Comparison of Variable Thiamine Dosing Strategies in Critically Ill Patients with Septic Shock

Thiamine has been utilized for metabolic resuscitation in septic shock (SS), but optimal thiamine dosing remains unknown. The purpose of this study was to assess variable thiamine dosing in critically ill patients with SS.

This retrospective, cohort study included SS patients on high-dose (HD >500 mg/d) or low-dose (LD ≤500 mg/d) thiamine for 72 hours without an alternative indication. The primary endpoint was to evaluate the impact of HD or LD thiamine on vasopressor alive-and-free days.

The analysis included 87 patients who received HD thiamine and 65 patients who received LD thiamine. The mean thiamine dose was 1.485.6 mg/d in the HD group and 323.8 mg/d in the LD group. The HD group more often utilized 30 mL/kg of intravenous fluid resuscitation (89% vs. 82%) and hydrocortisone at 300 mg/d (69% vs. 58%). Results found vasopressor alive-and-free days to be 17.13 in the HD group and 14.84 days in the LD group. No statistically discernible differences were found between the groups in 28-day mortality, intensive care unit length of stay, vasopressor free days, percentage decrease in lactate or serum creatinine, need for additional vasopressor(s), or hospital length of stay, although some of the observed differences are believed to be clinically meaningful.

Patients with SS who received HD thiamine had no statistically discernible differences in vasopressor alive-and-free days or intensive care unit length of stay as compared to the LD thiamine group. Larger, prospective, randomized trials are warranted to further investigate HD thiamine in critically ill patients with SS.