Efficacy of Testosterone Gel to Restore Normal Serum Values of Testosterone During the Acute Phase of Critical Illness in Adult ICU Patients

• Status: Unknown status
• Trial end date: 2020-03-31
• Target enrollment: 0
• Participant gender: All

Summary

Critically ill patients experience major insults that lead to increased protein catabolism. Hypermetabolism occurs early and rapidly during the first week of critical illness to provide amino acids for the production of energy via gluconeogenesis, and also for the synthesis of acute phase proteins and repair of tissue damage. During acute phase, neuroendocrine and inflammatory responses promote protein breakdown and amino acid release. Under stress conditions, protein synthesis cannot match the increased rate of muscle proteolysis because of a state of anabolism resistance, which limits uptake of amino acids into muscles. Hypermetabolism results in a significant loss of lean body mass with an impact on weaning from the ventilator and muscle recovery. Functional disability may be long term sometimes with no full return to normal.

In critically ill patients, severe and persistent testosterone deficiency is very common and is observed early after ICU admission. This acquired hypogonadism promotes the persistent loss of skeletal muscle protein and is related to poor outcome.

Administration of testosterone induces skeletal muscle fiber hypertrophy, decreases protein breakdown in healthy young men and burned patients. It has been repeatedly shown that testosterone treatment enhances muscle mass and strength in young and older hypogonadal men and women and can improve physical performance.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University Hospital, Clermont-Ferrand
• Treatments: Methyltestosterone; Testosterone; Testosterone 17 beta-cypionate; Testosterone enanthate; Testosterone undecanoate

Criteria

Inclusion Criteria:

• - Males and females aged over 18 years receiving invasive mechanical ventilation

• Invasive mechanical ventilation expected to be required for more than 48 hours

• Treatment with vasoactive drugs

• Written informed consent obtained from the legal representative

• Social security cover

Exclusion Criteria:

• - History of prostate or breast cancer, prostatic specific antigen (PSA) ≥ 4 ng/ml

• ICU length of stay > 72 h before enrollment

• Moribund defined as having a score SAPS II > 75 12 hours after admission

• Pre-existing illness with a life expectancy of <6 months

• Cardiac arrest

• Preexistent cognitive impairment or language barrier

• Acute intracranial or spinal cord injury

• Acute hemorrhagic or ischemic stroke

• Neuromuscular disease (Guillain-Barré, myasthenia)

• Inability to walk without assistance prior to acute ICU illness (use of a cane or walkers not excluded)

• Documented allergy to testosterone

• Age > 80 years

• Pregnancy or breast feeding

• Patient on judicial protection