric to nometry may offer the best combination of current technology to guard again st early perfusion-related dysoxia. Future techniques involving optical spe ctroscopy offer the exciting potential to assess oxygenation at the cellula r level. This may aid in ultra-early detection and resolution of perfusion- related dysoxia in addition to recognizing its transition to more complex i nflammatory-mediated circulatory and metabolic failure.