Vitamin D Supplementation in Mechanically Ventilated Patients in the Medical Intensive Care Unit

Abstract

Background: The utility of vitamin D (VITD) supplementation during critical illness and whether it may alter outcomes, including mortality and ventilator-free days, is unclear. We performed a retrospective cohort study in a generalizable population to investigate this question. Methods: We included all mechanically ventilated adults admitted to the medical intensive care unit (ICU) service at a tertiary center from 2009 to 2012 who were in the ICU for at least 72 hours. Patients were grouped as having received or not received VITD at any time during the first 7 days of their ICU stay, and we adjusted for the following covariates with multivariable analyses: simplified acute physiology score, age, gender, admission diagnosis, race/ethnicity, admission season, admission day of the week, and VITD supplementation prior to admission. Results: Among the 610 included patients, 281 received VITD, and 329 did not. There were no differences in outcomes between these groups. However, we did find significantly more ventilator-free days (21.0±2.6 [adjusted mean days±standard error] vs 17.6±2.4, P=0.04) and ICU-free days (18.5±2.5 vs 16.3±2.3, P=0.03) in patients who were taking VITD prior to admission (n=91) vs those who were not (n=519). No patients who were taking VITD before admission died vs 34.5% of those who were not (estimated odds ratio=4.9×10 −7 , 95% CI=3.1×10 −7 to 7.5×10 −7 , P<0.0001). Conclusion: These results suggest that VITD supplementation during critical illness may not provide benefit and that further research investigating potential supplementation in ambulatory patients at high risk of ICU admission (eg, severe underlying chronic disease) is warranted. (JPEN J Parenter Enteral Nutr. 2019;43:1037-1043

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

“…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.…”

Supplementation with vitamin D in the COVID-19 pandemic?

“… 55 Interestingly, another study conducted in a critical illness setting showed that although taking vitamin D during ICU hospitalization was not beneficial, patients who took vitamin D supplements before ICU admission experienced more ICU-free and ventilator-free days, indicating the importance of vitamin D supplementation in patients who may eventually need to be admitted to ICU. 56 In an RCT conducted in 2016 in the United States, 30 patients in the ICU who were receiving mechanical ventilatory support were assigned to 1 of 3 groups: (1) placebo (n = 10), (2) 50 000 IU/d vitamin D3 for 5 sequential days (ie, total dose, 250 000 IU; n = 9), and (3) 100 000 IU/d vitamin D3 for 5 sequential days (ie, total dose, 500 000 IU; n = 11). 57 In this study, administration of high doses of vitamin D3 safely increased the plasma concentration of 25(OH)D to the sufficient range (mean ± SD plasma 25(OH)D levels, 45.7 ± 19.6 ng/mL and 55.2 ± 14.4 ng/mL after the 250 000 IU and 500 000 IU vitamin D3 supplementations, respectively).…”

Are Adequate Vitamin D Levels Helpful in Fighting COVID-19? A Look at the Evidence

“…Vitamin D deficiency has been described to be associated with the development of acute respiratory failure [72,73], with type II alveolar cells displaying an upregulation of multiple genes associated with cell growth, differentiation and response to wounding in response to vitamin D treatment [72]. In critically ill patients with severe vitamin D deficiency, administration of high dose vitamin D was found to reduce hospital mortality [74] and increase ventilator-free days among mechanically-ventilated patients [75]. Besides its role in modulating the RAS and suppressing cytokine storm in ARDS, calcitriol has also been thought to attenuate lung injury by increasing surfactant production, stimulating epithelial repair, and inhibiting alveolar cell apoptosis [76,77].…”