10 fewer days of ICU Mechanical Ventilation 300,000 IU injection of vitamin D – RCT

Created September 2019

Effect of High-Dose Vitamin D on Duration of Mechanical Ventilation in ICU Patients

Iran J Pharm Res. 2019 Spring;18(2):1067-1072. doi: 10.22037/ijpr.2019.1100647.

Miri M1, Kouchek M1, Rahat Dahmardeh A1, Sistanizad M2,3.

* 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 * Intensive Care (ICU) helped by Vitamin D – review of past and on-going studies – Dec 2018 * ICU cost reduced by at least 27,000 dollars if get high dose vitamin D in first week - April 2017 * ICU adults getting 540,000 IU of Vitamin D were 2X more likely to be alive 30 days later – RCT June 2019 * Overview Loading of vitamin D * * Injection category listing has items along with related searches** 1. Cost savings with Vitamin D includes the following {include} --- 1. Trauma and surgery category starts with the following {include} --- 1. Important ICU Considerations - by VitaminDWiki 1. Start the Vitamin Dosing before the surgery if at all possible * Outcomes will be far better 1. Add vitamin D if < 30 ng, not just < 12 ng * Surgery/trauma reduces the vitamin D levels in a few days 1. Use a gut-compatible form of vitamin D if there is a chance that the patient has poor gut (~30% of patients) 1. Allocate some of the Vitamin D loading dose to very fast response type - inside the cheek or under the tongue * raises vitamin D levels in ~3 hours instead of 12 hours 1. Obese need larger doses to get to the same blood level 1. Test vitamin D levels about a week after surgery/ICU - and replenish if < 30 ng 1. Many studies have found that Omega-3 helps as well 1. Avoid use of injection (too slow) and Vitamin D2 - poor response 1. Consider adding something to increase amount of vitamin D which acutally gets to tissue * Resveratrol, etc increase the activation of the Vitamin D Receptor

📄 Download the PDF from VitaminDWiki

Note - injections take several days to give a response.
Other methods, such as sublingual, are much faster and lower cost

The relationship of vitamin D3 with the duration of mechanical ventilation and mortality is still unknown. Therefore, this study aimed to determine the effect of using high-dose vitamin D on the duration of mechanical ventilation among the patients admitted to the intensive care unit. The current double-blinded clinical trial was performed on 44 mechanically ventilated, adult patients. Using permuted block randomization, the patients were recruited in intervention and placebo arms. In the placebo group, four patients were excluded due to death before 72 h. The vitamin D level was measured in both groups on entrance and 7th day of the study. The intervention and placebo groups received intramuscular injection of 300,000 IU vitamin D and identical placebo, respectively. SOFA and CPIS score were evaluated daily for 7 days and on 14th and 28th days of the study. Also duration of mechanical ventilation and mortality rate were recorded. Fourteen males and 8 females were recruited in the intervention group, as well as 13 males and 5 females in the control group. There was no significant difference in baseline characteristics of the patients including gender and age. The mean duration of the mechanical ventilation was 17.63 ± 14 days in the intervention group versus 27.72 ± 22.48 days in the control group (p = 0.06).

Mortality rate in control and intervention groups was 61.1% versus 36.3% (p = 0.00), respectively. Administration of high-dose vitamin D could reduce mortality in mechanically ventilated patients. Despite decrease of 10 days in duration of mechanical ventilation, the difference was not statistically significant. Larger studies are recommended.

Tags: Cost savings Injection Loading dose Trauma and surgery