Effect of Oral Versus Intramuscular Vitamin D Replacement on Oxidative Stress and Outcomes in Traumatic Mechanical Ventilated Patients Admitted to Intensive Care Unit

Abstract

Background: This study aimed to evaluate the safety and efficacy of 2 forms of vitamin D supplementation on oxidative stress and weaning from the ventilator in patients with traumatic injury and vitamin D deficiency. Methods: Seventy-two patients were randomly divided into 3 groups: receiving 50,000 IU pearl cholecalciferol daily for 6 days, 1 intramuscular injection of 300,000 IU of cholecalciferol, or a control group that did not receive any supplement. Duration of mechanical ventilation, body composition, and biochemical biomarkers were measured before and after the intervention. Result: At the end of the study, the mean serum 25(OH)D increased in the intervention groups compared with the control group (P < .05). The interleukin 6, erythrocyte sedimentation rate, C-reactive protein levels, Sequential Organ Failure Assessment score, duration of mechanical ventilation, and length of intensive care unit admission significantly decreased; however, total antioxidant capacity concentration did not differ significantly between the 2 intervention groups. Among the body composition variables, extracellular water ratio changes were statically different in oral vitamin D group compared with the control group (P = .001). No side effects were reported with the supplements. Conclusions: Vitamin D administration improved clinical signs and biochemical biomarkers in a small group of patients with traumatic injury. Well-designed multicenter clinical studies with longer intervention duration are necessary for this field.

Vitamin D supplementation and the outcomes of critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials

“…Moreover, 142 studies were found to be irrelevant after the title and abstract were screened, and 19 studies were found to be irrelevant after the full text was screened. Eventually, 9 RCTs [19][20][21][22][23][24][25][26][27] were included in this meta-analysis ( Fig. 1, Appendix 1).…”

“…Only one RCT 25 was a multicenter study (Table 1). Four studies 20,22,23,25 were conducted in the United States, three 24,26,27 were in Iran, and two 19,21 in Austria. Overall, these nine RCTs included a total of 1,640 critically ill patients.…”

“…Several randomized controlled trials (RCTs) were conducted to investigate the effects of vitamin D supplementation on the outcomes of critically ill patients. However, their results are conflicting [19][20][21][22][23][24][25][26][27][28] . Some studies showed that vitamin D supplementation demonstrated positive effects by decreasing the length of hospital stay 23 , duration of mechanical ventilation (MV) 26,27 , and mortality rate 24,27 .…”

“…However, their results are conflicting [19][20][21][22][23][24][25][26][27][28] . Some studies showed that vitamin D supplementation demonstrated positive effects by decreasing the length of hospital stay 23 , duration of mechanical ventilation (MV) 26,27 , and mortality rate 24,27 . However, some studies 11,20,21,25,29,30 reported no change in the outcomes of critically ill patients.…”

“…Even 2 meta-analyses, the included studies of which were published before 2017 31,32 , provided inconsistent findings. Since 2017, four more RCTs [24][25][26][27] have reported their findings. Therefore, we conducted an updated meta-analysis of RCTs to assess the association between vitamin D supplementation and the outcomes of critically ill patients.…”