Role of anabolic testosterone agents and structured exercise to promote recovery in ICU survivors.
Role of anabolic testosterone agents and structured exercise to promote recovery in ICU survivors.
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DOI：
10.1097/mcc.0000000000000757
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发表时间：
2020-10
影响因子：
3.3
通讯作者：
Pastva AM
中科院分区：
文献类型：
--
作者：
Wischmeyer PE;Suman OE;Kozar R;Wolf SE;Molinger J;Pastva AM
重症监护病房（ICU）的幸存者经常遭受严重的，长期的身体残疾。“ICU生存”，或解决ICU护理后的生活质量障碍，是一个决定性的挑战，现有的护理标准未能成功地解决这些残疾。我们建议通过睾酮类似物治疗结合结构化运动来解决持续性catastrophic是一种有前途的新干预措施，以提高“ICU生存率”。在解决ICU后身体残疾方面缺乏成功的一个解释是，大多数ICU患者在ICU早期表现出严重的睾酮缺乏，尽管进行了康复努力，但仍会导致持续性的紧张症。氧甲氢龙是FDA批准的睾酮类似物，用于治疗ICU患者的肌无力。越来越多的试验表明，这种药物与结构化运动相结合具有临床益处，包括改善身体功能和烧伤及其他分解代谢状态的安全性。然而，尚未在非烧伤ICU人群中进行氧雄龙/睾酮和运动的试验。危重病导致分解代谢状态，包括在整个住院期间持续存在的严重睾酮缺乏，并导致持续的肌肉无力和身体功能障碍。合成代谢剂与充足的营养和结构化运动的组合可能对优化ICU幸存者的肌肉质量/力量和身体功能至关重要。需要对ICU人群进行进一步研究。
Intensive Care Unit (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 analogs combined with structured exercise is a promising novel intervention to improve “ICU Survivorship”. 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 strutured 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 non-burn ICU populations have been conducted. 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.