from hemorrhagic shock. With the development of, and improvement in, blood banking
capabilities and the realization that patients succumbed to the sequelae of hemorrhage,
medical personnel, during World War II, transfused the wounded more aggressively, and
hemorrhagic shock accounted for less mortality than in World War I. A new cause for
morbidity and mortality, however, was identified. Acute renal failure was more commonly
seen in World War II than in World War I. Clinicians came to realize that in addition to
replacing blood and blood products, they also needed to aggressively volume-resuscitate
patients. This realization affected the care of subsequent armed combatants. During the
Vietnam Conflict, wounded soldiers received blood products early and had intravascular
volume adequately replaced with both crystalloid and colloid-containing fluids. With this
aggressive volume resuscitation, though the incidence of renal dysfunction decreased, an
entirely new disease entity became apparent. ARDS, which had been almost unheard of
in World Wars I and II, became the disease of the Vietnam Conflict; one of the synonyms
was "De Nang Lung." Since the end of the Vietnam Conflict, we have been more aggressive
and successful in treating patients with ARDS. Now that patients are less likely to
die from hypoxia and acute respiratory failure associated with ARDS, we are confronted
with patients who have MODS.