Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS): A New Horizon for Surgical Critical Care and Induced Frailty

Inclusion Criteria: * Admission to the surgery or trauma ICU where clinical care can be managed by surgical critical care guided by standard operating procedures. * Age ≥18 years * Diagnosis of sepsis, severe sepsis, or septic shock * Entrance into the standard-of-care sepsis protocol * Ability to obtain patient/legally authorized representative informed consent. Exclusion Criteria: * Significant traumatic brain injury (evidence of neurologic injury on CT scan and a best Glascow Coma Scale \<8 within 24 hours of injury) * Refractory shock (i.e., patients who die within 12 hours) * Alternative or confounding diagnosis causing shock state (e.g., myocardial infarction or pulmonary embolus) * Uncontrollable source of sepsis (e.g., irreversible disease state such as unresectable dead bowel), * Patients deemed to be futile care or have advanced care directives limiting resuscitative efforts such as patient or patient's family who are not committed to aggressive management of the patient's condition. Expected lifespan of the patient is less than 3 months due to severe pre-existing comorbidities (ex. Recurrent, advanced or metastatic cancer). * Severe Congestive Heart Failure (NY Heart Association Class IV) * Child-Pugh Class C liver disease or pre-liver transplant. * Known HIV infection with CD4 count\<200 cells/mm3, * Organ transplant recipient on immunosuppressive agents * Known pregnancy * Inability to obtain informed consent * Prisoners * Institutionalized patients * Chemothe…