UF researchers uncover syndrome that hampers surgical recovery
Published: Thursday, June 14, 2012 at 6:27 p.m.
Last Modified: Thursday, June 14, 2012 at 7:52 p.m.
A team of researchers from the University of Florida College of Medicine has begun unlocking a mystery over why some patients who have undergone surgery or other trauma have difficulty recovering well enough to leave the intensive care unit.
The trouble comes when immature cells flood out of bone marrow in response to health threats, causing inflammation and a failure to protect the body as well as mature cells.
A greater understanding of the problem could lead to remedies that will heal patients sooner and reduce treatment costs, said Bruce McKinley, professor of surgery.
"It's an important syndrome that people do recognize. Describing it as such is kind of new, but the insight into the likely mechanism — that's what is really new," McKinley said.
"Something goes wrong. Basically their immune system tries to respond but is continually out of balance. This is all fueled by the body consuming itself."
The team reported its research in the June 8 edition of the Journal of Trauma and Acute Care Surgery and calls the ailment persistent inflammation, immunosuppression and catabolism syndrome, or PICS.
About 250,000 patients nationwide develop PICS annually from severe sepsis, an infection that overwhelms the immune system, UF researchers estimate. Add the PICS cases from trauma and emergency surgery and the actual number of cases is likely much higher, the researchers say.
Afflicted patients spend a long time in intensive care, become weaker as body mass is consumed, often must use ventilators and sometimes have organ failure, McKinley said.
The typical intensive care stay is five days. People with PICS might stay 10 or more days and even then are often discharged to a long-term assisted-care facility rather than going home.
By figuring out the problem, researchers say they hope to begin identifying patients who might be a risk for PICS and to develop ways to prevent or cure it.
McKinley said two possible avenues for remedy of PICS or prevention are nutritional support and exercise.
"If you are able to strengthen certain skeletal muscle groups — one of real interest is the diaphragm and the chest wall muscles — then you can get a little stronger and be able to breathe, and … get off the ventilator," McKinley said.
Researchers believe the extra medical costs associated with intensive and long-term care for PICS patients could reach $100 billion a year, according to a UF press release.
Dr. Ronald Maier, vice chairman of surgery at the University of Washington, was not involved in the UF research but spoke in the news release of the costs.
"The amount of resources and medical care that's required by these patients is enormous," Maier said. "If we can better understand it, we could then develop therapeutic interventions to minimize it or hopefully help it resolve more quickly."