Rude unhinging of the machinery of life: metabolic approaches to hemorrhagic shock

In 1862, Samuel Gross described shock as the "rude unhinging" of the machinery of life. As noted above, adequate oxygen delivery and metabolism are essential to the maintenance of cellular energy stores. Failure of adequate tissue oxygen delivery and utilization during shock can lead to organ dysfunction and death. Hemorrhagic shock after trauma can result in inherent mitochondrial dysfunction as manifested by decoupling. This pathologic condition has been recently termed cytopathic hypoxia. Since mitochondria are the ultimate consumer of oxygen in cells, mitochondria might indeed be the machinery of life rudely unhinged by shock. Yet, therapeutic strategies have been recently developed to support mitochondrial function in shock and related states. If these therapeutic interventions directed towards organelle and cellular resuscitation are proven to enhance human organ function and improve survival, then these strategies could augment current therapeutic regimens directed exclusively towards hemodynamic and ventilatory homeostasis.