1
|
Mumin MA, McKenzie CA, Page VJ, Hadfield D, Aitken LM, Hanks F, Cunningham E, Blackwood B, Van Dellen E, Slooter AJC, Grocott MPW, McAuley DF, Spronk PE. Whole blood thiamine, intravenous thiamine supplementation and delirium occurrence in the intensive care unit: retrospective cohort analyses. Int J Clin Pharm 2024; 46:631-638. [PMID: 38332207 DOI: 10.1007/s11096-023-01690-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Thiamine di-phosphate is an essential cofactor in glucose metabolism, glutamate transformation and acetylcholinesterase activity, pathways associated with delirium occurrence. We hypothesised that a deficiency in whole blood thiamine and intravenous thiamine supplementation could impact delirium occurrence. AIM To establish whether a deficiency in whole blood thiamine and/or intravenous thiamine supplementation within 72 h of intensive care admission is associated with delirium occurrence. METHOD The first dataset was secondary analysis of a previous study in an intensive care unit in the Netherlands, reported in 2017. The second dataset contained consecutive intensive care admissions 2 years before (period 1: October 2014 to October 2016) and after (period 2: April 2017 to April 2019) routine thiamine supplementation was introduced within 72 h of admission. Delirium was defined as a positive Confusion Assessment Method-Intensive Care Unit score(s) in 24 h. RESULTS Analysis of the first dataset (n = 57) using logistic regression showed no relationship between delirium and sepsis or whole blood thiamine, but a significant association with age (p = 0.014). In the second dataset (n = 3074), 15.1% received IV thiamine in period 1 and 62.6% during period 2. Hierarchical regression analysis reported reduction in delirium occurrence in the second period; this did not reach statistical significance, OR = 0.81 (95% CI 0.652-1.002); p = 0.052. CONCLUSION No relationship was detected between whole blood thiamine and delirium occurrence on admission, at 24 and 48 h. It remains unclear whether routine intravenous thiamine supplementation during intensive care admission impacts delirium occurrence. Further prospective randomised clinical trials are needed.
Collapse
Affiliation(s)
- Muhammad A Mumin
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
- Institute of Pharmaceutical Sciences, Kings College London, London, UK.
- National Institute of Health and Social Care Research, Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton School of Medicine, Southampton, UK.
| | - Cathrine A McKenzie
- Institute of Pharmaceutical Sciences, Kings College London, London, UK
- National Institute of Health and Social Care Research, Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton School of Medicine, Southampton, UK
- Pharmacy and Critical Care, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Valerie J Page
- Intensive Care, West Hertfordshire NHS Foundation Trust, Watford General Hospital, Vicarage Road, Watford, Hertfordshire, UK
| | - Daniel Hadfield
- Institute of Pharmaceutical Sciences, Kings College London, London, UK
- King's Critical Care, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Leanne M Aitken
- School of Health and Psychological Sciences, City, University of London, Northampton Square, London, UK
| | - Fraser Hanks
- Institute of Pharmaceutical Sciences, Kings College London, London, UK
- Pharmacy, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - Emma Cunningham
- Centre for Public Health, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Bronagh Blackwood
- Centre for Public Health, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Edwin Van Dellen
- Departments of Psychiatry and Intensive Care, UMC Utrecht University Medical Center, Utrecht, The Netherlands
- Department of Neurology, UZ Brussel and Vrrije Universiteit Brussel, Brussels, Belgium
| | - Arjen J C Slooter
- Departments of Psychiatry and Intensive Care, UMC Utrecht University Medical Center, Utrecht, The Netherlands
- Department of Neurology, UZ Brussel and Vrrije Universiteit Brussel, Brussels, Belgium
| | - Michael P W Grocott
- National Institute of Health and Social Care Research, Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton School of Medicine, Southampton, UK
- Pharmacy and Critical Care, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Daniel F McAuley
- Centre for Public Health, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Peter E Spronk
- Department of Intensive Care Medicine, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, The Netherlands
- Expertise Center for Intensive Care Rehabilitation (ExpIRA), Apeldoorn, The Netherlands
| |
Collapse
|
2
|
Karimi E, Gholizadeh M, Abdolahi M, Sedighiyan M, Salehinia F, Siri G, Asanjarani B, Yousefi A, Gandomkar H, Abdollahi H. Effect of vitamin B1 supplementation on blood creatinine and lactate levels and clinical outcomes in patients in intensive care units: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 2024; 82:804-814. [PMID: 37553224 DOI: 10.1093/nutrit/nuad096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
CONTEXT The metabolic response to stress can deplete the remaining thiamine stores, leading to thiamine deficiency. OBJECTIVE This study is the first meta-analysis of the effectiveness of thiamine supplementation on clinical and biochemical outcomes in adult patients admitted to the intensive care unit (ICU). DATA SOURCES Scopus, PubMed, and Cochrane databases were searched to select studies up to 20 November 2022. STUDY SELECTION Studies investigating the effect of thiamine supplementation on serum lactate and creatinine levels, the need for renal replacement therapy, length of ICU stay, and mortality rate in ICU patients were selected. DATA EXTRACTION After excluding studies based on title and abstract screening, 2 independent investigators reviewed the full texts of the remaining articles. In the next step, a third investigator resolved any discrepancy in the article selection process. RESULTS Of 1628 retrieved articles, 8 were selected for final analysis. This study showed that thiamine supplementation reduced the serum creatinine level (P = .03) compared with placebo. In addition, according to subgroup analysis, serum creatinine concentration was significantly lower in patients >60 years old (P < .00001). However, there was no statistically significant difference in the lactate level between the thiamine supplementation and placebo groups (P = .26). Thiamine supplementation did not decrease the risk of all-cause mortality (P = .71) or the need for renal replacement therapy (P = .14). The pooled results of eligible randomized controlled trials also showed that thiamine supplementation did not reduce the length of ICU stay in comparison to the placebo group (P = .39). CONCLUSION This meta-analysis provides evidence that thiamine supplementation has a protective effect against blood creatinine increase in ICU patients. However, further high-quality trials are needed to discover the effect of thiamine supplementation on clinical and biochemical outcomes in ICU patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO no. CRD42023399710 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=399710).
Collapse
Affiliation(s)
- Elmira Karimi
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Mohammad Gholizadeh
- Faculty of Nutrition and Food Technology, Department of Clinical Nutrition, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Abdolahi
- Department of Clinical Nutrition, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sedighiyan
- Faculty of Nutrition and Food Technology, Department of Clinical Nutrition, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Salehinia
- Department of Internal Medicine, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Goli Siri
- Department of Internal Medicine, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Behzad Asanjarani
- Department of Internal Medicine, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolghasem Yousefi
- Department of Anesthesiology, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Gandomkar
- Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Abdollahi
- Department of Anesthesiology, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Teixeira FDC, Fernandes TEDL, Leal KCDS, Ribeiro KRB, Dantas DV, Dantas RAN. Factors associated with increased lactate levels in cardiac surgeries: scoping review. Rev Bras Enferm 2024; 77:e20230117. [PMID: 38511788 PMCID: PMC10941673 DOI: 10.1590/0034-7167-2023-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/06/2023] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES to map the factors associated with increased lactate levels in the postoperative period of cardiac surgery using extracorporeal circulation. METHODS this is a scoping review carried out in December 2022, across ten data sources. It was prepared in accordance with the recommendations of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension for Scoping Reviews checklist. RESULTS the most recurrent findings in studies regarding the factors responsible for the increase in lactate were: tissue hypoperfusion, cardiopulmonary bypass time and use of vasoactive drugs. In 95% of studies, increased lactate was related to increased patient mortality. CONCLUSIONS discussing the causes of possible complications in cardiac surgery patients is important for preparing the team and preventing complications, in addition to ensuring quality recovery.
Collapse
|
4
|
Moskowitz A, Donnino MW. Reply to Mumin et al.: The Challenges of Using and Measuring Thiamine in Critical Care. Am J Respir Crit Care Med 2024; 209:607-608. [PMID: 37972374 PMCID: PMC10919115 DOI: 10.1164/rccm.202310-1740le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Ari Moskowitz
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, New York; and
| | - Michael W. Donnino
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
5
|
Suero OR, Park Y, Wieruszewski PM, Chatterjee S. Management of Vasoplegic Shock in the Cardiovascular Intensive Care Unit after Cardiac Surgery. Crit Care Clin 2024; 40:73-88. [PMID: 37973358 DOI: 10.1016/j.ccc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Vasoplegic shock after cardiac surgery is characterized by hypotension, a high cardiac output, and vasodilation. Much of the understanding of this pathologic state is informed by the understanding of septic shock. Adverse outcomes and mortality are increased with vasoplegic shock. Early recognition and a systematic approach to its management are critical. The need for vasopressors to sustain an adequate blood pressure as well as pharmacologic adjuncts to mitigate the inflammatory inciting process are necessary. The rationale behind vasopressor escalation and consideration of adjuncts are discussed.
Collapse
Affiliation(s)
- Orlando R Suero
- Baylor St. Lukes Medical Center, 6720 Bertner Avenue, Room 0-520, Houston, TX 77030, USA
| | - Yangseon Park
- Baylor St. Lukes Medical Center, 6720 Bertner Avenue, Room 0-520, Houston, TX 77030, USA
| | - Patrick M Wieruszewski
- Department of Pharmacy, Mayo Clinic, RO_MB_GR_722PH, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Subhasis Chatterjee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, TX, USA.
| |
Collapse
|
6
|
Moskowitz A, Berg KM, Grossestreuer AV, Balaji L, Liu X, Cocchi MN, Chase M, Gong MN, Gong J, Parikh SM, Ngo L, Berlin N, Donnino MW. Thiamine for Renal Protection in Septic Shock (TRPSS): A Randomized, Placebo-controlled, Clinical Trial. Am J Respir Crit Care Med 2023; 208:570-578. [PMID: 37364280 PMCID: PMC10492240 DOI: 10.1164/rccm.202301-0034oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023] Open
Abstract
Rationale: Kidney injury is common and associated with worse outcomes in patients with septic shock. Mitochondrial resuscitation with thiamine (vitamin B1) may attenuate septic kidney injury. Objectives: To assess whether thiamine supplementation attenuates kidney injury in septic shock. Methods: The TRPSS (Thiamine for Renal Protection in Septic Shock) trial was a multicenter, randomized, placebo-controlled trial of thiamine versus placebo in septic shock. The primary outcome was change in serum creatinine between enrollment and 72 hours after enrollment. Measurements and Main Results: Eighty-eight patients were enrolled (42 patients received the intervention, and 46 received placebo). There was no significant between-groups difference in creatinine at 72 hours (mean difference, -0.57 mg/dl; 95% confidence interval, -1.18, 0.04; P = 0.07). There was no difference in receipt of kidney replacement therapy (14.3% vs. 21.7%, P = 0.34), acute kidney injury (as defined by stage 3 of the Kidney Disease: Improving Global Outcomes acute kidney injury scale; 54.7% vs. 73.9%, P = 0.07), or mortality (35.7% vs. 54.3%, P = 0.14) between the thiamine and placebo groups. Patients who received thiamine had more ICU-free days (median [interquartile range]: 22.5 [0.0-25.0] vs. 0.0 [0.0-23.0], P < 0.01). In the thiamine-deficient cohort (27.4% of patients), there was no difference in rates of kidney failure (57.1% thiamine vs. 81.5% placebo) or in-hospital mortality (28.6% vs. 68.8%) between groups. Conclusions: In the TRPSS trial, there was no statistically significant difference in the primary outcome of change in creatinine over time. Patients who received thiamine had more ICU-free days, but there was no difference in other secondary outcomes. Clinical trial registered with www.clinicaltrials.gov (NCT03550794).
Collapse
Affiliation(s)
- Ari Moskowitz
- Division of Critical Care Medicine, Montefiore Medical Center, The Bronx, New York
- Bronx Center for Critical Care Outcomes and Resuscitation Research, The Bronx, New York
- Center for Resuscitation Science
| | - Katherine M. Berg
- Center for Resuscitation Science
- Division of Pulmonary, Critical Care, and Sleep Medicine
| | | | - Lakshman Balaji
- Center for Resuscitation Science
- Department of Emergency Medicine, and
| | | | - Michael N. Cocchi
- Center for Resuscitation Science
- Department of Emergency Medicine, and
| | - Maureen Chase
- Center for Resuscitation Science
- Department of Emergency Medicine, and
| | - Michelle Ng Gong
- Division of Critical Care Medicine, Montefiore Medical Center, The Bronx, New York
- Bronx Center for Critical Care Outcomes and Resuscitation Research, The Bronx, New York
| | - Jonathan Gong
- Department of Emergency Medicine, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York; and
| | - Samir M. Parikh
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Long Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Michael W. Donnino
- Center for Resuscitation Science
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Department of Emergency Medicine, and
| |
Collapse
|
7
|
Gundogan K, Sahin GG, Ergul SS, Ozer NT, Temel S, Akbas T, Ercan T, Yildiz H, Dizdar OS, Simsek Z, Aydın K, Ulu R, Zerman A, Dal HC, Aydin E, Ozyilmaz E, Ateş N, Gonderen K, Yalcin N, Topeli A, Tok G, Edipoglu O, Ergan B, Aydemir FD, Akbudak IH, Ergun R, Yuksel RC, Sungur M, Griffith DP, Ziegler TR. Evaluation of whole blood thiamine pyrophosphate concentrations in critically ill patients receiving chronic diuretic therapy prior to admission to Turkish intensive care units: A pragmatic, multicenter, prospective study. J Crit Care 2023; 77:154326. [PMID: 37186999 DOI: 10.1016/j.jcrc.2023.154326] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND/OBJECTIVES Thiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations. SUBJECTS/METHODS This observational study was performed in 15 medical ICUs. Serial whole blood TPP concentrations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission. RESULTS A total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with serum phosphorus levels at each time point (P < 0.05 for all). CONCLUSIONS Our results show that 18% of these critically ill patients exhibited low whole blood TPP concentrations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy.
Collapse
Affiliation(s)
- Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye.
| | - Gulsah G Sahin
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Serap S Ergul
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Nurhayat T Ozer
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Sahin Temel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye
| | - Turkay Akbas
- Division of Intensive Care Medicine, Department of Internal Medicine, Duzce University School of Medicine, Duzce, Turkiye
| | - Talha Ercan
- Division of Intensive Care Medicine, Department of Internal Medicine, Duzce University School of Medicine, Duzce, Turkiye
| | - Hamit Yildiz
- Department of Internal Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkiye
| | - Oguzhan S Dizdar
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Zuhal Simsek
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Kaniye Aydın
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Ramazan Ulu
- Department of Nephrology, Firat Medical Faculty, Elazig, Turkiye
| | - Avsar Zerman
- Department of Intensive Care Unit, Kirsehir Ahi Evran University, Kirsehir, Turkiye
| | - Hayriye C Dal
- Department of Intensive Care Unit, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkiye
| | - Emre Aydin
- Department of Nephrology, School of Medicine, Dicle University, Diyarbakır, Turkiye
| | - Ezgi Ozyilmaz
- Division of Intensive Care Medicine, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkiye
| | - Nazire Ateş
- Division of Intensive Care Medicine, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkiye
| | - Kamil Gonderen
- Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkiye
| | - Nazif Yalcin
- Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkiye
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkiye
| | - Gulay Tok
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkiye
| | - Ozlem Edipoglu
- Department of Intensive Care Unit, Health Sciences University, İzmir Dr.Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkiye
| | - Begum Ergan
- Division of Intensive Care Medicine, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkiye
| | - Ferhan D Aydemir
- Division of Intensive Care Medicine, Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkiye
| | - Ismail H Akbudak
- Division of Intensive Care Medicine, Department of Internal Medicine, Pamukkale University School of Medicine, Denizli, Turkiye
| | - Recai Ergun
- Department of Chest Diseases, Selçuk University Faculty of Medicine, Konya, Turkiye
| | - Recep C Yuksel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye
| | - Murat Sungur
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Daniel P Griffith
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA
| | - Thomas R Ziegler
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
8
|
Vammen L, Johannsen CM, Baltsen CD, Nørholt C, Eggertsen M, Mortensen S, Vormfenne L, Povlsen A, Donnino MW, Løfgren B, Andersen LW, Granfeldt A. Thiamine for the Treatment of Cardiac Arrest-Induced Neurological Injury: A Randomized, Blinded, Placebo-Controlled Experimental Study. J Am Heart Assoc 2023; 12:e028558. [PMID: 36942758 PMCID: PMC10122898 DOI: 10.1161/jaha.122.028558] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/06/2023] [Indexed: 03/23/2023]
Abstract
Background Thiamine supplementation has demonstrated protective effects in a mouse model of cardiac arrest. The aim of this study was to investigate the neuroprotective effects of thiamine in a clinically relevant large animal cardiac arrest model. The hypothesis was that thiamine reduces neurological injury evaluated by neuron-specific enolase levels. Methods and Results Pigs underwent myocardial infarction and subsequently 9 minutes of untreated cardiac arrest. Twenty minutes after successful resuscitation, the pigs were randomized to treatment with either thiamine or placebo. All pigs underwent 40 hours of intensive care and were awakened for assessment of functional neurological outcome up until 9 days after cardiac arrest. Nine pigs were included in both groups, with 8 in each group surviving the entire intensive care phase. Mean area under the curve for neuron-specific enolase was similar between groups, with 81.5 μg/L per hour (SD, 20.4) in the thiamine group and 80.5 μg/L per hour (SD, 18.3) in the placebo group, with an absolute difference of 1.0 (95% CI, -57.8 to 59.8; P=0.97). Likewise, there were no absolute difference in neurological deficit score at the end of the protocol (2 [95% CI, -38 to 42]; P=0.93). There was no absolute mean group difference in lactate during the intensive care period (1.1 mmol/L [95% CI, -0.5 to 2.7]; P=0.16). Conclusions In this randomized, blinded, placebo-controlled trial using a pig cardiac arrest model with myocardial infarction and long intensive care and observation for 9 days, thiamine showed no effect in changes to functional neurological outcome or serum levels of neuron-specific enolase. Thiamine treatment had no effect on lactate levels after successful resuscitation.
Collapse
Affiliation(s)
- Lauge Vammen
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Cecilie Munch Johannsen
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | | | - Casper Nørholt
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Mark Eggertsen
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Signe Mortensen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Lasse Vormfenne
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Amalie Povlsen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Cardiothoracic AnesthesiaCopenhagen University Hospital, RigshospitaletRisskovDenmark
| | - Michael W. Donnino
- Center for Resuscitation Science, Department of Emergency MedicineBeth Israel Deaconess Medical CenterBostonMAUSA
- Department of Internal Medicine, Division of PulmonaryCritical Care, and Sleep Medicine, Beth Israel Deaconess Medical CenterBostonMAUSA
| | - Bo Løfgren
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Research Center for Emergency MedicineAarhus University HospitalAarhusDenmark
- Department of MedicineRanders Regional HospitalRandersDenmark
| | - Lars W. Andersen
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Prehospital Emergency Medical ServicesCentral Denmark RegionAarhusDenmark
| | - Asger Granfeldt
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| |
Collapse
|
9
|
Odelli AL, Holyoak A, Yadav S, Page SM, Lindsay D. The effect of cardiopulmonary bypass on blood thiamine concentration and its association with post-operative lactate concentration. J Cardiothorac Surg 2022; 17:260. [PMID: 36207738 PMCID: PMC9541071 DOI: 10.1186/s13019-022-02016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/24/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Cardiothoracic surgery is a large field in Australia, and evidence suggests post-cardiopulmonary bypass (CPB) hyperlactataemia is associated with higher morbidity and mortality. Low thiamine levels are a potentially common yet treatable cause of hyperlactataemia and may occur in the setting of exposure to CPB non-biological material. We hypothesized that cardiopulmonary bypass would result in decreased whole-blood thiamine levels, which may therefore result in increased whole-blood lactate levels in the post-operative period. Methods Adult patients undergoing non-emergent CPB were recruited in a single centre, prospective, analytic observational study at Townsville University Hospital, Australia. The primary outcome was a comparison of pre- and post-CPB thiamine diphosphate level, secondarily aiming to assess any relationship between lactate and thiamine levels. Prospective pre- and post-CPB blood samples were taken and analysed at a central reference laboratory. Results Data was available for analysis on 78 patients. There was a statistically significant increase in thiamine diphosphate level from pre-CPB: 1.36 nmol/g Hb, standard deviation (SD) 0.31, 95% confidence intervals (CI) 1.29–1.43, to post-CPB: 1.77 nmol/g Hb, SD 0.53, 95% CI 1.43–1.88, p value < 0.001. There was a non-statistically significant (p > 0.05) trend in rising whole-blood lactate levels with increasing time. Analysis of lactate levels at varying time periods found a significant difference between baseline measurements and increased levels at 13–16 h (p < 0.05). There was no significant relationship observed between whole-blood thiamine levels and post-operative lactate levels. Conclusion Whole-blood thiamine levels were found to increase immediately post-CPB in those undergoing elective cardiac surgery. There was no correlation between whole-blood thiamine levels and post-operative arterial lactate levels.
Collapse
Affiliation(s)
- Andrea L Odelli
- Intensive Care Unit, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW, 2305, Australia.
| | - Adam Holyoak
- Medical Superintendent, Thursday Island Hospital, Thursday Island, QLD, Australia
| | - Sumit Yadav
- Director of Cardiothoracic Surgery, Townsville University Hospital, Douglas, QLD, Australia
| | - Sarah M Page
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | | |
Collapse
|
10
|
Shokri-Mashhadi N, Aliyari A, Hajhashemy Z, Saadat S, Rouhani MH. Is it time to reconsider the administration of thiamine alone or in combination with vitamin C in critically ill patients? A meta-analysis of clinical trial studies. J Intensive Care 2022; 10:8. [PMID: 35177121 PMCID: PMC8851730 DOI: 10.1186/s40560-022-00594-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/04/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Although the effect of thiamine alone or in combination with vitamin C has been studied in multiple trials (RCT and interventional studies), their results are inconsistent. This meta-analysis aimed to assess impact of thiamine administration alone, thiamine in combination with vitamin C, and co-administration of low-dose hydrocortisone, vitamin C and thiamine (HVT) on clinical outcomes in critically ill patients. METHODS AND MATERIALS After electronic searches on PubMed, Scopus, Cochrane Library, and Web of Science databases, initially 3367 papers were found, and 20 interventional studies were included in our analysis. We assessed the risk-difference between treatment and control (standard treatment) groups by pooling available data on ICU length of stay, number of ventilator free days, mortality, and changes in Sequential Organ Failure Assessment (SOFA) scores. RESULTS The results of present studies revealed no significant effect of thiamine in combination with vitamin C, and HVT on number of free days of ventilation. Thiamine alone supplementation was associated with high mortality percentage (WMD: 5.17%; 95% CI: 2.67, 7.67). Thiamine in combination with vitamin C had no significant impact on mortality rate. In contrast, HVT could decrease mortality rate (WMD: - 7.23%; 95% CI: - 10.31, - 4.16; I-square: 0.0%). There was no significant effect of thiamine alone, co-administration of thiamine and vitamin C, and HVT on ICU length of stay. The results of the meta-analysis showed that thiamine alone and HVT supplementation had no significant effect on SOFA score. Interestingly, co-supplementation of thiamine and vitamin C had a significant decreasing effect on SOFA score (WMD: - 0.73; 95% CI: - 1.29, - 0.17; I-square: 0.0%). CONCLUSION In contrast to HVT, thiamine supplementation alone was associated with increased mortality rate in ICU. However, co-supplementation of thiamine and vitamin C had a significant decreasing effect on SOFA score.
Collapse
Affiliation(s)
- Nafiseh Shokri-Mashhadi
- Food Security Research Center and Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Aliyari
- Food Security Research Center and Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Hajhashemy
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Saadat
- Faculty of Mathematics and Natural Sciences, Department of Computer Sciences, Heinrich Heine Universität, Düsseldorf, Germany
| | - Mohammad Hossein Rouhani
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
11
|
Travica N, Ried K, Hudson I, Scholey A, Pipingas A, Sali A. The effects of cardiovascular and orthopaedic surgery on vitamin concentrations: a narrative review of the literature and mechanisms of action. Crit Rev Food Sci Nutr 2021:1-31. [PMID: 34619992 DOI: 10.1080/10408398.2021.1983762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Given the rise in worldwide chronic diseases, supplemented by an aging population, the volume of global major surgeries, encompassing cardiac and orthopedic procedures is anticipated to surge significantly. Surgical trauma can be accompanied by numerous postoperative complications and metabolic changes. The present review summarized the results from studies assessing the effects of orthopedic and cardiovascular surgery on vitamin concentrations, in addition to exploring the possible mechanisms associated with changes in concentrations. Studies have revealed a potentially severe depletion in plasma/serum concentrations of numerous vitamins following these surgeries acutely. Vitamins C, D and B1 appear particularly vulnerable to significant depletions, with vitamin C and D depletions consistently transpiring into inadequate and deficient concentrations, respectively. The possible multifactorial mechanisms impacting postoperative vitamin concentrations include changes in hemodilution and vitamin utilization, redistribution, circulatory transport and absorption. For a majority of vitamins, there has been a lack of investigation into the effects of both, cardiac and orthopedic surgery. Additionally, studies were predominantly restricted to short-term postoperative investigations, primarily performed within the first postoperative week of surgery. Overall, results indicated that further examination is necessary to determine the severity and clinical significance of the possible depletions in vitamin concentrations that ensue cardiovascular and orthopedic surgery.
Collapse
Affiliation(s)
- Nikolaj Travica
- Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, the Institute for Mental and Physical Health and Clinical Translation (IMPACT), Geelong, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia.,The National Institute of Integrative Medicine, Melbourne, Australia
| | - Karin Ried
- The National Institute of Integrative Medicine, Melbourne, Australia.,Honorary Associate Professor, Discipline of General Practice, University of Adelaide, South Australia, Australia.,Torrens University, Melbourne, Australia
| | - Irene Hudson
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia.,Digital Health, CRC, College of STEM, Mathematical Sciences, Royal Melbourne Institute of Technology (RMIT), Melbourne, Australia.,School of Mathematical and Physical Science, University of Newcastle, Newcastle, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Avni Sali
- The National Institute of Integrative Medicine, Melbourne, Australia
| |
Collapse
|
12
|
Lange S, Mędrzycka-Dąbrowska W, Friganovic A, Oomen B, Krupa S. Delirium in Critical Illness Patients and the Potential Role of Thiamine Therapy in Prevention and Treatment: Findings from a Scoping Review with Implications for Evidence-Based Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168809. [PMID: 34444556 PMCID: PMC8392497 DOI: 10.3390/ijerph18168809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Thiamine is a water-soluble vitamin and is necessary for energy metabolism. Critically ill patients are at particular risk of developing thiamine deficiency and related complications. One of the complications that can occur is delirium. Delirium is a disorder that affects the body's response to treatment, length of stay in the ward, mortality, long-term cognitive impairment, and significantly increases treatment costs. In addition, studies show that delirium medication is more effective in preventing than in treating delirium. Given its low cost, availability, and minimal risk of side effects, thiamine supplementation could prove to be a relevant strategy in the prevention and treatment of delirium. METHODS PubMed, Cochrane Library, Ovid, and ClinicalTrials.gov databases were searched using relevant keywords that focus on the use of thiamine to prevent or treat delirium in critically ill patients. RESULTS Seven articles were included in the analysis. CONCLUSION The small number of studies and considerable heterogeneity prevent conclusions supporting the use of thiamine as an adjuvant in the prevention and treatment of delirium among critically ill patients. There is a need for high-quality, large-scale randomized clinical trials to confirm the beneficial effects of thiamine in the prevention and treatment of delirium.
Collapse
Affiliation(s)
- Sandra Lange
- Department of Anesthesiology and Intensive Care, Hospitals Tczewskie SA, 83-110 Tczew, Poland;
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdańsk, Poland
- Correspondence:
| | - Adriano Friganovic
- Department of Anesthesiology and Intensive Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia
| | - Ber Oomen
- European Specialist Nurses Organization (ESNO), 6821HR Arnhem, The Netherlands;
| | - Sabina Krupa
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-310 Rzeszow, Poland;
| |
Collapse
|
13
|
Marwali EM, Caesa P, Purnama Y, Rayhan M, Budiwardhana N, Fitria L, Fakhri D, Portman MA. Thiamine levels in Indonesian children with congenital heart diseases undergoing surgery using cardiopulmonary bypass machine. Asian Cardiovasc Thorac Ann 2021; 30:307-313. [PMID: 34102906 DOI: 10.1177/02184923211024103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study evaluated thiamine levels in Indonesian children with congenital heart diseases before and after cardiopulmonary bypass and their relationship with clinical and surgical outcomes. METHOD A prospective, single center cross-sectional study was conducted to evaluate thiamine levels in 25 children undergoing congenital heart diseases surgery with cardiopulmonary bypass procedure. Thiamine levels were quantified using a high-performance liquid chromatography method. RESULT Preoperative thiamine deficiency was observed in one subject. Thiamine levels did not differ statistically between nutritional status and clinical outcomes categories. There were no significant changes in thiamine levels before and after cardiopulmonary bypass (median pre versus post (P25-75): 50 ng/mL (59.00-116.00) and 83.00 ng/mL (70.00-101.00), p = 0.84), although a significant reduction in thiamine levels were observed with longer cardiopulmonary bypass duration (p = 0.017, R = -0.472). CONCLUSION Thiamine levels were not significantly impacted by cardiac surgery except in patients undergoing extremely long cardiopulmonary bypass duration. However, clinical outcome was not affected by thiamine levels.
Collapse
Affiliation(s)
- Eva M Marwali
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Putri Caesa
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Yoel Purnama
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Muhammad Rayhan
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Novik Budiwardhana
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Liza Fitria
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Dicky Fakhri
- Pediatric Cardiac Surgery, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Michael A Portman
- Department of Cardiothoracic Surgery Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
14
|
Sedhai YR, Shrestha DB, Budhathoki P, Jha V, Mandal SK, Karki S, Baniya R, Cable CA, Kashiouris MG. Effect of thiamine supplementation in critically ill patients: A systematic review and meta-analysis. J Crit Care 2021; 65:104-115. [PMID: 34118501 DOI: 10.1016/j.jcrc.2021.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/31/2021] [Accepted: 05/26/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Several studies have previously shown the benefit of thiamine supplementation in critically ill patients. In order to fully appraise the available data, we performed a meta-analysis of 18 published studies. METHODS A thorough systematic search was conducted. The studies enrolling critically ill patients receiving thiamine supplementation was compared with the standard of care (SOC) group. Data was analyzed using RevMan 5.4. Clinical outcomes were pooled using Odds Ratio (OR) and mean differences. RESULT Eighteen studies (8 RCTs and 10 cohort studies) met the criteria for quantitative synthesis. In the analysis of RCTs, thiamine supplementation showed 42% lower odds of developing ICU delirium (OR 0.58, 95% CI, 0.34-0.98). A reduction in mortaliy was observed on performing fixed effect model analysis however, a level of statistical significance could not be reached on performing randon effect model analysis (OR, 0.78; 95% CI, 0.59 to 1.04). Further sub-group analysis of 13 studies in patients with sepsis, there was no difference in mortality between the two groups (OR, 0.83; 95% CI, 0.63 to 1.09). CONCLUSION Thiamine supplementation in critically ill patients showed a reduction in the incidence of ICU delirium among RCTs. However, there was no significant benefit in terms of overall mortality, and mortality in patients with sepsis. Further, large scale randomized prospective studies are warranted to investigate the role of thiamine supplementation in critically ill patients.
Collapse
Affiliation(s)
- Yub Raj Sedhai
- Department of Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA.
| | | | - Pravash Budhathoki
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA
| | - Vivek Jha
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal
| | - Sujit Kumar Mandal
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal; Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | | | - Ramkaji Baniya
- Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA
| | - Casey A Cable
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, VCU School of Medicine, Richmond, VA, USA
| | - Markos G Kashiouris
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, VCU School of Medicine, Richmond, VA, USA.
| |
Collapse
|
15
|
Effects of thiamine on vasopressor requirements in patients with septic shock: a prospective randomized controlled trial. BMC Anesthesiol 2020; 20:280. [PMID: 33167911 PMCID: PMC7650202 DOI: 10.1186/s12871-020-01195-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/20/2020] [Indexed: 01/17/2023] Open
Abstract
Background Thiamine, an essential vitamin for aerobic metabolism and glutathione cycling, may decrease the effects of critical illnesses. The objective of this study was to determine whether intravenous thiamine administration can reduce vasopressor requirements in patients with septic shock. Methods This study was a prospective randomized double-blind placebo-controlled trial. We included adult patients with septic shock who required a vasopressor within 1–24 h after admission between March 2018 and January 2019 at a tertiary hospital in Thailand. Patients were divided into two groups: those who received 200 mg thiamine or those receiving a placebo every 12 h for 7 days or until hospital discharge. The primary outcome was the number of vasopressor-free days over 7 days. The pre-defined sample size was 31 patients per group, and the study was terminated early due to difficult recruitment. Results Sixty-two patients were screened and 50 patients were finally enrolled in the study, 25 in each group. There was no difference in the primary outcome of vasopressor-free days within the 7-day period between the thiamine and placebo groups (mean: 4.9 days (1.9) vs. 4.0 days (2.7), p = 0.197, mean difference − 0.9, 95% CI (− 2.9 to 0.5)). However, the reductions in lactate (p = 0.024) and in the vasopressor dependency index (p = 0.02) at 24 h were greater among subjects who received thiamine repletion vs. the placebo. No statistically significant difference was observed in SOFA scores within 7 days, vasopressor dependency index within 4 days and 7 days, or 28-day mortality. Conclusions Thiamine was not associated to a significant reduction in vasopressor-free days over 7-days in comparison to placebo in patients with septic shock. Administration of thiamine could be associated with a reduction in vasopressor dependency index and lactate level within 24 h. The study is limited by early stopping and low sample size. Trial registration TCTR, TCTR20180310001. Registered 8 March 2018, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=3330. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12871-020-01195-4.
Collapse
|
16
|
Yamada Y, Kusakari Y, Akaoka M, Watanabe M, Tanihata J, Nishioka N, Bochimoto H, Akaike T, Tachibana T, Minamisawa S. Thiamine treatment preserves cardiac function against ischemia injury via maintaining mitochondrial size and ATP levels. J Appl Physiol (1985) 2020; 130:26-35. [PMID: 33119470 DOI: 10.1152/japplphysiol.00578.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Thiamine (vitamin B1) is necessary for energy production, especially in the heart. Recent studies have demonstrated that thiamine supplementation for cardiac diseases is beneficial. However, the detailed mechanisms underlying thiamine-preserved cardiac function have not been elucidated. To this end, we conducted a functional analysis, metabolome analysis, and electron microscopic analysis to unveil the mechanisms of preserved cardiac function through supplementation with thiamine for ischemic cardiac disease. Male Sprague-Dawley rats (around 10 wk old) were used. Following pretreatment with or without thiamine pyrophosphate (TPP; 300 µM), hearts were exposed to ischemia (40 min of global ischemia followed by 60 min of reperfusion). We measured the left ventricle developed pressure (LVDP) throughout the protocol. The LVDP during reperfusion in the TPP-treated heart was significantly higher than that in the untreated heart. Metabolome analysis was performed using capillary electrophoresis-time-of-flight mass spectrometry, and it revealed that the TPP-treated heart retained higher adenosine triphosphate (ATP) levels compared with the untreated heart after ischemia. The metabolic pathway showed that there was a significant increase in fumaric acid and malic acid from the tricarboxylic acid cycle following ischemia. Electron microscope analysis revealed that the mitochondria size in the TPP-treated heart was larger than that in the untreated heart. Mitochondrial fission in the TPP-treated heart was also inhibited, which was confirmed by a decrease in the phosphorylation level of DRP1 (fission related protein). TPP treatment for cardiac ischemia preserved ATP levels probably as a result of maintaining larger mitochondria by inhibiting fission, thereby allowing the TPP-treated heart to preserve contractility performance during reperfusion.NEW & NOTEWORTHY We found that treatment with thiamine can have a protective effect on myocardial ischemia. Thiamine likely mediates mitochondrial fission through the inhibition of DRP1 phosphorylation and the preservation of larger-sized mitochondria and ATP concentration, leading to higher cardiac contractility performance during the subsequent reperfusion state.
Collapse
Affiliation(s)
- Yuki Yamada
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoichiro Kusakari
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Munetoshi Akaoka
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masato Watanabe
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Tanihata
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Naritomo Nishioka
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Bochimoto
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Toru Akaike
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiaki Tachibana
- Division of Molecular Cell Biology, Core Research Facilities for Basic Science, The Jikei University School of Medicine, Tokyo, Japan
| | - Susumu Minamisawa
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
17
|
Efficacy of Thiamine in the Treatment of Postcardiac Arrest Patients: A Randomized Controlled Study. Crit Care Res Pract 2020; 2020:2981079. [PMID: 32587766 PMCID: PMC7298263 DOI: 10.1155/2020/2981079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/12/2020] [Accepted: 05/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background Thiamine administration has been shown to improve survival in a postcardiac arrest animal study. We aimed to evaluate the efficacy of thiamine in comatose out-of-hospital cardiac arrest (OHCA) patients following return of spontaneous circulation. Methods A randomized, double-blinded, placebo-controlled study was conducted. Thirty-seven OHCA patients were randomly assigned to receive either thiamine 100 mg every 8 hours or a placebo. The primary outcome was 28-day all-cause mortality. Results Over the course of 2 years, 37 patients were randomized to either receive thiamine (n = 20) or a placebo (n = 17). The primary outcome was not different between the groups: 10/20 (50%) in the thiamine group vs. 8/17 (47.1%) in the placebo group (P=0.93 by the log-rank test). There were no significant differences in secondary outcomes between the groups (good neurological outcome, lactate level, and S100B level). Conclusions In this study, there were no significant differences in survival outcome. Further studies with a larger population are necessary to confirm these results.
Collapse
|
18
|
Shah R, Wenger RK, Patel PA, Davis S, Ha B, Feinman JW, Patel S, Pulton D, Weiss SJ, Restrepo-Cardenas J, Aljure OD, Vasquez CR, Augoustides JG. Severe Vasoplegic Shock During Coronary Artery Bypass Surgery: Therapeutic challenges and Dilemmas in Hemodynamic Rescue. J Cardiothorac Vasc Anesth 2020; 34:1341-1347. [PMID: 32146101 DOI: 10.1053/j.jvca.2020.01.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Ronak Shah
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert K Wenger
- Department of Surgery, Division of Cardiac Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Scott Davis
- Department of Anesthesiology, Chester County Hospital, University of Pennsylvania, Philadelphia, PA
| | - Bao Ha
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Patel
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danielle Pulton
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Oscar D Aljure
- Department of Anesthesiology, Miller School of Medicine, University of Miami, Miami, FL
| | - Charles R Vasquez
- Department of Surgery, Division of Cardiac Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
19
|
Yanase F, Bitker L, Hessels L, Osawa E, Naorungroj T, Cutuli SL, Young PJ, Ritzema J, Hill G, Latimer-Bell C, Hunt A, Eastwood GM, Hilton A, Bellomo R. A Pilot, Double-Blind, Randomized, Controlled Trial of High-Dose Intravenous Vitamin C for Vasoplegia After Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 34:409-416. [DOI: 10.1053/j.jvca.2019.08.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 01/06/2023]
|
20
|
Colunga Biancatelli RML, Berrill M, Mohammed YH, Marik PE. Melatonin for the treatment of sepsis: the scientific rationale. J Thorac Dis 2020; 12:S54-S65. [PMID: 32148926 DOI: 10.21037/jtd.2019.12.85] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sepsis affects 30 million people worldwide, leading to 6 million deaths every year (WHO), and despite decades of research, novel initiatives are drastically needed. According to the current literature, oxidative imbalance and mitochondrial dysfunction are common features of septic patients that can cause multiorgan failure and death. Melatonin, alongside its traditionally accepted role as the master hormonal regulator of the circadian rhythm, is a promising adjunctive drug for sepsis through its anti-inflammatory, antiapoptotic and powerful antioxidant properties. Several animal models of sepsis have demonstrated that melatonin can prevent multiorgan dysfunction and improve survival through restoring mitochondrial electron transport chain (ETC) function, inhibiting nitric oxide synthesis and reducing cytokine production. The purpose of this article is to review the current evidence for the role of melatonin in sepsis, review its pharmacokinetic profile and virtual absence of side effects. While clinical data is limited, we propose the adjunctive use of melatonin is patients with severe sepsis and septic shock.
Collapse
Affiliation(s)
- Ruben Manuel Luciano Colunga Biancatelli
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.,Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy
| | - Max Berrill
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.,St. Peter's Hospital, Department of Respiratory Medicine, London, UK
| | - Yassen H Mohammed
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| |
Collapse
|
21
|
Wenger S, Litton E. Thiamine - Essential Post Cardiopulmonary Bypass? J Cardiothorac Vasc Anesth 2020; 34:601-602. [PMID: 31926802 DOI: 10.1053/j.jvca.2019.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/28/2019] [Indexed: 11/11/2022]
|
22
|
Lomivorotov VV, Moroz G, Ismoilov S, Shmyrev V, Efremov S, Abubakirov M, Batalov V, Landoni G, Lembo R, Bogachev-Prokophiev A, Sapegin A, Bellomo R. Sustained High-dose Thiamine Supplementation in High-risk Cardiac Patients Undergoing Cardiopulmonary Bypass: A Pilot Feasibility Study (The APPLY trial). J Cardiothorac Vasc Anesth 2019; 34:594-600. [PMID: 31558398 DOI: 10.1053/j.jvca.2019.08.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the feasibility and investigate possible cardiovascular effects of a sustained high-dose intravenous thiamine protocol in patients undergoing combined valvular and coronary artery bypass graft surgery. DESIGN Randomized, placebo-controlled, pilot feasibility trial. SETTING Cardiac surgery department of a tertiary hospital. PARTICIPANTS Forty patients undergoing combined valvular and coronary artery bypass surgery. INTERVENTIONS Intravenous thiamine (600 mg on the day of surgery, and 400 mg/day on postoperative days 1, 2, and 3) or placebo. MEASUREMENTS AND MAIN RESULTS The primary feasibility endpoints were recruitment rate and protocol compliance. Secondary endpoints included markers of possible biological and physiological effects. The mean recruitment rate was 8 patients per month and protocol compliance was 97.5%. There were no differences in median peak postoperative lactate (2.7 mmol/L [interquartile range [IQR] 1.4-4.6] for thiamine v 2.5 mmol/L [IQR 1.4-3.6] for placebo; p = 0.53), median peak postoperative creatinine (104 µmol/L [IQR 92.5-129] for thiamine v 99 µmol/L [IQR 86.5-109.5] for placebo; p = 0.53), median nadir postoperative cardiac index (1.8 L/min/m2 [IQR 1.5-2.1] for thiamine v 2.2 L/min/m2 [IQR 1.5-2.5] for placebo; p = 0.25), or the number of patients on vasopressor/inotropic agents (thiamine, 12 [63%]; placebo, 12 [60%]; p = 0.80), or in the total inotrope/vasopressor dose 0.14 µg/kg for thiamine v 0.12 µg/kg for placebo; p = 0.88). CONCLUSIONS A double-blind trial of sustained high-dose intravenous thiamine supplementation in higher-risk cardiac surgery patients was feasible and appeared to be safe. However, such treatment did not demonstrate evidence of biological or physiological effects.
Collapse
Affiliation(s)
- Vladimir V Lomivorotov
- E. Meshalkin National Medical Research Center, Novosibirsk, Russia; Novosibirsk State University, Novosibirsk, Russia.
| | - Gleb Moroz
- E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | | | - Vladimir Shmyrev
- E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Sergey Efremov
- Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Marat Abubakirov
- E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Vasily Batalov
- E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrey Sapegin
- E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
23
|
Spoelstra-de Man AME, Oudemans-van Straaten HM, Elbers PWG. Vitamin C and thiamine in critical illness. BJA Educ 2019; 19:290-296. [PMID: 33456905 DOI: 10.1016/j.bjae.2019.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2019] [Indexed: 01/29/2023] Open
Affiliation(s)
- A M E Spoelstra-de Man
- Amsterdam University Medical Centers, Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | | | - P W G Elbers
- Amsterdam University Medical Centers, Vrije Universiteit Medical Center, Amsterdam, Netherlands
| |
Collapse
|
24
|
Gralak MA, Dębski B, Drywień M. Thiamine deficiency affects glucose transport and β-oxidation in rats. J Anim Physiol Anim Nutr (Berl) 2019; 103:1629-1635. [PMID: 31259440 PMCID: PMC6851678 DOI: 10.1111/jpn.13146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 04/07/2019] [Accepted: 06/03/2019] [Indexed: 12/13/2022]
Abstract
Thiamine is recognized as a cofactor for many enzymes involved in intermediary metabolism responsible for energy production. Animal model of thiamine deficiency (TD) included direct evaluation of glucose uptake by estimation of 3H‐deoxyglucose transport across red blood cells membranes and β‐oxidation of fatty acids in isolated leucocytes. Feeding of animals with the thiamine‐deficient diet (0.018 mg/kg diet) for 30 days resulted in disturbances in energy production. The thiamine intake was limited not only by vitamin B1 deficiency in the diet, but also by time‐dependent drop of feed consumption by rats fed this diet. At the end of experiment, diet consumption in this group of rats was 52% lower than in the control group. This was accompanied by low glucose uptake by erythrocytes of rats suffering vitamin B1 deficiency for longer time. At the end of experimental period, glucose uptake was over 2 times lower in TD erythrocytes than in control RBC. Such drop of energy production was not compensated by delivery of energy from fatty acid degradation. In leucocytes from TD rats, the β‐oxidation was also suppressed. Observed significant decrease of serum insulin from 2.25 ± 0.25 ng/ml (day 0) to 1.94 ± 0.17 ng/ml (day 30) might have significant impact on observed energy production disorders. The results from this study indicate that the thiamine deficiency significantly reduces feed intake and causes modest abnormalities in glucose and fatty acid utilization.
Collapse
Affiliation(s)
- Mikołaj Antoni Gralak
- Department of Physiological Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Bogdan Dębski
- Department of Physiological Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Małgorzata Drywień
- Department of Human Nutrition, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| |
Collapse
|
25
|
Ortoleva JP, Cobey FC. A Systematic Approach to the Treatment of Vasoplegia Based on Recent Advances in Pharmacotherapy. J Cardiothorac Vasc Anesth 2019; 33:1310-1314. [DOI: 10.1053/j.jvca.2018.11.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Indexed: 12/31/2022]
|
26
|
Polegato BF, Pereira AG, Azevedo PS, Costa NA, Zornoff LAM, Paiva SAR, Minicucci MF. Role of Thiamin in Health and Disease. Nutr Clin Pract 2019; 34:558-564. [DOI: 10.1002/ncp.10234] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Bertha F. Polegato
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Amanda G. Pereira
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Paula S. Azevedo
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Nara A. Costa
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Leonardo A. M. Zornoff
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Sergio A. R. Paiva
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Marcos F. Minicucci
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| |
Collapse
|
27
|
Gundogan K, Akbudak IH, Bulut K, Temel S, Sungur M, Guven M, Dave NJ, Griffith DP, Ziegler TR. Thiamin Status in Adults Receiving Chronic Diuretic Therapy Prior to Admission to a Medical Intensive Care Unit: A Pilot Study. Nutr Clin Pract 2019; 34:565-571. [DOI: 10.1002/ncp.10241] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kursat Gundogan
- Division of Medical Intensive Care; Department of Medicine; Enteral and Parenteral Nutrition Unit; Erciyes University School of Medicine; Kayseri Turkey
| | - Ismail Hakki Akbudak
- Division of Medical Intensive Care; Department of Medicine; Enteral and Parenteral Nutrition Unit; Erciyes University School of Medicine; Kayseri Turkey
| | - Kadir Bulut
- Division of Medical Intensive Care; Department of Medicine; Enteral and Parenteral Nutrition Unit; Erciyes University School of Medicine; Kayseri Turkey
| | - Sahin Temel
- Division of Medical Intensive Care; Department of Medicine; Enteral and Parenteral Nutrition Unit; Erciyes University School of Medicine; Kayseri Turkey
| | - Murat Sungur
- Division of Medical Intensive Care; Department of Medicine; Enteral and Parenteral Nutrition Unit; Erciyes University School of Medicine; Kayseri Turkey
| | - Muhammet Guven
- Division of Medical Intensive Care; Department of Medicine; Enteral and Parenteral Nutrition Unit; Erciyes University School of Medicine; Kayseri Turkey
| | - Nisha J. Dave
- Nutrition and Metabolic Support Service; Emory University Hospital; Atlanta Georgia USA
| | - Daniel P. Griffith
- Nutrition and Metabolic Support Service; Emory University Hospital; Atlanta Georgia USA
| | - Thomas R. Ziegler
- Nutrition and Metabolic Support Service; Emory University Hospital; Atlanta Georgia USA
- Division of Endocrinology; Metabolism and Lipids; Emory University School of Medicine; Atlanta Georgia USA
| |
Collapse
|
28
|
Moskowitz A, Andersen LW, Huang DT, Berg KM, Grossestreuer AV, Marik PE, Sherwin RL, Hou PC, Becker LB, Cocchi MN, Doshi P, Gong J, Sen A, Donnino MW. Ascorbic acid, corticosteroids, and thiamine in sepsis: a review of the biologic rationale and the present state of clinical evaluation. Crit Care 2018; 22:283. [PMID: 30373647 PMCID: PMC6206928 DOI: 10.1186/s13054-018-2217-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/03/2018] [Indexed: 12/12/2022] Open
Abstract
The combination of thiamine, ascorbic acid, and hydrocortisone has recently emerged as a potential adjunctive therapy to antibiotics, infectious source control, and supportive care for patients with sepsis and septic shock. In the present manuscript, we provide a comprehensive review of the pathophysiologic basis and supporting research for each element of the thiamine, ascorbic acid, and hydrocortisone drug combination in sepsis. In addition, we describe potential areas of synergy between these therapies and discuss the strengths/weaknesses of the two studies to date which have evaluated the drug combination in patients with severe infection. Finally, we describe the current state of current clinical practice as it relates to the thiamine, ascorbic acid, and hydrocortisone combination and present an overview of the randomized, placebo-controlled, multi-center Ascorbic acid, Corticosteroids, and Thiamine in Sepsis (ACTS) trial and other planned/ongoing randomized clinical trials.
Collapse
Affiliation(s)
- Ari Moskowitz
- Beth Israel Deaconess Medical Center, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, MA USA
| | - Lars W. Andersen
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA USA
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - David T. Huang
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA USA
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Katherine M. Berg
- Beth Israel Deaconess Medical Center, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, MA USA
| | - Anne V. Grossestreuer
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA USA
| | - Paul E. Marik
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA USA
| | - Robert L. Sherwin
- Department of Emergency Medicine, Wayne State University School of Medicine/Detroit Receiving Hospital, Detroit, MI USA
| | - Peter C. Hou
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Lance B. Becker
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Feinstein Institute for Medical Research, Manhasset, NY USA
| | - Michael N. Cocchi
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA USA
- Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Pratik Doshi
- Department of Emergency Medicine and Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX USA
| | - Jonathan Gong
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY USA
| | - Ayan Sen
- Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ USA
| | - Michael W. Donnino
- Beth Israel Deaconess Medical Center, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, MA USA
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA USA
- Beth Israel Deaconess Medical Center, Emergency Medicine, One Deaconess Rd, W/CC 2, Boston, MA 02215 USA
| |
Collapse
|
29
|
Attaluri P, Castillo A, Edriss H, Nugent K. Thiamine Deficiency: An Important Consideration in Critically Ill Patients. Am J Med Sci 2018; 356:382-390. [PMID: 30146080 DOI: 10.1016/j.amjms.2018.06.015] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
Thiamine is an essential cofactor for 4 enzymes involved in the production of energy (ATP) and the synthesis of essential cellular molecules. The total body stores of thiamine are relatively small, and thiamine deficiency can develop in patients secondary to inadequate nutrition, alcohol use disorders, increased urinary excretion and acute metabolic stress. Patients with sepsis are frequently thiamine deficient, and patients undergoing surgical procedures can develop thiamine deficiency. This deficiency can cause congestive heart failure, peripheral neuropathy, Wernicke's encephalopathy, Korsakoff's syndrome and gastrointestinal beriberi. In addition, thiamine deficiency can contribute to the development of intensive care unit complications, such as heart failure, delirium, critical care neuropathy, gastrointestinal dysfunction and unexplained lactic acidosis. Consequently, clinicians need to consider thiamine deficiency in patients admitted to intensive care units and the development of thiamine deficiency during the management of critically ill patients. Intravenous thiamine can correct lactic acidosis, improve cardiac function and treat delirium.
Collapse
Affiliation(s)
- Pradeep Attaluri
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Austin Castillo
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Hawa Edriss
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
| |
Collapse
|
30
|
Hill A, Nesterova E, Lomivorotov V, Efremov S, Goetzenich A, Benstoem C, Zamyatin M, Chourdakis M, Heyland D, Stoppe C. Current Evidence about Nutrition Support in Cardiac Surgery Patients-What Do We Know? Nutrients 2018; 10:nu10050597. [PMID: 29751629 PMCID: PMC5986477 DOI: 10.3390/nu10050597] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 12/27/2022] Open
Abstract
Nutrition support is increasingly recognized as a clinically relevant aspect of the intensive care treatment of cardiac surgery patients. However, evidence from adequate large-scale studies evaluating its clinical significance for patients’ mid- to long-term outcome remains sparse. Considering nutrition support as a key component in the perioperative treatment of these critically ill patients led us to review and discuss our understanding of the metabolic response to the inflammatory burst induced by cardiac surgery. In addition, we discuss how to identify patients who may benefit from nutrition therapy, when to start nutritional interventions, present evidence about the use of enteral and parenteral nutrition and the potential role of pharmaconutrition in cardiac surgery patients. Although the clinical setting of cardiac surgery provides advantages due to its scheduled insult and predictable inflammatory response, researchers and clinicians face lack of evidence and several limitations in the clinical routine, which are critically considered and discussed in this paper.
Collapse
Affiliation(s)
- Aileen Hill
- Department of Intensive Care Medicine, University Hospital RWTH, D-52074 Aachen, Germany.
- 3CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, D-52074 Aachen, Germany.
| | - Ekaterina Nesterova
- Department of Anesthesiology and Intensive Care Medicine, National Pirogov Medical Center, 105203 Moscow, Russia.
| | - Vladimir Lomivorotov
- Department of Anesthesiology and Intensive Care Medicine, E. Meshalkin National Medical Research Center, 630055 Novosibirsk, Russia.
| | - Sergey Efremov
- Department of Anesthesiology and Intensive Care Medicine, E. Meshalkin National Medical Research Center, 630055 Novosibirsk, Russia.
| | - Andreas Goetzenich
- 3CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, D-52074 Aachen, Germany.
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital RWTH, D-52074 Aachen, Germany.
| | - Carina Benstoem
- Department of Intensive Care Medicine, University Hospital RWTH, D-52074 Aachen, Germany.
- 3CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, D-52074 Aachen, Germany.
| | - Mikhail Zamyatin
- Department of Anesthesiology and Intensive Care Medicine, National Pirogov Medical Center, 105203 Moscow, Russia.
| | - Michael Chourdakis
- Department of Medicine, School of Health Sciences, 54124 Thessaloniki, Greece.
| | - Daren Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON K7L 2V7, Canada.
| | - Christian Stoppe
- Department of Intensive Care Medicine, University Hospital RWTH, D-52074 Aachen, Germany.
- 3CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, D-52074 Aachen, Germany.
| |
Collapse
|
31
|
Andersen LW. Lactate Elevation During and After Major Cardiac Surgery in Adults: A Review of Etiology, Prognostic Value, and Management. Anesth Analg 2017; 125:743-752. [PMID: 28277327 DOI: 10.1213/ane.0000000000001928] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Elevated lactate is a common occurrence after cardiac surgery. This review summarizes the literature on the complex etiology of lactate elevation during and after cardiac surgery, including considerations of oxygen delivery, oxygen utilization, increased metabolism, lactate clearance, medications and fluids, and postoperative complications. Second, the association between lactate and a variety of outcomes are described, and the prognostic role of lactate is critically assessed. Despite the fact that elevated lactate is strongly associated with many important outcomes, including postoperative complications, length of stay, and mortality, little is known about the optimal management of postoperative patients with lactate elevations. This review ends with an assessment of the limited literature on this subject.
Collapse
Affiliation(s)
- Lars W Andersen
- From the *Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; †Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ‡Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark; and §Department of Medicine, Regional Hospital Holstebro, Aarhus University, Holstebro, Denmark
| |
Collapse
|