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

被引：37

作者：

Andersen, Lars W. ^{[1
,2
,3
]}

Holmberg, Mathias J. ^{[1
,3
]}

Berg, Katherine M. ^{[4
]}

Chase, Maureen ^{[1
]}

Cocchi, Michael N. ^{[1
,5
]}

Sulmonte, Christopher ^{[1
]}

Balkema, Julia ^{[1
]}

MacDonald, Mary ^{[1
]}

Montissol, Sophia ^{[1
]}

Senthilnathan, Venkatachalam ^{[6
]}

Liu, David ^{[6
]}

Khabbaz, Kamal ^{[6
]}

Lerner, Adam ^{[7
]}

Novack, Victor ^{[8
,9
]}

Liu, Xiaowen ^{[1
]}

Donnino, Michael W. ^{[1
,4
]}

机构：

[1] Beth Israel Deaconess Med Ctr, Ctr Resuscitat Sci, Dept Emergency Med, 330 Brookline Ave, Boston, MA 02215 USA

[2] Aarhus Univ Hosp, Dept Anesthesiol, Norrebrogade 44, DK-8000 Aarhus C, Denmark

[3] Aarhus Univ Hosp, Res Ctr Emergency Med, Norrebrogade 44, DK-8000 Aarhus C, Denmark

[4] Beth Israel Deaconess Med Ctr, Div Pulm & Crit Care, Dept Med, 330 Brookline Ave, Boston, MA 02215 USA

[5] Beth Israel Deaconess Med Ctr, Div Crit Care, Dept Anesthesia Crit Care, 330 Brookline Ave, Boston, MA 02215 USA

[6] Beth Israel Deaconess Med Ctr, Div Cardiothorac Surg, Dept Surg, 330 Brookline Ave, Boston, MA 02215 USA

[7] Beth Israel Deaconess Med Ctr, Dept Anesthesia, 330 Brookline Ave, Boston, MA 02215 USA

[8] Soroka Univ, Med Ctr, Clin Res Ctr, POB 151, IL-84965 Beer Sheva, Israel

[9] Ben Gurion Univ Negev, Fac Hlth Sci, POB 151, IL-84965 Beer Sheva, Israel

来源：

CRITICAL CARE | 2016年 / 20卷

基金：

美国国家卫生研究院;

关键词：

Thiamine; Lactate; Cardiac surgery; Coronary artery bypass grafting; Pyruvate dehydrogenase; Aerobic; Anaerobic; Metabolism; Oxygen consumption; PYRUVATE-DEHYDROGENASE COMPLEX; MECHANICALLY VENTILATED PATIENTS; MICROPLATE-BASED ACTIVITY; ARTERY-BYPASS-SURGERY; LACTATE LEVELS; INTRAVENOUS THIAMINE; OXYGEN-CONSUMPTION; SURGICAL-PATIENTS; BLOOD LACTATE; GRAFT-SURGERY;

D O I：

10.1186/s13054-016-1245-1

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.

引用

页数：11

共 49 条

[1] Postoperative Lactate Levels and Hospital Length of Stay After Cardiac Surgery [J].