Thiamine for prevention of postoperative delirium in patients undergoing gastrointestinal surgery: A randomized clinical trial

Moslemi, Rohollah; Khalili, Hossein; Mohammadi, Mostafa; Mehrabi, Zeinab; Mohebbi, Niayesh

doi:10.4103/jrpp.jrpp_19_124

Cited by 11 publications

(14 citation statements)

References 37 publications

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“…73 In a randomized study of patient undergoing gastrointestinal surgery, thiamine administration (200 mg/ daily for 3 days) was associated with significant reduction in post-operative delirium. 74 It should be noted that the increased secretion of IL-17 by TH17 cells contributes to the proinflammatory cytokine storm characteristic of COVID-19. 75 In an ex-vivo study, Vatsalya et al demonstrated that 200 mg thiamine/day decreased TH17 cell activation.…”

Section: Thiamine and Covid-19mentioning

confidence: 99%

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

Kory

Meduri

Iglesias

et al. 2020

J Intensive Care Med

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In December 2019, COVID-19, a severe respiratory illness caused by the new coronavirus SARS-CoV-2 (COVID-19) emerged in Wuhan, China. The greatest impact that COVID-19 had was on intensive care units (ICUs), given that approximately 20% of hospitalized cases developed acute respiratory failure (ARF) requiring ICU admission. Based on the assumption that COVID-19 represented a viral pneumonia and no anti-coronaviral therapy existed, nearly all national and international health care societies’ recommended “supportive care only” avoiding other therapies outside of randomized controlled trials, with a specific prohibition against the use of corticosteroids in treatment. However, early studies of COVID-19-associated ARF reported inexplicably high mortality rates, with frequent prolonged durations of mechanical ventilation (MV), even from centers expert in such supportive care strategies. These reports led the authors to form a clinical expert panel called the Front-Line COVID-19 Critical Care Alliance (www.flccc.net ). The panel collaboratively reviewed the emerging clinical, radiographic, and pathological reports of COVID-19 while initiating multiple discussions among a wide clinical network of front-line clinical ICU experts from initial outbreak areas in China, Italy, and New York. Based on the shared early impressions of “ what was working and what wasn’t working,” the increasing medical journal publications and the rapidly accumulating personal clinical experiences with COVID-19 patients, a treatment protocol was created for the hospitalized patients based on the core therapies of methylprednisolone, ascorbic acid, thiamine, heparin and co-interventions (MATH+). This manuscript reviews the scientific and clinical rationale behind MATH+ based on published in-vitro, pre-clinical, and clinical data in support of each medicine, with a special emphasis of studies supporting their use in the treatment of patients with viral syndromes and COVID-19 specifically. The review concludes with a comparison of published multi-national mortality data with MATH+ center outcomes.

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Section: Thiamine and Covid-19mentioning

confidence: 99%

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

Kory

Meduri

Iglesias

et al. 2020

J Intensive Care Med

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“…On day 3, delirium occurred in three (6.2%) and eight (16.7%) patients in the thiamine and placebo groups, respectively. Secondary outcomes of the study: mean morphine equivalent dose and duration of mechanical ventilation were not statistically significantly different between groups [39].…”

Section: Resultsmentioning

confidence: 80%

“…In the clinical trials identified by us, only the IRCT20190224042815N1 trial showed a beneficial effect of thiamine use as a preventive agent for delirium among patients undergoing gastrointestinal surgery in a critical condition [39]. Other studies in which this was a primary or secondary outcome showed no significant statistical difference between the thiamine (alone or in combination) and placebo groups [37,40,41].…”

Section: Discussionmentioning

confidence: 94%

“…Firstly, there is no standard dosing schema for thiamine. Andersen et al administered thiamine before and after surgery, Moslemi et al used a dose of 200 mg once daily for three days, while Nakamura et al applied 200 mg thiamine three times daily for a duration of seven days [39,40]. In the study by Sevransky et al, a dose of 100 mg thiamine was administered in combination with vitamin C and hydrocortisone [41].…”

Section: Discussionmentioning

confidence: 99%

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Delirium in Critical Illness Patients and the Potential Role of Thiamine Therapy in Prevention and Treatment: Findings from a Scoping Review with Implications for Evidence-Based Practice

Lange¹,

Mędrzycka‐Dąbrowska

Friganović

et al. 2021

IJERPH

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Introduction: Thiamine is a water-soluble vitamin and is necessary for energy metabolism. Critically ill patients are at particular risk of developing thiamine deficiency and related complications. One of the complications that can occur is delirium. Delirium is a disorder that affects the body’s response to treatment, length of stay in the ward, mortality, long-term cognitive impairment, and significantly increases treatment costs. In addition, studies show that delirium medication is more effective in preventing than in treating delirium. Given its low cost, availability, and minimal risk of side effects, thiamine supplementation could prove to be a relevant strategy in the prevention and treatment of delirium. Methods: PubMed, Cochrane Library, Ovid, and ClinicalTrials.gov databases were searched using relevant keywords that focus on the use of thiamine to prevent or treat delirium in critically ill patients. Results: Seven articles were included in the analysis. Conclusion: The small number of studies and considerable heterogeneity prevent conclusions supporting the use of thiamine as an adjuvant in the prevention and treatment of delirium among critically ill patients. There is a need for high-quality, large-scale randomized clinical trials to confirm the beneficial effects of thiamine in the prevention and treatment of delirium.

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“…[42][43][44] Single randomized trials favoring pharmacotherapy to prevent postoperative delirium include parecoxib in joint replacement, methylprednisolone in hip fracture, intravenous acetaminophen in cardiac surgery, aripiprazole in neurosurgery, and thiamine in gastrointestinal surgery, but require replication before widespread adoption. [45][46][47][48][49] Thus, the current evidence does not support routine use of second-generation antipsychotics or haloperidol for the prevention of postoperative delirium; multicomponent nonpharmacologic prevention interventions, therefore, remain the optimal strategy to decrease the risk of postoperative delirium.…”

Section: Pharmacologic Delirium Preventionmentioning

confidence: 99%

Postoperative Delirium

Wong¹,

Maltzahn²

2021

Can Journ Gen Int Med

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There is strong evidence to support prevention of postoperative delirium through comprehensive geriatric assessment and multicomponent nonpharmacologic interventions. Risk assessment must be accompanied by communication of the risk to the patient, caregivers, and perioperative interdisciplinary team to engage all in evidence-based prevention interventions. However, once postoperative delirium has developed, efforts should be focused on prevention of short- and long-term adverse effects. RÉSUMÉDes données probantes solides appuient la prévention du délire postopératoire en recourant à une évaluation gériatrique complète et à des interventions non pharmacologiques à plusieurs composantes. L’évaluation des risques doit s’accompagner d’une communication du risque au patient, aux soignants et à l’équipe interdisciplinaire périopératoire afin que tous participent aux interventions de prévention fondées sur des données probantes. Toutefois, une fois que le délire postopératoire s’est installé, les efforts doivent être axés sur la prévention des effets indésirables à court et à long terme.

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Thiamine for prevention of postoperative delirium in patients undergoing gastrointestinal surgery: A randomized clinical trial

Cited by 11 publications

References 37 publications

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

Delirium in Critical Illness Patients and the Potential Role of Thiamine Therapy in Prevention and Treatment: Findings from a Scoping Review with Implications for Evidence-Based Practice

Postoperative Delirium

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