TY - JOUR
T1 - Thiamine as an adjunctive therapy in cardiac surgery
T2 - A randomized, doubleblind, placebo-controlled, phase II trial
AU - Andersen, Lars W.
AU - Holmberg, Mathias J.
AU - Berg, Katherine M.
AU - Chase, Maureen
AU - Cocchi, Michael N.
AU - Sulmonte, Christopher
AU - Balkema, Julia
AU - MacDonald, Mary
AU - Montissol, Sophia
AU - Senthilnathan, Venkatachalam
AU - Liu, David
AU - Khabbaz, Kamal
AU - Lerner, Adam
AU - Novack, Victor
AU - Liu, Xiaowen
AU - Donnino, Michael W.
N1 - Publisher Copyright:
© 2016 Andersen et al.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - 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.
AB - 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.
KW - Aerobic
KW - Anaerobic
KW - Cardiac surgery
KW - Coronary artery bypass grafting
KW - Lactate
KW - Metabolism
KW - Oxygen consumption
KW - Pyruvate dehydrogenase
KW - Thiamine
UR - http://www.scopus.com/inward/record.url?scp=85008622690&partnerID=8YFLogxK
U2 - 10.1186/S13054-016-1245-1
DO - 10.1186/S13054-016-1245-1
M3 - Article
C2 - 27044557
AN - SCOPUS:85008622690
SN - 1364-8535
VL - 20
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 92
ER -