"Getting patients resuscitated through sepsis, septic shock, and hemorrhagic shock is not the end...it's the beginning." In this episode, Dr. Brakenridge from Harborview Medical Center joins us to discuss PICS and the impact of this syndrome on our critically ill and injured patients and their families. Also referred to as the Post-Intensive Care Syndrome, Dr. Brakenridge shares with us the evolution and results of translational research into this now well-recognized morbid condition which often occurs in the setting of chronic critical illness. From the importance of breaking  the cycle of "sepsis recidivism" to the. application of the SCCM A to F bundle, this episode is a MUST listen for those of us taking care of patients in the ICU. TIME STAMPS 00:12  Introduction 01:46  What is PICS? The role of chronic critical illness (CCI) 05:13  Phenotypes vs. endotypes 06:47  The role of biomarkers in PICS 08:50  When does acute critical illness turn into CCI? 10:14  Risk factors for PICS 15: 07  Prognostication and determining patient trajectory 18:32  The Glue Grant Experience: Genomics of Injury 22:48  Hemorrhagic shock resuscitation: Then and now 25:33  Sepsis recidivism & avoiding secondary insults  29:08 ICU delirium 31:55  The role of early mobilization 32:41  The impact of catabolism in sepsis 34:50  Is there a role for anabolic steroids to counteract PICS? 37:52  What's ahead in terms of PICS translational research? 39:44  Cytokine and immunomodulator therapies 41:49  Final thoughts RECOMMENDED READINGS Brakenridge SC, Wang Z, Cox M, Raymond S, Hawkins R, Darden D, Ghita G, Brumback B, Cuschieri J, Maier RV, Moore FA, Mohr AM, Efron PA, Moldawer LL. Distinct immunologic endotypes are associated with clinical trajectory after severe blunt trauma and hemorrhagic shock. J Trauma Acute Care Surg. 2021 Feb 1;90(2):257-267. Efron PA, Mohr AM, Bihorac A, Horiguchi H, Hollen MK, Segal MS, Baker HV, Leeuwenburgh C, Moldawer LL, Moore FA, Brakenridge SC. Persistent inflammation, immunosuppression, and catabolism and the development of chronic critical illness after surgery. Surgery. 2018 Aug;164(2):178-184. doi: 10.1016/j.surg.2018.04.011. Epub 2018 May 26. Sauaia A, Moore FA, Moore EE. Postinjury Inflammation and Organ Dysfunction. Crit Care Clin. 2017 Jan;33(1):167-191. Stortz JA, Murphy TJ, Raymond SL, Mira JC, Ungaro R, Dirain ML, Nacionales DC, Loftus TJ, Wang Z, Ozrazgat-Baslanti T, Ghita GL, Brumback BA, Mohr AM, Bihorac A, Efron PA, Moldawer LL, Moore FA, Brakenridge SC. Evidence for Persistent Immune Suppression in Patients Who Develop Chronic Critical Illness After Sepsis. Shock. 2018 Mar;49(3):249-258.  Support the show (https://www.patreon.com/traumaicurounds)