Crit Care Med. 2018 Dec; 46(12): e1128–e1135. doi: 10.1097/CCM.0000000000003405
Dhruv Parekh, PhD,corresponding author1–,3 Rachel C. A. Dancer, PhD,1,4 Aaron Scott, PhD,1 Vijay K. D’Souza, PhD,1 Phillip A. Howells, FRCA,1 Rahul Y. Mahida, MRCP,1 Jonathan C. Y. Tang, PhD,5 Mark S. Cooper, PhD,6 William D. Fraser, MD,5 LamChin Tan, FRCS,7 Fang Gao, MD,1,4 Adrian R. Martineau, PhD,8 Olga Tucker, MD,1,4 Gavin D. Perkins, MD,3,4 and David R. Thickett, DM1,2
Typically Vitamin D levels < 30 ng do not provide much benefit
In this study the average levels following surgery were only 22 ng
- Critical illness – Vitamin D levels start low and then drop for several days – Feb 2018
- Congenital heart surgery dropped vitamin D levels by 40 percent – July 2013
- After hip surgery Vitamin D levels dropped by 32 percent – Sept 2018
- Pro-inflammatory cytokines cause the 74 percent drop in vitamin D after knee arthroplasty – Feb 2014
Note: Vitamin D levels dropped after surgery: Both Placebo and 300,000 IU
Observational studies suggest an association between vitamin D deficiency and adverse outcomes of critical illness and identify it as a potential risk factor for the development of lung injury. To determine whether preoperative administration of oral high-dose cholecalciferol ameliorates early acute lung injury postoperatively in adults undergoing elective esophagectomy.
Design: A double-blind, randomized, placebo-controlled trial.
Setting: Three large U.K. university hospitals.
Patients: Seventy-nine adult patients undergoing elective esophagectomy were randomized.
Interventions: A single oral preoperative (3–14 d) dose of 7.5 mg (300,000 IU; 15 mL) cholecalciferol or matched placebo.
Measurements and Main Results:
Primary outcome was change in extravascular lung water index at the end of esophagectomy. Secondary outcomes included Pao2:Fio2 ratio, development of lung injury, ventilator and organ-failure free days, 28 and 90 day survival, safety of cholecalciferol supplementation, plasma vitamin D status (25(OH)D, 1,25(OH)2D, and vitamin D-binding protein), pulmonary vascular permeability index, and extravascular lung water index day 1 postoperatively. An exploratory study measured biomarkers of alveolar-capillary inflammation and injury. Forty patients were randomized to cholecalciferol and 39 to placebo. There was no significant change in extravascular lung water index at the end of the operation between treatment groups (placebo median 1.0 [interquartile range, 0.4–1.8] vs cholecalciferol median 0.4 mL/kg [interquartile range, 0.4–1.2 mL/kg]; p = 0.059). Median pulmonary vascular permeability index values were significantly lower in the cholecalciferol treatment group (placebo 0.4 [interquartile range, 0–0.7] vs cholecalciferol 0.1 [interquartile range, –0.15 to –0.35]; p = 0.027). Cholecalciferol treatment effectively increased 25(OH)D concentrations, but surgery resulted in a decrease in 25(OH)D concentrations at day 3 in both arms. There was no difference in clinical outcomes.
Conclusions: High-dose preoperative treatment with oral cholecalciferol was effective at increasing 25(OH)D concentrations and reduced changes in postoperative pulmonary vascular permeability index, but not extravascular lung water index.