CHEST Guidelines-Thiamine

Thiamine_chest
Pdf Summary
The document discusses literature and studies about the use of probiotics and thiamine in critical care settings, particularly for critically ill children and patients with sepsis. Probiotics have been shown to potentially benefit conditions such as antibiotic-associated diarrhea, Clostridium difficile-associated diarrhea, and other infections in the ICU, including necrotizing enterocolitis in preterm neonates. However, studies specifically assessing their efficacy in critically ill children are limited. Some trials suggest their potential in reducing infections and colonization by certain pathogens, but more extensive and well-structured research is needed to establish their role definitively.<br /><br />Furthermore, the document addresses the role of thiamine in severe sepsis. An editorial comments on a study by Marik et al., which evaluated the combination of hydrocortisone, vitamin C, and thiamine in treating sepsis, noting a reduction in organ failure and mortality. The commentary argues for considering thiamine an essential component due to its role in energy metabolism and reducing oxidative damage. Thiamine deficiency is common in sepsis, often due to increased metabolic demand, leading to potential energy depletion in cells. It has been shown to reduce lactate levels and mortality in septic patients with deficiencies and may help mitigate septic renal dysfunction. <br /><br />Thiamine is a crucial cofactor in energy metabolism. Its deficiency, common in critically ill patients, can lead to metabolic disturbances. While thiamine supplementation shows promise, particularly during the hypermetabolic state of sepsis, the overall effectiveness of the combination, as well as each component, warrants further rigorous investigation. The document concludes that both probiotics and thiamine could offer substantial benefits in ICU settings, but more comprehensive studies are essential to confirm their efficacy.
Keywords
probiotics
thiamine
critical care
sepsis
critically ill children
antibiotic-associated diarrhea
necrotizing enterocolitis
energy metabolism
lactate levels
ICU