Abstract
BackgroundThiamine 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.MethodsWe 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.ResultsSixty-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.ConclusionsThere 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 registrationclinicaltrials.gov NCT02322892, December 14, 2014Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1245-1) contains supplementary material, which is available to authorized users.
Highlights
Thiamine is a vitamin that is essential for adequate aerobic metabolism
A marker of anaerobic metabolism, is commonly seen after major cardiac surgery and multiple studies have found an association between elevated post-operative lactate levels and increased morbidity and mortality [5,6,7,8,9,10]
We included a number of additional outcomes including pyruvate dehydrogenase (PDH) measurements, global and cellular oxygen consumption, and more granular clinical outcomes including an assessment of post-operative complications
Summary
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. Over 230,000 patients in the United States undergo coronary artery bypass grafting (CABG) each year [1] Mortality in this patient population is relatively low, complications increasing both morbidity and length of stay remain significant [2,3,4]. The rise in lactate in these settings is thought to be secondary to inadequate oxygen delivery and/or a deficit in aerobic metabolism [13] The importance of this decrease in aerobic metabolism is supported by an association between low oxygen consumption and poor outcome in critically ill states including sepsis, high-risk surgery, and post-cardiac arrest patients [14,15,16]
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