• Paul E Wischmeyer, Oscar E Suman, Rosemary Kozar, Steven E Wolf, Jeroen Molinger, and Amy M Pastva.
• Duke Human Pharmacology and Physiology Lab (HPPL), Center for Perioperative Organ Protection (CPOP), Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina.
• Curr Opin Crit Care. 2020 Oct 1; 26 (5): 508-515.

Purpose Of ReviewICU 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 FindingsOne 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.SummaryCritical 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.

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