Dangers of growth hormone therapy in critically ill patients

Prolonged stay of patients is the major challenge for modern intensive care because of its effects on morbidity and resource utilization. Severe traum a or infection are associated with the catabolic response, characterized by increased protein turnover and negative nitrogen balance. Severe catabolis m leads to end-organ dysfunction and muscular weakness prolonging the need for mechanical ventilation. Catabolism cannot be prevented with standard pa renteral or enteral nutritional formulas. In order to prevent the complicat ions of catabolism in intensive care patients, recombinant growth hormone ( rhGH) has been applied during two decades as an experimental therapy for pa tients requiring parenteral nutrition and for those with respiratory failur e. Administration of rhGH has resulted in positive nitrogen balance, and st udies in mechanically ventilated patients suggest that it may shorten the n eed for ventilatory support. In contrast to the results of these relatively small studies, a recent multinational randomized controlled trial revealed that the administration of rhGH (with doses 10-20 times higher than those used for replacement therapy) increases the mortality of critically ill pat ients. This excessive mortality in patients treated with rhGH was related t o infections and development of multiple organ failure. Administration of h igh doses of rhGH to critically ill patients cannot thus be recommended.