IV Thiamine fails again in Septic Shock

Miyamoto, Yoshihisa, Aso, Shotaro et el published results of retrospective Cohort study in critical care medicine.

With ongoing covid 19, all possible medications are being tried for which they were not originally intended. Similarly several medications have been tried in septic shock but failed. Recent trial was discussed here. Given there was a lot of interest in thiamine in septic shock, It’s off label use has skyrocketed.

STUDY

It was a retrospective study conducted in tertiary centers of Japan. Patients of septic shock  Will require norepinephrine and also received thiamine 100 mg  were identified. These were managed with patients who did not receive thiamine.

MAIN RESULTS

Total of 68,571 eligible patients were studied, including 18,780 and 49,791 patients in the thia-
mine and control groups, respectively. The 28-day  mortality were 19.2% (3,609/18,780) and 17.8% (8,845/49,791)  in the thiamine and control groups, respectively.

After adjusting for  confounders by inverse probability of treatment weighting, no sig-
nificant differences were observed between the two groups.

DISCUSSION

“The art of medicine consists of amusing the patient while nature cures the disease.” ― Voltaire

This famous quote from 17th century philosopher still stands true.  First duty of physician is “primum non nocere”. Do no harm.  It is very important not to use any medication which has no potential benefit.

Thiamine has repeatedly failed in septic shock, including observational studies, randomized trials and  meta-analysis. However, every few years it is brought to life by one or another physician.

This is especially true in setting of New disease Such as Covid 19.

Hopefully, Common sense we will prevail and we will stop using medications based on anecdotal evidence or celebrity endorsement.

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