title: Endpoints in resuscitation.
abstract: OBJECTIVE
  Shock occurs because of a failure to deliver adequate oxygen to meet the metabolic demands of the body resulting in metabolic acidosis, inflammation, and coagulopathy. Resuscitation is the process of treating shock in an attempt to restore normal physiology. Various hemodynamic, metabolic, and regional endpoints have been described to evaluate the degree of shock and guide resuscitation efforts. We will briefly describe these endpoints, and propose damage control resuscitation as an additional endpoint.
  
  
  RESULTS
  Serum lactate, base deficit, and pH are well established endpoints of resuscitation that provide valuable information when trended over time; however, a single value is inadequate to determine adequacy of resuscitation. Rapid normalization of central venous oxygen concentration has been associated with improved survival, and bedside transthoracic echocardiography can be a reliable assessment of volume status. In hypovolemic/hemorrhagic shock, early hypotensive, or controlled resuscitation strategies have been associated with improved survival, and hemostatic strategies guided by thrombelastography using a balanced transfusion approach result in improved hemostasis.
  
  
  CONCLUSIONS
  Numerous endpoints are available; however, no single endpoint is universally applicable. Damage control resuscitation strategies have demonstrated improved survival, hemostasis, and less early death from exsanguination, suggesting that hemorrhage control should be an additional endpoint in resuscitation.
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Connelly
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
mesh_terms: D051722:ADAM Proteins / Q000097:blood; D000071120:ADAMTS13 Protein; D015415:Biomarkers; D016638:Critical Illness / Q000628:therapy*; D019483:Disintegrins / Q000097:blood; D023381:Endpoint Determination; D006360:Heat-Shock Proteins / Q000097:blood; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D019344:Lactic Acid / Q000097:blood; D010100:Oxygen / Q000097:blood; D019007:P-Selectin / Q000097:blood; D012151:Resuscitation / Q000379:methods*; D012769:Shock / Q000097:blood / Q000628:therapy*
chemical_list: D015415:Biomarkers; D019483:Disintegrins; D006360:Heat-Shock Proteins; D019007:P-Selectin; D019344:Lactic Acid; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human; D010100:Oxygen