Protracted reduction in tissue perfu-sion after major trauma (henceforth referred to as trauma) in an individual produces profound effects on tissue metabolism, structure and function. This is apparent at cellular, organ and systemic levels. Major changes after trauma occur in the microcirculation, cell membrane transport and function, energy metabolism, and function of mitochondrial, immunological and cardiovascular systems. With continued hypoxia/ischaemia and sludging of blood1, parenchymal and endothe-lial cells are likely to swell, preventing rapid return of normal blood flow after fluid resuscitation.
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