- High dose vitamin D improves total serum antioxidant capacity and ICU outcome in critically ill patients - A randomized, double-blind clinical trial
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High dose vitamin D improves total serum antioxidant capacity and ICU outcome in critically ill patients - A randomized, double-blind clinical trial
European Journal of Integrative Medicine Volume 42, February 2021, https://doi.org/10.1016/j.eujim.2020.101271
Mohammad Sistanizad a b, Mehran Kouchek c, MirMohammad Miri c, Sara Salarian c, Seyedpouzhia Shojaei c, Fatemeh Moeini Vasegh a, Hossein Seifi Kafshgari d, Roja Qobadighadikolaei eAbstract
Introduction
Mechanical ventilation can increase the rate of free radicals in the systemic circulation due to its effect on the inflammatory system. Previous research has suggested that vitamin D has antioxidant properties. This study aimed to evaluate the effect of vitamin D on total Antioxidant Capacity (TAC) and its relationship with ICU patients' outcomes.Methods
In this prospective randomized clinical trial, 36 ventilated ICU patients were randomly allocated to receive either a single intramuscular vitamin D 300,000 IU or its placebo. Serum Vitamin D and TAC were measured before and on day 7 after the intervention. Clinical Pulmonary Infection Score (CPIS) and sequential organ failure assessment (SOFA) scores were measured daily for seven days and on days 14 and 28.Results
Thirty patients completed the study. The results show that injection of vitamin D leads to a significant increase in the- mean changes of vitamin D level on the seventh day of the study (+3.5±1.3 vs -0.4±0.2 P=0.00) and
- TAC levels (3.2±3.9 vs -2.0±2.6 P=0.00.
- ICU length of stay was 18.3±8.4 and 25.4±6.6 days in the intervention and placebo arms of the study.
Twelve patients in the placebo group and 5 in the vitamin D group died within the 28 day study period. The duration of mechanical ventilation was 15.7± 9.3 vs. 22.6± 9.1 days in vitamin D and placebo arms, respectively.
Conclusion
Administration of vitamin D may increase TAC levels and decrease the length of stay and duration of mechanical ventilation in ICU patients.Introduction
Vitamin D is a fat-soluble vitamin acting by its metabolite 1,25-dihydroxy vitamin D3, and it has more substantial effects on various metabolic activities than initially anticipated [1], [2], [3]. A multitude of new studies has shown numerous biological effects of vitamin D on the modulation of bone as well as muscle metabolism. In addition to these known effects, vitamin D also plays an important role in immune function and cardiovascular modulation effects which may be required for the evolution of recovery from critical illness [2,[[4], [5], [[6]].Vitamin D deficiency is widespread among all age groups. Furthermore, almost one billion adults in the world are vitamin D deficient [7]. Moreover, Vitamin D deficiency has been detected in 40% to 70% of critically ill patients [2,[[8], [9], [[10]].
Multiple studies have also indicated that vitamin D deficiency can cause greater illness severity, morbidity, and mortality [11], [12], [13]. The daily recommended low-dose administration of vitamin D (400 to 4000 IU daily) cannot quickly reinstate 25 hydroxyvitamin D levels in acutely ill patients [14], besides that recent studies have also shown that higher bolus doses of vitamin D (single loading dose from 50,000 to 600,000 IU) can restore 25 hydroxyvitamin D levels rapidly and safely in the acutely ill patients [15], [16], [17], [18]. However, the correlation between vitamin D deficiency and its replacement, the severity of the disease, mortality, and length of hospital stay in critically ill patients remains controversial. Some studies revealed no correlation [9,10,19]. In contrast, several meta-analyses have also reported that patients with low vitamin D levels have more extended ICU stays and higher morbidity and mortality [8,13,20]. Also, the relationship between vitamin D deficiency and the severity of the disease has been demonstrated in some other studies. However, vitamin D's connection to prolonged duration of ICU stay, increased prevalence of renal failure, and sepsis has not been confirmed [10,18,19].
Moreover, a current study showed that vitamin D acts as an antioxidant throughout the expression of multiple molecules included in the antioxidant defense system such as glutathione (GSH), superoxide dismutase (SOD), and GSH peroxidase superoxide dismutase. Furthermore, vitamin D represses the expression of NADPH (nicotinamide adenine dinucleotide phosphate) oxidase [21].
Despite several trials being conducted on the effect of vitamin D in critically ill patients, there have been insufficient studies to assess the association between the plasma concentration of 25-OH Vitamin D, oxidative system markers, ICU length of stay, and duration of mechanical ventilation in ventilated ICU patients. Therefore, the principal goal of the current clinical trial was to evaluate the effect of vitamin D supplementation on total antioxidant capacity in intubated critically ill patients. More, as secondary objectives, we evaluated the effect of single high dose vitamin D administration on the patient's duration of mechanical ventilation and length of ICU stay. Furthermore, the aforementioned steps were performed to determine patients' ICU outcomes and also to pinpoint the relationship between TAC and ICU outcomes.
Section snippets
Study design
The present study was a randomized, placebo-controlled, single-center, double-blinded clinical trial that was conducted on ventilated ICU patients admitted to the ICU of Imam Hussein Hospital after acceptance by the ethics committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran (1397.12.IR.SBMU.PHNM) and registration and approval by Iranian Clinical Trial Registry (IRCT) with code of IRCT20120703010178N16.Entry criteria: The patients were selected using convenience sampling and recruited into . . .
Results
A total of 64 ventilated patients were admitted into the ICU between September 2019 and March 2020 and were evaluated based on the defined inclusion criteria. Based on the inclusion/exclusion criteria, 28 subjects were excluded and the remaining patients were recruited. After randomization into two groups, 20 patients were allocated to the Vitamin D (intervention) group and 16 patients were allocated to the control group. A further six patients were excluded during follow up and 30 patients . . .Vitamin D level
Measurement of vitamin D levels on the seventh day of the study indicated an increase from 7.3 ± 2.3 to 11.1 ± 3.7 (ng/dL) in the Vitamin D group (P-value = 0.00) and a decrease from 5.24 ± 0.7 to 4.8 ± 0.9 (ng/dL) in the placebo group (P-value =0.34). The mean difference between the two groups was also significant (P-value =0.00). Data are shown in Table 2. . . .
Note by VitaminDWiki - Vitamin D levels increased 73 ng/ml in 7 daysDiscussion
Most critically ill patients demonstrate oxidative imbalance. Furthermore, by considering lower TAC values in critically ill patients [24], the critical role of free radicals in increasing the duration of mechanical ventilation, complications due to infections, and longer length of hospital stays becomes clear. However, the fact that vitamin D might be a powerful tool against the mentioned detrimental pathways, the current study aimed at comparing the effect of vitamin D on total antioxidant . . .Conclusion
In conclusion, the results of this research supported the idea that the administration of high-dose vitamin D could be a powerful tool in reducing the duration of mechanical ventilation, the duration of hospitalization, and mortality rate. These beneficial effects could be explained by the effect of vitamin D on increasing TAC blood levels in ICU patients. Considering the current COVID 19 crisis and its effect on oxidative stress, these findings also could be relevant for patients suffering . . .
VitaminDWiki -
38 studies in both categories Trauma-surgery and Loading Dose This list is automatically updated
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- ICU mortality reduced by non-oral vitamin D – meta-analysis May 2021
- Taking Vitamin D just before and after surgery helps (open-heart in this case) – RCT Feb 2021
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- ICU Vitamin D injection (300,000 IU) helped - RCT Feb 2021
- Those getting an injection of 300,000 IU Vitamin D got out of the ICU a week sooner – RCT Dec 2020
- ICU patients greatly helped by Vitamin D loading doses – if gut-friendly – Oct 2020
- Fewer days in ICU after 300,000 IU of vitamin D, but not 540,000 – meta-analysis Aug 2020
- 3X less Septic Shock in children with sepsis getting 150,000 IU of Vitamin D - RCT June 2020
- 100,000 IU daily of Vitamin D for 5 days increased Hemoglobin in Mechanically Ventilated adults – RCT Jan 2018
- Traumatic Brain Injury – 120,000 IU of Vitamin D resulted in 3 fewer days on ventilators – RCT March 2020
- Hip surgery with multiple doses of 50,000 IU of vitamin D weekly both before and after – RCT 2023
- Use of Vitamin D in a trauma surgery - Dr. Matthews on Facebook – Jan 2020
- Surgeries often deplete Vitamin D - 300,000 IU resulted in little response – Nov 2018
- 10 fewer days of ICU Mechanical Ventilation 300,000 IU injection of vitamin D – RCT March 2019
- Intensive Care (ICU) helped by Vitamin D – review of past and on-going studies – Dec 2018
- ICU adults getting 540,000 IU of Vitamin D were 2X more likely to be alive 30 days later – RCT June 2019
- Traumatic Brain Injury recovery helped by injection of 100,000 IU of Vitamin D – March 2019
- Rapidly restore Vitamin D levels with 10,000 IU per kg for children in ICU – RCT 2024
- Esophageal Cancer surgery helped by 300,000 IU of Vitamin D – RCT Sept 2018
- Severe sepsis may be prevented by 400,000 IU of vitamin D – RCT 2023
- Critically ill children – randomized clinical trial to give single doses of up to 400,000 IU of vitamin D – 2019
- Vitamin D loading doses reduce ICU mortality by 30 percent – meta-analysis April 2017
- Hospital ICU added high dose vitamin D - malpractice lawsuit costs dropped from 26 million dollars to ZERO - Oct 2016
- Children in Intensive Care need Vitamin D loading dose of 10000 IU per kg (nearing a consensus) - Oct 2016
- Vitamin D Loading dose - 20,000 IU daily is not enough if obese, etc. (Cancer) great table and chart – Oct 2016
- Rapid Normalization of Vitamin D in Critically Ill Children (10,000 IU per kg) – clinical trial
- VITdAL-ICU - AMA RCT Sept 2014
- Critically ill need vitamin D – how much and which test to use is TBD – Nov 2014
- ICU survival increased with vitamin D single 540K IU loading dose - JAMA Sept 2014
- 540000 IU before ICU raised vitamin D by 25 ng in 2 days – March 2011
- Hip surgery followed by 100000 IU then 1000 IU of vitamin D daily – June 2010
- 600,000 IU intramuscular D3 helped BMD after pancreatic surgery – June 2010
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