Intravenous thiamine is associated with increased oxygen consumption in critically ill patients with preserved cardiac index.
BACKGROUND
Oxygen consumption may be impaired in critically ill patients.


OBJECTIVE
To evaluate the effect of intravenous thiamine on oxygen consumption ([Formula: see text]o2) in critically ill patients.


METHODS
This was a small, exploratory open-label pilot study conducted in the intensive care units at a tertiary care medical center. Critically ill adults requiring mechanical ventilation were screened for enrollment. Oxygen consumption ([Formula: see text]o2) and cardiac index (CI) were recorded continuously for 9 hours. After 3 hours of baseline data collection, 200 mg of intravenous thiamine was administered. The outcome was change in [Formula: see text]o2 after thiamine administration.


RESULTS
Twenty patients were enrolled and 3 were excluded because of incomplete [Formula: see text]o2 data, leaving 17 patients for analysis. There was a trend toward increase in [Formula: see text]o2 after thiamine administration (16.3 ml/min, SE 8.5; P = 0.052). After preplanned adjustment for changes in CI in case of a delivery-dependent state in some patients (with exclusion of one additional patient because of missing CI data), this became statistically significant (16.9 ml/min, SE 8.6; P = 0.047). In patients with average CI greater than our cohort's mean value of 3 L/min/m(2), [Formula: see text]o2 increased by 70.9 ml/min (±16; P < 0.0001) after thiamine. Thiamine had no effect in patients with reduced CI (< 2.4 L/min/m(2)). There was no association between initial thiamine level and change in [Formula: see text]o2 after thiamine administration.


CONCLUSIONS
The administration of a single dose of thiamine was associated with a trend toward increase in [Formula: see text]o2 in critically ill patients. There was a significant increase in [Formula: see text]o2 in those patients with preserved or elevated CI. Further study is needed to better characterize the role of thiamine in oxygen extraction. Clinical trial registered with www.clinicaltrials.gov (NCT01462279).
1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine.
Katherine M
KM
Berg
Shiva
S
Gautam
Justin D
JD
Salciccioli
Tyler
T
Giberson
Brian
B
Saindon
Michael W
MW
Donnino
D000293:Adolescent; D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007275:Injections, Intravenous; D007362:Intensive Care Units; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D010101:Oxygen Consumption / Q000187:drug effects*; D010865:Pilot Projects; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013831:Thiamine / Q000008:administration & dosage*; D016896:Treatment Outcome; D016276:Ventricular Function / Q000187:drug effects*; D014803:Vitamin B Complex / Q000008:administration & dosage; D055815:Young Adult
D014803:Vitamin B Complex; D010100:Oxygen; D013831:Thiamine
o2; oxygen consumption; oxygen extraction; thiamine