Measuring the compensatory reserve to identify shock.

Successful management of shock heavily relies on the ability to identify early stages of hemorrhage. During blood loss and reduced blood volume, multiple physiological mechanisms are able to compensate in order to preserve tissue oxygenation and blood flow. Unfortunately, this compensation makes the crucial early stage identification of hemorrhage complicated as traditionally monitored vital signs reflect this compensation, and do not change until significant amounts of blood have been lost. New insights and a recent body of literature utilizing a human model of hemorrhage provide evidence that it is possible to measure the body's reserve to continue to compensate for a reduced circulating blood volume. The function of 'compensatory reserve' can be accurately assessed from real-time measurements of changes in arterial waveform features. In this review, the compensatory mechanisms and physiology underlying the development and evaluation of a new non-invasive technology that allows for real-time measurement of the compensatory reserve will be discussed, along with clinical implications for earlier and more accurate prediction of shock utilizing the body's compensatory reserve. (C) 2017 Lippincott Williams & Wilkins, Inc.

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