Hemorrahagic shock: a new look at an old problem.

Shock research during the past 20 years has resulted in advances in our understanding of the effects of shock and resuscitation at the cellular, molecular, and, increasingly, the genetic level. The authors have measured post-shock restoration of cellular energy stores as an indicator of cellular recovery from shock, and cellular apoptosis as an indicator of tissue damage. Using these assessment tools, we have searched for pharmacologic agents that can be used as adjuncts to fluid and blood resuscitation to reduce cellular damage and--we hope--improve survival. Promising results have been obtained from two quite distinct molecular species, specifically crocetin and glutamine. Both of these agents, when given during resuscitation, significantly improve restoration of cellular energy stores, reduce apoptotic cell death and, at least in the case of crocetin, improve overall survival.