Thiamine as an adjunctive therapy in cardiac surgery: A randomized, doubleblind, placebo-controlled, phase II trial

Lars W. Andersen, Mathias J. Holmberg, Katherine M. Berg, Maureen Chase, Michael N. Cocchi, Christopher Sulmonte, Julia Balkema, Mary MacDonald, Sophia Montissol, Venkatachalam Senthilnathan, David Liu, Kamal Khabbaz, Adam Lerner, Victor Novack, Xiaowen Liu, Michael W. Donnino

    Research output: Contribution to journalArticlepeer-review

    29 Scopus citations

    Abstract

    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.

    Original languageEnglish
    Article number92
    JournalCritical Care
    Volume20
    Issue number1
    DOIs
    StatePublished - 1 Jan 2016

    Keywords

    • Aerobic
    • Anaerobic
    • Cardiac surgery
    • Coronary artery bypass grafting
    • Lactate
    • Metabolism
    • Oxygen consumption
    • Pyruvate dehydrogenase
    • Thiamine

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine

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