Fluid Resuscitation -- Copyright -- Reviewers -- Preface -- Photographs -- Contents -- Executive Summary -- 1 Introduction -- HISTORY OF FLUID RESUSCITATION -- ORIGIN, SCOPE AND ORGANIZATION OF THE REPORT -- 2 Pathophysiology of Acute Hemorrhagic Shock -- DEFINITIONS OF HEMORRHAGIC SHOCK -- Organ Involvement in Shock -- PHYSIOLOGIC RESPONSES TO HEMORRHAGE -- Shock Decompensation -- Cellular Responses to Shock -- Altered Energy Metabolism, Ion Compartmentalization, Lipid Metabolism, and Radical Production and Metabolism -- Alterations in Macrophage Function -- Surgical Bleeding Disorders -- Fundamental Alterations in Transcription and Translation: Apoptosis -- Alterations in Secretion of and Cellular Responsiveness to Growth Factors -- HEMATOLOGIC ABNORMALITIES ASSOCIATED WITH SHOCK AND RESUSCITATION -- Transfusion of the Patient in Shock -- Massive Transfusion -- Risks of Blood Transfusion -- Blood Substitutes and Alternatives to Transfusion -- Disseminated Intravascular Coagulation -- CONCLUSIONS AND RECOMMENDATIONS -- 3 Experience With and Complications of Fluid Resuscitation -- OVERVIEW OF COLLOID AND CRYSTALLOID RESUSCITATION -- COMPLICATIONS OF RESUSCITATION IN GENERAL -- Effects of Fluid Resuscitation on Coagulation -- Oxygen Toxicity Associated with Resuscitation -- Reperfusion-Mediated Injury -- Oxygen-Derived Free Radicals -- Nitric Oxide -- Activated Neutrophils -- Complications of Late Resuscitation of Shock -- COMPLICATIONS OF COLLOID RESUSCITATION -- COMPLICATIONS OF CRYSTALLOID RESUSCITATION -- Effects of Crystalloid Resuscitation on Immune Function -- Effects of Crystalloid Resuscitation on Cytokine Response -- Adverse Effects of Large-Volume Crystalloid Resuscitation -- Adverse Effects of Lactated Ringer's Solution -- Safety and Efficacy of Hypertonic Saline Solutions -- ALTERNATIVE RESUSCITATION APPROACHES -- SUMMARY.

CONCLUSIONS AND RECOMMENDATIONS -- 4 Novel Approaches to Treatment of Shock -- PREVENTION -- Oxygen Therapeutics -- First-, Second-, and Third-Generation Therapeutics -- Perfluorochemicals -- Liposomes -- Other Novel Approaches -- INTERVENTION -- Targets for Intervention -- Therapies for Reperfusion-Mediated Free-Radical Damage -- Antioxidant or Scavenging Strategies -- Iron Chelation -- Inhibition of Polymorphonuclear Neutrophil Adherence and Activation -- Nitric Oxide Inhibition -- Novel Strategies for Scavenging Free Radicals -- Hormonal Influences -- Diagnostic Instrumentation -- TOLERANCE -- RECOMMENDATIONS -- 5 Protocols of Care at the Site of Injury -- THE COMBAT ENVIRONMENT -- Expected Condition of Combatant on the Battlefield -- Limits of Battlefield Care for the Injured Combatant -- Resuscitation Needs of the Injured Combatant on the Battlefield -- Immediate Versus Delayed Fluid Resuscitation -- Current Protocols -- CONCLUSIONS AND RECOMMENDATIONS -- Training First Responders -- Available Approaches for Treatment of Injury -- Hemorrhage -- Airway and Breathing -- Additional Considerations -- Prompt Aeromedical Evacuation -- Monitoring -- 6 Future Directions -- ANIMAL MODELS -- Effects of Extent of Hypotension and Rates of Hemorrhage on Immune Function in Mouse Models -- Swine Models of Combined Hemorrhage and Injury -- Value of Animal Models -- Technical Models -- Role of Anesthesia -- CLINICAL TRIALS -- Role of Clinical Trials in Development of Therapies -- Endpoints and Indications -- Evaluation of Resuscitation Protocols -- Unique Problems of Clinical Trials of Trauma -- Heterogeneity of Subject Population -- Informed Consent -- Applicability of Civilian Clinical Data to Military Needs -- Clinical Research and Clinical Trials in Trauma Centers -- CONCLUSIONS AND RECOMMENDATIONS -- References -- Appendixes -- A Acknowledgments.

Conference Speakers -- Conference Attendees -- Other Contributors -- B Acronyms -- C Conference Agenda -- D Committee and Staff Biographies -- Committee Biographies -- Iom Project Staff -- Index.