Lack of effects of recombinant growth hormone on muscle function in patients requiring prolonged mechanical ventilation: a prospective, randomized, controlled study.
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.


METHODS
Prospective, randomized, controlled, single-blind study.


METHODS
Intensive care unit.


METHODS
Twenty patients requiring > or = 7 days of mechanical ventilation for acute respiratory failure.


METHODS
Random assignment to receive either 0.43 IU (approximately 0.14 mg) recombinant growth hormone/kg body weight/day (treated group), or saline (nontreated group) for 12 days.


RESULTS
Nutritional support was guided by indirect calorimetry. Cumulative nitrogen balance was positive throughout the study period in the treated group 17.3 (44.9 +/- 17.3[SEM] g/12 days) vs. the nontreated group (-65.8 +/- 11.8 g/12 days) (p<.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<.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 +/- O.5 kg) (p<.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 reaction is accompanied neither by an improvement in muscle strength nor by a shorter duration of ventilatory supports.
Pichard
C
C
Division of Nutrition, Geneva University Hospital, Switzerland.
Kyle
U
U
Chevrolet
J C
JC
Jolliet
P
P
Slosman
D
D
Mensi
N
N
Temler
E
E
Ricou
B
B
D000208:Acute Disease; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D013006:Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy; D012132:Respiratory Muscles / Q000187:drug effects* / Q000503:physiopathology
D011994:Recombinant Proteins; D013006:Growth Hormone