Lack of effects of recombinant growth hormone on muscle function in patients requiring prolonged mechanical ventilation: a prospective, randomized, controlled study
Pichard, C.; Kyle, U.; Chevrolet, J.C.; Jolliet, P.; Slosman, D.; Mensi, N.; Temler, E.; Ricou, B.
Critical Care Medicine 24(3): 403-413
1996
ISSN/ISBN: 0090-3493 PMID: 8625627 Document Number: 469400
Objective: To evaluate the benefit of recombinant human growth hormone administration on muscle strength and duration of weaning in critically ill patients undergoing prolonged mechanical ventilation. Design: Prospective, randomized, controlled, single-blind study. Setting: Intensive care unit. Patients: Twenty patients requiring gtoreq 7 days of mechanical ventilation for acute respiratory failure. Intervention: Random assignment to receive either 0.43 IU ( apprx 0.14 mg) recombinant growth hormone/kg body weight/day (treated group), or saline (nontreated group) for 12 days. Measurements and Main Results: Nutritional support was guided by indirect calorimetry. Cumulative nitrogen balance was positive throughout the study period in the treated group (44.9 +- 17.3 (SEM) g/12 days) vs. the nontreated group (-65.8 +- 11.8 g/12 days) (p lt .0001). Despite similar initial plasma concentrations, recombinant growth hormone supplementation resulted in marked increases in growth hormone, insulin like growth factor-1, and insulin concentrations (p lt .05, .02, and .0001, respectively, vs. nontreated group). Body impedance determined net fat-free mass increased in the treated group (0.8 +- 0.6 kg) vs. the nontreated group (-1.1 +- 0.5 kg) (p lt .03). Initial peripheral muscle function, assessed by computer-controlled electrical stimulation of the adductor pollicis, was similarly lower in treated and nontreated groups than sex and age-matched normal controls, and decreased further during the study period. Arterial blood gases, cumulative total mechanical ventilation time, and number of hrs/day of mechanical ventilation during weaning were similar in both patient groups. Only three of the ten patients in each group were weaned from mechanical ventilation by day 12. Conclusions: Daily administration of recombinant growth hormone in mechanically ventilated patients with acute respiratory failure promotes a marked nitrogen retention. However, this action is accompanied neither by an improvement in muscle strength nor by a shorter duration of ventilatory support.