The GAINS trial - Growth and Anabolism in Intensive Care Survivors

ICU acquired weakness, the result of catabolism, immobility and critical illness polymyoneuropathy is of significant consequence to long-stay ICU patients. Recent advances have tried to prevent ICU acquired weakness by early mobilisation of patients and optimising nutrition. The loss of lean body mass in critical illness is also associated with misalignment between catabolic and anabolic hormones. One potential treatment may be to provide anabolic support in the recovery phase from prolonged critical illness. Nandrolone is a synthetic anabolic steroid that has greater anabolic (growth) and less androgenic (masculinizing) properties than testosterone. It has previously been used successfully in patients with weight loss in HIV/AIDS, and muscle wasting in patients with chronic obstructive pulmonary disease and end stage renal failure. This is a pilot multicentre randomized placebo controlled trial that will look at the effects of nandrolone given weekly for three weeks, versus placebo, in patients who have lost significant amounts of weight or strength while in the ICU. Our primary outcome will be changes in muscle strength, but we will also be looking for changes in weight and length of stay.