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. Author manuscript; available in PMC: 2018 Apr 1.
Published in final edited form as: Crit Care Clin. 2017 Apr;33(2):245–258. doi: 10.1016/j.ccc.2016.12.001

Figure 2. PICS paradigm.

Figure 2

Following a major inflammatory insult (trauma, sepsis, burns, acute pancreatitis, etc) there is a simultaneous inflammatory and immunosuppressive response. Early deaths from acute MOF are now rare due to early recognition of shock and rapid implementation of supportive care thorough effective application of EBM and SOPs. Survivors may progress through two pathways: 1) patients readily return to immune homeostasis and achieve a rapid recovery; 2) patients smolder in the ICU with CCI and develop chronic inflammation, suppression of adaptive immunity, ongoing protein catabolism with cachectic wasting, and suffer from recurrent nosocomial infections. These patients often suffer from PICS, many of which fail to achieve functional independence, are discharged to LTACs, have and extremely poor quality of life, and ultimately succumb to an indolent death.

Adapted from Gentile LF, Cuenca AG, Efron PA, et al. Persistent inflammation and immunosuppression: A common syndrome and new horizon for surgical intensive care. The journal of trauma and acute care surgery. Jun 2012 72(6):1491–1501.

Abbreviations: MOF – multiple organ failure; SIRS – systemic inflammatory response syndrome; CARS – compensatory anti-inflammatory response syndrome; CCI – Chronic Critical Illness; ICU – Intensive Care Unit; PICS – persistent immune suppression inflammation and catabolism syndrome;