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Parenteral Thiamine (PT) for prevention and treatment of delirium in critically ill adults: A Systematic Review (SR)

Parenteral Thiamine (PT) for prevention and treatment of delirium in critically ill adults: A Systematic Review (SR)
Parenteral Thiamine (PT) for prevention and treatment of delirium in critically ill adults: A Systematic Review (SR)
Background
Delirium is an acute confusional state, common in critical illness and associated with cognitive decline. There is no effective pharmacotherapy to prevent or treat delirium, although it is scientifically plausible that thiamine could be effective. Thiamine studies in dementia patients are inconclusive. Aside from small numbers, all used oral administration: bioavailability of thiamine is poor; parenteral thiamine bypasses this. In the UK, parenteral thiamine is administered as a compound vitamin B and C solution (Pabrinex®). The aim of this review is to evaluate the effectiveness of parenteral thiamine (alone or in a compound solution) in preventing or treating delirium in critical illness.

Methods
We will search for studies in electronic databases (MEDLINE (Pro-Quest), EMBASE, CINAHL, LILACS, CNKI, AMED, and Cochrane CENTRAL), clinical trials registries (WHO International Clinical Trials Registry, ClinicalTrials.gov, and Controlled-trials.com), and grey literature (Google Scholar, conference proceedings, and Index to Theses). We will perform complementary searches of reference lists of included studies, relevant reviews, clinical practice guidelines, or other pertinent documents (e.g. official documents and government reports). We will consider quasi-randomised or randomised controlled trials in critically ill adults. We will include studies that evaluate parenteral thiamine versus standard of care, placebo, or any other non-pharmacological or pharmacological interventions. The primary outcomes will be the delirium core outcome set, including incidence and severity of delirium and cognition. Secondary outcomes are adapted from the ventilation core outcome set: duration of mechanical ventilation, length of stay, and adverse events incidence. Screening, data extraction, and risk of bias assessment will be undertaken independently by two reviewers. If data permits, we will conduct meta-analyses using a random effects model and, where appropriate, sensitivity and subgroup analyses to explore sources of heterogeneity.

Discussion
This review will provide evidence for the effectiveness of parental thiamine in the prevention or treatment of delirium in critical care. Findings will contribute to establishing the need for a multicentre study of parenteral thiamine in the prevention and treatment of critical care delirium.
1073-449X
Mckenzie, C. A.
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Mumin, M. A.
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Page, V.
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Hadfield, D.
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Spronk, P. E.
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Hopkins, P.
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Strain, D.
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Ostermann, M.
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Cunningham, E.
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Cape, A.
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Slooter, A.
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McAuley, D. F.
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Blackwood, B.
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Mckenzie, C. A.
ec344dee-5777-49c5-970e-6326e82c9f8c
Mumin, M. A.
3b0ad2ea-ecde-48c0-b9cc-2461c02afff2
Page, V.
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Hadfield, D.
7087d730-2947-4615-a08f-f673632d5ead
Spronk, P. E.
492c310b-fa77-4992-bf1b-eab87d9e42ca
Hopkins, P.
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Strain, D.
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Ostermann, M.
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Cunningham, E.
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Cape, A.
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Slooter, A.
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McAuley, D. F.
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Blackwood, B.
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Mckenzie, C. A., Mumin, M. A., Page, V., Hadfield, D., Spronk, P. E., Hopkins, P., Strain, D., Ostermann, M., Cunningham, E., Cape, A., Slooter, A., McAuley, D. F. and Blackwood, B. (2020) Parenteral Thiamine (PT) for prevention and treatment of delirium in critically ill adults: A Systematic Review (SR). American Journal of Respiratory and Critical Care Medicine, 9 (131).

Record type: Meeting abstract

Abstract

Background
Delirium is an acute confusional state, common in critical illness and associated with cognitive decline. There is no effective pharmacotherapy to prevent or treat delirium, although it is scientifically plausible that thiamine could be effective. Thiamine studies in dementia patients are inconclusive. Aside from small numbers, all used oral administration: bioavailability of thiamine is poor; parenteral thiamine bypasses this. In the UK, parenteral thiamine is administered as a compound vitamin B and C solution (Pabrinex®). The aim of this review is to evaluate the effectiveness of parenteral thiamine (alone or in a compound solution) in preventing or treating delirium in critical illness.

Methods
We will search for studies in electronic databases (MEDLINE (Pro-Quest), EMBASE, CINAHL, LILACS, CNKI, AMED, and Cochrane CENTRAL), clinical trials registries (WHO International Clinical Trials Registry, ClinicalTrials.gov, and Controlled-trials.com), and grey literature (Google Scholar, conference proceedings, and Index to Theses). We will perform complementary searches of reference lists of included studies, relevant reviews, clinical practice guidelines, or other pertinent documents (e.g. official documents and government reports). We will consider quasi-randomised or randomised controlled trials in critically ill adults. We will include studies that evaluate parenteral thiamine versus standard of care, placebo, or any other non-pharmacological or pharmacological interventions. The primary outcomes will be the delirium core outcome set, including incidence and severity of delirium and cognition. Secondary outcomes are adapted from the ventilation core outcome set: duration of mechanical ventilation, length of stay, and adverse events incidence. Screening, data extraction, and risk of bias assessment will be undertaken independently by two reviewers. If data permits, we will conduct meta-analyses using a random effects model and, where appropriate, sensitivity and subgroup analyses to explore sources of heterogeneity.

Discussion
This review will provide evidence for the effectiveness of parental thiamine in the prevention or treatment of delirium in critical care. Findings will contribute to establishing the need for a multicentre study of parenteral thiamine in the prevention and treatment of critical care delirium.

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Accepted/In Press date: 4 May 2020
Published date: 5 June 2020

Identifiers

Local EPrints ID: 477960
URI: http://eprints.soton.ac.uk/id/eprint/477960
ISSN: 1073-449X
PURE UUID: d1edaf6c-ede6-4b66-85ec-4c001a0e94fb
ORCID for C. A. Mckenzie: ORCID iD orcid.org/0000-0002-5190-9711

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Date deposited: 16 Jun 2023 17:02
Last modified: 17 Mar 2024 04:23

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Contributors

Author: C. A. Mckenzie ORCID iD
Author: M. A. Mumin
Author: V. Page
Author: D. Hadfield
Author: P. E. Spronk
Author: P. Hopkins
Author: D. Strain
Author: M. Ostermann
Author: E. Cunningham
Author: A. Cape
Author: A. Slooter
Author: D. F. McAuley
Author: B. Blackwood

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