Vitamin D Status and Supplementation in Adult Patients Receiving Extracorporeal Membrane Oxygenation

Abstract

The prevalence of vitamin D deficiency in critical illness is known to be high and associated with adverse clinical outcomes. Patients receiving extracorporeal membrane oxygenation (ECMO) may be at increased risk of vitamin D deficiency due to high severity of acute illness. Challenges with drug dosing in ECMO patients are recognised due to increased volume of distribution and drug absorption to circuit components. To describe the prevalence of vitamin D deficiency in ECMO patients and the effect of intramuscular dosing of cholecalciferol on levels of vitamin D metabolites, and to compare these data with intensive care unit (ICU) patients not receiving ECMO, two prospective studies were performed sequentially: an observational study of 100 consecutive ICU patients and an interventional study assessing effects of intramuscular cholecalciferol in 50 ICU patients. The subgroup of patients who required ECMO support in each of these studies was analysed and compared to patients who did not receive ECMO. Twenty-four ECMO patients, 12 from the observational study and 12 from the interventional study (who received intramuscular cholecalciferol) were studied-21/24 (88%) ECMO patients were vitamin D deficient at baseline compared to 65/126 (52%) of non-ECMO patients (P=0.006). Of the 12 ECMO patients who received cholecalciferol, six patients (50%) achieved correction of deficiency compared to 36/38 (95%) non-ECMO patients (P=0.001). The prevalence of vitamin D deficiency is higher in ECMO patients compared to other critically ill adults. Correction of deficiency with single dose cholecalciferol is not reliable; higher or repeated doses should be considered to correct deficiency.

The pathophysiology of SARS-CoV-2: A suggested model and therapeutic approach

“…It is also noteworthy that vitamin C levels are also commonly depleted in patients with sepsis and ARDS [ 314 , 315 ] and several authors have reported downregulation of NF-κB following its administration [ 316 , 317 ]. Vitamin D is also severely depleted in many patients with sepsis and ARDS [ 318 , 319 ] and dietary supplementation with this molecule also results in significant inhibition of NF-κB [ [320] , [321] , [322] , [323] , [324] ]. There is also growing interest in vitamin D supplementation in treating COVID-19 following the publication of a paper reporting severely depleted levels of this vitamin in patients with COVID-19 pneumonia and COVID-19 ARDS [ 325 ].…”

Nutrition during extracorporeal life support: A review of pathophysiological bases and application of guidelines

“…Additionally, a single loading dose seems to be insufficient to restore vitamin D bioavailability. 78,79 Current guidelines recommend the administration of 500.000 IU of cholecalciferol within the first week in patients with severe deficiency. The COVID-19 pandemic is a new challenge for ICU nutrition on a global level.…”

“…Given that these patients are the most severely ill in the ICU, it is not surprising that ECLS patients have higher rates of severe vitamin D deficiency. Additionally, a single loading dose seems to be insufficient to restore vitamin D bioavailability 78,79 . Current guidelines recommend the administration of 500.000 IU of cholecalciferol within the first week in patients with severe deficiency 7 …”

Preventing the development of severe COVID-19 by modifying immunothrombosis

“…The weight of evidence suggests that severe vitamin (Vit) D deficiency is a common occurrence in intensive care unit ( ICU ) patients with sepsis, septic shock and ARDS [ 253 , 254 ]. In addition, several authors have reported positive correlations between Vit D levels and increasing illness severity [ [253] , [254] , [255] ]. The extent of Vit D depletion also appears to be predictive of increased mortality reviewed [ 256 ].…”