Parenteral Thiamine (PT) for prevention and treatment of delirium in critical illness: A Systematic Review (SR)

McKenzie, Cathrine, Mumin, M.A., Page, Valerie J., Hadfield, D, Spronk, Peter E., Hopkins, P, Strain, David, Ostermann, Marlies, Cunningham, E., Cape, A., Slooter, A., McAuley, David F. and Blackwood, Bronagh (2020) Parenteral Thiamine (PT) for prevention and treatment of delirium in critical illness: A Systematic Review (SR). American Journal of Respiratory and Critical Care Medicine, 2021 (203), [A2887]. (doi:10.1164/ajrccm-conference.2021.203.1_MeetingAbstracts.A2887).

Abstract

Rationale Delirium is common in critical illness and has poor outcomes, including cognitive decline. Impaired glucose metabolism is proposed as the final common pathway. Thiaminedi-phosphate (TDP) is essential in glucose metabolism, TDP depletion could contribute to delirium and cognitive decline. Oral thiamine studies in dementia were inconclusive as smallnumbers and poor bioavailability, PT overcomes this. The aim of this review was to evaluate the effectiveness of PT in preventing or treating delirium in critical illness. Methods Theprotocol was registered (CRD42019118808) and published. [1] We included randomized controlled trials (RCT) in critical care that evaluated PT to treat or prevent delirium comparedwith control. Outcomes included delirium incidence and severity, and duration of mechanical ventilation. We searched electronic databases and international trial registries. Screening,data extraction and risk of bias (ROB) were were undertaken by CMcK and MM: certainty of evidence was graded by CMcK and BB. Data were reported as odds ratios (OR), 95%confidence intervals (CI) and mean difference (MD) and 95% CI. Results From 5190 citations; 23 studies selected for full text review and one included. The RCT (n=98) evaluated PTversus placebo in a post-operative population admitted to the intensive care unit (ICU).[2] The interventions were 200 mg of PT or matched placebo for 3 days. The trial reportedsignificantly lower incidence of delirium in PT group at days 1 and 2, but not day 3 (low certainty of evidence); and no difference in days receiving mechanical ventilation (very lowcertainty of evidence) (Table 1). The study reported no other outcomes of interest for SR. Conclusion On the basis of an RCT in post-operative critical care, there is insufficientevidence to recommend PT for preventing or treating delirium in critical illness. Further work should focus on establishing efficacy in critical illness. 1.McKenzie, C. A. et al. (2020)‘Parenteral thiamine for prevention and treatment of delirium in critically ill adults : a systematic review protocol’. Systematic Reviews 9:131https://doi.org/10.1186/s13643-020-01380-z 2. Moslemi, R. et al. (2020) ‘Thiamine for Prevention of Postoperative Delirium in Patients Undergoing Gastrointestinal Surgery: A Randomized Clinical Trial’,JResPharmPrac., 9(1) http://dx.doi.org/10.4103/jrpp.JRPP_19_124.

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Contributors

Author: Cathrine McKenzie

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