Role of anabolic testosterone agents and structured exercise to promote recovery in ICU survivors

Abstract

Purpose of review: ICU survivors frequently suffer significant, prolonged physical disability. 'ICU Survivorship', or addressing quality-of-life impairments post-ICU care, is a defining challenge, and existing standards of care fail to successfully address these disabilities. We suggest addressing persistent catabolism by treatment with testosterone analogues combined with structured exercise is a promising novel intervention to improve 'ICU Survivorship'.

Recent findings: One explanation for lack of success in addressing post-ICU physical disability is most ICU patients exhibit severe testosterone deficiencies early in ICU that drives persistent catabolism despite rehabilitation efforts. Oxandrolone is an FDA-approved testosterone analogue for treating muscle weakness in ICU patients. A growing number of trials with this agent combined with structured exercise show clinical benefit, including improved physical function and safety in burns and other catabolic states. However, no trials of oxandrolone/testosterone and exercise in nonburn ICU populations have been conducted.

Summary: Critical illness leads to a catabolic state, including severe testosterone deficiency that persists throughout hospital stay, and results in persistent muscle weakness and physical dysfunction. The combination of an anabolic agent with adequate nutrition and structured exercise is likely essential to optimize muscle mass/strength and physical function in ICU survivors. Further research in ICU populations is needed.

Conflict of interest statement

Conflict of Interest Disclosure:

PEW- Has received grant funding related to this work from NIH, Canadian Institutes of Health Research, Abbott, Baxter, Fresenius, Nutricia, and Takeda. PEW serves as a consultant to Abbott, Fresenius, Baxter, Nutricia, and Takeda for research related to nutrition in surgery and ICU care; received unrestricted gift donation for surgical and critical care nutrition research from Musclesound and Cosmed; received honoraria or travel expenses for CME lectures on improving nutrition care in surgery and critical care from Abbott, Baxter, Nutricia, and Fresenius. OS – receives grant funding from the NIH JW- receives grant funding support from the International Anesthesiology Research Society (IARS). SEW – receives grant funding from the NIH and NIDILRR JM- Receives research grant funding from Nutricia, MuscleSound, and Cosmed. AP- Has received grant funding related to this work from NIH, Canadian Institutes of Health Research, PCORI and American Physical Therapy Association. RK- declares funding from DOD and NIH.

Figures

Figure 1:

Etiology and Proposed Treatment Triad for Post-ICU Physical Disability