Thiamine Supplementation in the Critically Ill Case Study

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Vitamin B1 (thiamine) is an essential component of enzymes that aid in metabolism (Manzanares & Hardy, 2011). It is, therefore, a basic component in life since people must metabolize to live. It is also a component of the membranes in living organisms that aid in structure formation. Thiamine is required in the body of people to replace the depreciating amount since its half-life is short. In addition to this, it is also crucial to note that thiamine stores are less and requires efficient supply. People who are unable to get vitamin B1 through feeding, such as the critically ill, receive its supplement through injection. ICU physicians must remain conscious about vitamin B1 deficiency and learn about posology, and administer time for the same. To facilitate their alertness, I will make a summary of vitamin B1 characters and assess the present evidence on the status of Thiamine and its supplementation for patients who are seriously ill in various populations (Manzanares & Hardy, 2011).

It requires the formation of a strong foundation to deliver the necessity of vitamin B1 supplementation. Therefore, scientists conducted a study intending to evaluate this supplementation. This study was conducted in randomly picked incidents of the critically ill in the world. The study investigated the levels of thiamine in those who are critically ill with different problems. The problems investigated included severe sepsis, pediatric, heart failure, burns and trauma, renal failure, cardiac surgery, systemic inflammation, Wernicke encephalopathy, and refeeding syndrome. The sample involved in this study originated from different places such as Germany, Australia, and Brazil among others. This study, therefore, ensured randomization hence the result was impartial. This study also provided ready data since files were available in the operating organizations. The study was conclusive because it had provided and incorporated a diversity of critical issues.

The study on severe sepsis and systemic inflammation revealed several issues. The cohort study in Australia revealed that surviving and dying patients who had not received thiamine during admission had approximately equal levels of thiamine. For severe sepsis, patients with liver dysfunction portrayed a correlation that was positive. Patient with normal liver functioning, however, had a correlation that was significantly negative. The study conducted in the pediatric intensive care unit (PICU) showed deficiency of thiamine that had not been known in children. It was later noted that there was a high prevalence of vitamin B1 deficiency in children during admission to PICU. On burns and traumas, metabolism of lactate in patients burnt critically would influence the effective use of tailored diet. The other result of the study is that congestive heart failure (CHF) patients incur a relationship between urine excretion and deficiency of vitamin B1. A study conducted on patients of cardiac surgery showed a reduction in the levels of vitamin B1. The German study for patient with renal failure found that supplementing thiamine routinely together with appropriate diet helps to normalize vitamin B1 level. Lastly, chronically alcoholic patients with Wernicke encephalopathy should receive a higher dose of vitamin B1 supplement to allow the proper amount in the brain (Manzanares & Hardy, 2011).

The study conducted above was random. It has incorporated varieties of critical incidents, spread of geographic area and facility allocation. These warrants the viability of data collected and prevents use of biased data to make conclusions. Information used in this case has minimal probability of mistakes. It also delivers a worldwide perspective to ensure that information is viewed in a broad way. However, randomization could also lead to inappropriate comparisons when information comes from different places with different policies and strategies of ICU performance.

There are consistent follow up of research issue. These follow ups respond to the character of research. They derive questions which triggered researcher to research in search of answers. For instance, the research conducted by Seear and others was followed up ten years later by Lima. These follow ups enhanced more discoveries and arose more questions.

Despite the successes, negative results are prevalent in the studies performed in the research. For instance, in severe sepsis study conducted on 30 patients, data revealed that 3 were deficient of vitamin B1 during admission while a similar number of patients developed deficiency after 3 days. These results were not coherent because the author failed to provide an explanation for it. For this data, listing and mentioning of the observation is necessary because it triggers more scientists to account for incidences of this kind (Manzanares & Hardy, 2011).

The study carried out by researchers was valid. It enumerated an issue and made progress by providing evidence from different regions and incidents. It also achieves its aim by ensuring that clinicians are directed and equipped during performances. This study is also randomized because it incorporates varieties of randomized factors such as geographical differences and diversities of incident. We cannot describe the research as blinded because it had a leading hypothesis to direct it. However, I would state that it lacked a proper discussion to join all the researches. The follow up of the study and the researches performed were incomplete. The results were not organized logically to form a logical conclusion. It is also open that there were no discussions and coherent conclusions. Additionally, the study portrays some conflicting variables such as in the Australian presentation showing indifferences in the levels of vitamin B1. The information derived from this study might influence the perspective in which clinicians perceive the treatment of critically ill patient. This study could make clinicians more sensitive when checking for vitamin B1 deficiency and during its supplementation. This is because it emphasizes on the risk factor related to failure and dosage of supplementation. To achieve quality results, I would have designed a research with similar ideas but a continuous flow of ideas, discussions and comprehensive conclusions supported by evidence.

Control event rate refers to the measure of the rate in response of supplemented thiamine in a chosen group of people. On the other hand, experimental event rate is the rate in response of a non-control group in a setup. Lastly, risk difference (absolute risk reduction) is a reduction hazard of an event related to a control event. However, these aspects cannot be measured because of lack reliable and complete data from the field.

The aspects of research require proper follow up, and logical arrangement of ideas to warrant appropriate and accurate results. Since vitamin B1 is a potential life threat when deficient, it is vital to investigate its routes in the biological processes. Otherwise, ignorance to thiamine deficiency could lead to unexpected brain damage. I, therefore, recommend the need of follow up and timely initiation of proper treatment according to ESPEN guidelines. With these strategies in place, the critically ill will receive the care they deserve.

Reference

Manzanares, V. & Hardy, G. (2011). Thiamine supplementation in the critically ill. Lippincott Williams & Wilkins, 14(1), 37-56.

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