Hemorrhagic Shock

Hemorrhagic shock is a form of hypovolemic shock in which severe blood loss leads to inadequate oxygen delivery at the cellular level. If hemorrhage continues unchecked, death quickly follows. The causes of hemorrhage resulting in shock vary widely and include trauma, maternal hemorrhage, gastrointestinal hemorrhage, perioperative hemorrhage, and rupture of an aneurysm.1-4 Death from hemorrhage represents a substantial global problem, with more than 60,000 deaths per year in the United States and an estimated 1.9 million deaths per year worldwide, 1.5 million of which result from physical trauma.5 Because trauma affects a disproportionate number of young people, these 1.5 million deaths result in nearly 75 million years of life lost (Table 1). Furthermore, those who survive the initial hemorrhagic insult have poor functional outcomes and significantly increased long-term mortality.3,8 This article summarizes recent advances in our knowledge of the pathobiology of hemorrhagic shock and details new approaches to treatment for these critically ill patients.