SUBCELLULAR ASPECTS OF THE RESPONSE TO TRAUMA

The following propositions are discussed. 1. Development of permanent membrane damage in vivo depends upon reduction of whole-body oxygen consumption( $V˙$ O ₂ ) to below ‘basal’. In man this rarely occurs until several hours after injury. 2. While $V˙$ O ₂ is maintained, effects are neural and hormonal in origin. 3. One cannot predict the feffects of injury in vivo from subcellular mechanisms; the interactions with physiological factors are too complex. 4. Observations on animal models in which $V˙$ O ₂ is low often fail to match those on patients, unlike those on models with at least basal $V˙$ O ₂ . 5. There appear to be at least two types of insulin resistance, one essentially hormonalin origin, the other, more persistent, involving membrane changes that can be studied in vitro.