Thiamine as an adjunctive therapy in cardiac surgery: a randomized, double-blind, placebo-controlled, phase II trial

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • Lars Wiuff Andersen
  • Mathias J Holmberg
  • KM Berg, Beth Israel Deaconess Medical Center
  • ,
  • M Chase, Beth Israel Deaconess Medical Center
  • ,
  • MN Cocchi, Beth Israel Deaconess Medical Center
  • ,
  • C Sulmonte, Beth Israel Deaconess Medical Center
  • ,
  • J Balkema, Beth Israel Deaconess Medical Center
  • ,
  • M MacDonald, Beth Israel Deaconess Medical Center
  • ,
  • S Montissol, Beth Israel Deaconess Medical Center
  • ,
  • V Senthilnathan, Beth Israel Deaconess Medical Center
  • ,
  • D Liu, Beth Israel Deaconess Medical Center
  • ,
  • K Khabbaz, Beth Israel Deaconess Medical Center
  • ,
  • A Lerner, Beth Israel Deaconess Medical Center
  • ,
  • V Novack, Clinical Research Center, Soroka University Medical Center Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel, Ben-Gurion University of the Negev, 84990 Midreshet Ben-Gurion, Israel
  • ,
  • X Liu, Beth Israel Deaconess Medical Center
  • ,
  • MW Donnino, Beth Israel Deaconess Medical Center

BACKGROUND: Thiamine is a vitamin that is essential for adequate aerobic metabolism. The objective of this study was to determine if thiamine administration prior to coronary artery bypass grafting would decrease post-operative lactate levels as a measure of increased aerobic metabolism.

METHODS: We performed a randomized, double-blind, placebo-controlled trial of patients undergoing coronary artery bypass grafting. Patients were randomized to receive either intravenous thiamine (200 mg) or placebo both immediately before and again after the surgery. Our primary endpoint was post-operative lactate levels. Additional endpoints included pyruvate dehydrogenase activity, global and cellular oxygen consumption, post-operative complications, and hospital and intensive care unit length of stay.

RESULTS: Sixty-four patients were included. Thiamine levels were significantly higher in the thiamine group as compared to the placebo group immediately after surgery (1200 [683, 1200] nmol/L vs. 9 [8, 13] nmol/L, p < 0.001). There was no difference between the groups in the primary endpoint of lactate levels immediately after the surgery (2.0 [1.5, 2.6] mmol/L vs. 2.0 [1.7, 2.4], p = 0.75). Relative pyruvate dehydrogenase activity was lower immediately after the surgery in the thiamine group as compared to the placebo group (15% [11, 37] vs. 28% [15, 84], p = 0.02). Patients receiving thiamine had higher post-operative global oxygen consumption 1 hour after the surgery (difference: 0.37 mL/min/kg [95% CI: 0.03, 0.71], p = 0.03) as well as cellular oxygen consumption. We found no differences in clinical outcomes.

CONCLUSIONS: There were no differences in post-operative lactate levels or clinical outcomes between patients receiving thiamine or placebo. Post-operative oxygen consumption was significantly increased among patients receiving thiamine.

TRIAL REGISTRATION: clinicaltrials.gov NCT02322892, December 14, 2014.

OriginalsprogEngelsk
Artikelnummer92
TidsskriftCritical Care
Vol/bind20
Antal sider11
ISSN1466-609X
DOI
StatusUdgivet - 2016

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