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Use of Human Growth Hormone Combined with Nutritional Support in a Critical Care Unit
Thomas R. Ziegler, M.D.
Laboratory of Surgical Metabolism and Nutrition and the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
Lorraine S. Young, R.D., M.S.
Laboratory of Surgical Metabolism and Nutrition and the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
Elisabetta Ferrari-Baliviera, M.D.
Laboratory of Surgical Metabolism and Nutrition and the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
Robert H. Demling, M.D.
Laboratory of Surgical Metabolism and Nutrition and the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
Douglas W. Wilmore, M.D.
Laboratory of Surgical Metabolism and Nutrition and the Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
The administration of growth factors may potentially accelerate recovery during critical illness by reducing body protein catabolism, enhancing wound healing, and improving skeletal muscle function. The purpose of this phase 1 study was to evaluate the safety and initial efficacy of a recombinant growth factor, human growth hormone (GH), combined with nutritional support in a critical care unit. Following an initial control week, 11 individuals received GH (10 mg/day) daily for 1-6 consecutive weeks. Near constant nutrient intake was provided via parenteral and/or enteral feedings throughout the study period. Vital signs and other clinical parameters, blood values, and nutrient excretion were monitored daily. GH administration was not associated with clinically significant adverse effects. During the first 2 weeks of study, nitrogen excretion decreased from 1356 ± 157 mmol/day (19.0 ± 2.2 g/ day) during control to 899 ± 107 mmol/day (12.6 ± 1.4 g/day) with growth hormone (p < 0.002) in association with markedly reduced urea generation. Significant reductions in potassium excretion (control 100 ± 11 mmol/day us 69 ± 6 with GH; p < 0.01) and phosphorus excretion (31 ± 5 mmol/day us 18 ± 3; p < 0.025) also occurred during GH. The protein-conserving effects of GH were sustained during several weeks of treatment. Growth hormone enhanced the efficiency of administered protein and facilitated nitrogen retention without clinically significant adverse effects in this small patient group. Controlled trials are indicated to determine whether use of this anabolic hormone reduces hospitalization time and improves other clinical outcomes in severely injured patients when combined with appropriate nutritional support. (Journal of Parenteral and Enteral Nutrition 14:574-581, 1990)
Journal of Parenteral and Enteral Nutrition, Vol. 14, No. 6,
574-581 (1990)
DOI: 10.1177/0148607190014006574
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