Comes with own set of trade-offs, but here's a good place to start:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699141/
Without doubt, calorie and protein delivery is mandatory to allow for recovery, both clinically and functionally, but it alone will not optimize our patients' chances to hold their children again. As I have stated in past discussions [
35], we as humans are not evolved to survive major critical or surgical illness. Mother Nature never intended us to survive major trauma from the saber-tooth tiger attack on the caveman, and similarly we are not evolved to survive major trauma, sepsis, or surgical interventions.
Although we may save many patients using modern technology and get them out of the ICU, our lean body mass reserve and overall metabolic reserve are not sufficient in many cases to allow for a meaningful QOL again. As previously discussed, hypermetabolism and catabolism can persist for months to years after illness/injury [13,14] and this will require not only optimal nutrition, but perhaps pharmacologic intervention to overcome.
Further, anabolic agents such as oxandrolone have shown to be efficacious in reducing the length of stay, shortening time to wound healing, and improving survival in major burns [
36]. These agents unquestionably improve lean body mass and function in both patients and athletes. However, the question remaining unanswered is when to initiate them? Ideally, these agents (oxandrolone, Growth Hormone, etc.) would be initiated following the transition from the "acute phase" to the recovery phase [
35] (see Figure
Figure5).5). An objective measurement predicting this transition has yet to be described; we would like to hypothesize that a measure of muscle health, like the muscle glycogen test described previously, could one day be a measure to signal this transition. We noted that a number of patients showed recovery of their muscle glycogen (with scores increasing from 0 to >15) over the first week of ICU stay.
When muscle glycogen scores begin to increase, we hypothesize patients may be able to sustain anabolism and be responsive to an anabolic agent like oxandrolone (Figure (Figure55).