University of Maryland Medical Center, Baltimore, Maryland, USA.
R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.
Nutr Clin Pract. 2020 Jun;35(3):514-521. doi: 10.1002/ncp.10468. Epub 2020 Feb 21.
Venovenous extracorporeal membrane oxygenation (VV ECMO) induces a systemic inflammatory response, which may progress to persistent inflammation, immunosuppression, and catabolism syndrome (PICS). The anabolic steroid oxandrolone may improve the metabolic aberrations of PICS. We report our experience with 3 patients on VV ECMO who received oxandrolone after demonstrating refractory catabolism on serial nitrogen balance (NB) studies or persistent weakness. Patients in cases 1 and 3 were started on oxandrolone on VV ECMO days 45 and 29, respectively, for negative NB despite nutrition optimization. The case 2 patient started oxandrolone for persistent weakness 68 days after cannulation. All patients demonstrated improvements in NB results. One patient developed mild transaminitis while on oxandrolone, which did not alter his medication course and resolved after the medication was discontinued. The impact of oxandrolone on functional capacity varied between patients. Oxandrolone may be beneficial in persistently catabolic VV ECMO patients to improve NB results. In some patients, this may support functional recovery. Additional research is needed to identify optimal patients for therapy and to investigate the impact of oxandrolone in this population.
静脉-静脉体外膜肺氧合（VV ECMO）可引发全身炎症反应，进而发展为持续性炎症、免疫抑制和分解代谢综合征（PICS）。同化类固醇氧雄龙可能改善 PICS 的代谢异常。我们报告了 3 例接受 VV ECMO 治疗的患者的经验，这些患者在连续氮平衡（NB）研究或持续虚弱时表现出难治性分解代谢，随后接受了氧雄龙治疗。病例 1 和 3 的患者分别在 VV ECMO 第 45 天和第 29 天开始接受氧雄龙治疗，尽管进行了营养优化，但 NB 仍为负值。病例 2 的患者在插管后 68 天因持续虚弱开始使用氧雄龙。所有患者的 NB 结果均有所改善。1 例患者在使用氧雄龙时出现轻度转氨酸升高，但未改变其用药方案，停药后恢复正常。氧雄龙对患者功能能力的影响因人而异。氧雄龙可能对持续分解代谢的 VV ECMO 患者有益，可改善 NB 结果。在某些患者中，这可能有助于功能恢复。需要进一步研究以确定适合治疗的最佳患者，并研究氧雄龙在该人群中的作用。
