CRITICAL CARE OUTCOMES: Edited by Stephen BrettRole of anabolic testosterone agents and structured exercise to promote recovery in ICU survivorsWischmeyer, Paul E.a; Suman, Oscar E.b; Kozar, Rosemaryc; Wolf, Steven E.b,e; Molinger, Jeroena,d; Pastva, Amy M.fAuthor Information aDuke Human Pharmacology and Physiology Lab (HPPL), Center for Perioperative Organ Protection (CPOP), Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina bDepartment of Surgery, University of Texas Medical Branch, 301 University, Galveston, Texas cShock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA dDepartment of Intensive Care Medicine, Erasmus MC, Erasmus University Rotterdam, Rotterdam, The Netherlands eShriners Hospital for Children – Texas, Galveston, Texas fDivision of Physical Therapy, Department of Orthopedic Surgery, Duke Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, North Carolina, USA Correspondence to Paul E. Wischmeyer, MD, EDIC, FASPEN, FCCM, Professor of Anesthesiology and Surgery, Duke University School of Medicine DUMC, Box 3094 Mail # 41, 2301 Erwin Road, 5692 HAFS, Durham, NC 27710, USA. Tel: +1 919 681 6646; e-mail: [email protected] Current Opinion in Critical Care: October 2020 - Volume 26 - Issue 5 - p 508-515 doi: 10.1097/MCC.0000000000000757 Buy Metrics 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. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.