Scott Brakenridge, M.D., MSCS., is an assistant professor of surgery on the acute care surgery team at UF Health. Dr. Brakenridge joined the UF faculty in 2013 specifically to work with the multi-disciplinary research team investigating the persistent inflammation/immunosuppression and catabolism syndrome (PICS) that occurs after surgical sepsis. He is currently one of the principal investigators for an NIH-funded P50 center grant for the UF Sepsis and Critical Illness Research Center to study the persistent inflammation, immunosuppression and catabolism syndrome (PICS) following sepsis in surgical intensive care unit patients. His current research projects include:
Persistent inflammation/immunosuppresion and catabolism syndrome (PICS) – Advances in critical care medicine over the past two decades have significantly decreased in-hospital mortality following sepsis in surgical and trauma patients. However, instead of dying from septic shock and sudden multiple organ failure, patients survive with an extended course of chronic critical illness. When we studied the epidemiology of these patients, we recognized that many of the survivors lingered in the intensive care unit with manageable organ dysfunctions. Their clinical course is characterized by recurrent inflammatory insults (e.g., repeat operations and nosocomial infections, which are those that originate in a hospital), a persistent acute-phase response with ongoing loss of lean body mass despite optimal nutritional support, poor wound healing and bedsores. These patients (especially the elderly) are commonly discharged to long-term acute care facilities and skilled nursing facilities with significant cognitive and functional impairments, from which they rarely recover fully. Few ever return to independent function and more than 60 percent of these patients are dead within two years. The researchers in the laboratory of inflammation biology and surgical science at UF Health hypothesize that chronic critical illness, driven by PICS and characterized by morbid long-term outcomes, is now the predominant clinical trajectory in surgical ICU sepsis survivors.
Induced Frailty after and surgical sepsis and traumatic injury – The Induced Frailty phenotype after sepsis is similar to the frailty syndrome of elderly adults, which is a state of high vulnerability for adverse health outcomes.The overall concept of frailty during advanced age is a state of high vulnerability for adverse health outcomes, including disability, dependency, falls, need for long-term care and mortality. However, what is unique about the proposed phenotype of Induced Frailty is that it is an acute, rather than chronic change in health status, ultimately leading to poor long-term outcomes. Although not strictly age-dependent, this clinical phenotype appears to occur most commonly in older individuals that survive sepsis or severe traumatic injury, where functional, “robust” and “pre-frail” individuals before this insult subsequently develop a new, post-sepsis baseline state of cognitive, physiologic and functional morbidities consistent with the frailty syndrome of the elderly. As opposed to the slow, progressive, deterioration of the health state of elderly individuals described by traditional frailty, this frailty phenotype appears to develop within weeks to months of an acute, pro-inflammatory insult (such as sepsis or severe injury) yet persists and/or deteriorates over months to years, and often at a significantly younger age. We hypothesize that this clinical phenotype is secondary to well described mechanisms of persistent immunologic and catabolic dysfunction (i.e. PICS) that occur after sepsis.