Impaired GH-IGF-1 activity contribu

Impaired GH-IGF-1 activity contributes to the wasting and catabolism of CCI, suggesting that replacement with recombinant human GH (rhGH) may be advantageous.However, in 2 large parallel RCTs of patients with PACI(total n  532), Takala et a l157 demonstrated an excessmorbidity and mortality in the treatment group, despiteimproved nitrogen balance. A possible explanation for the negative outcome relates to the supra-physiologic doses used, due to the incorrect assumption that GH resistance persists in the chronic phases of critical illness. Furthermore, insulin resistance and hyperglycemia resulting from GH therapy, combined with inadequate metabolic control,may have contributed to toxicity and negated other potential benefits of therapy.13 Routine use of rhGH is therefore not advised in the CCI patient