Vitamin D in critical care: where are we now and what is next?
Current Opinion in Critical Care: Aug 2021 - Vol 27 - Issue 4 - p 378-384, doi: 10.1097/MCC.0000000000000849
Amrein, Karina; Hoffmann, Magdalenaa,b; Lobmeyr, Elisabethc; Martucci, Gennarod
Many doctors do not prescribe enough to make a difference
- Less than 3 percent of hip fracture patients prescribed enough Vitamin D to make a difference (Malta in this case) – July 2021
- Curing patients is not a sustainable business model – Goldman Sachs – April 2018
- 17 reasons why are doctors reluctant to accept vitamin D
- Do not expect your doctor to know about vitamin D
- Do not expect a doctor to recommend a pill which will eliminate his job (vitamin D)
- VITAMIN D: Public Shouldn’t Wait For Doctors To Usher In New “Golden Era” Of Preventive Medicine
- Let 1000 die from vitamin D deficiency rather than incur 1 lawsuit
- Survey Shows Dogma Not Data Can Dictate Doctors' Decisions - June 2010
The items which are in both Intervention and Trauma/Surgery are listed here
- Spinal TB surgery now includes Vitamin D as the standard of care (5,000 IU daily) – Sept 2024
- Sepsis (with mechanical ventilation) treated by 5days of 50,000 IU of Vitamin D – RCT May 2024
- Half as much AFIB after bypass if 600,000 IU of vitamin D before surgery – RCT April 2022
- Half as many problems if take Vitamin D (300,000 IU) before thyroidectomy – RCT Jan 2021
- Those getting an injection of 300,000 IU Vitamin D got out of the ICU a week sooner – RCT Dec 2020
- Traumatic Brain Injury – 120,000 IU of Vitamin D resulted in 3 fewer days on ventilators – RCT March 2020
- Better Surgical outcomes if preceded by Vitamin D loading dose – Oct 2018
- Knee replacement not helped by 2,000 IU of vitamin D (both too late and too little) – RCT July 2018
- Heart attack ICU costs cut in half by Vitamin D – Oct 2018
- Urinary sepsis – a single Vitamin D injection reduced hospital days by 40 percent – RCT April 2018
- Ventilator-associated pneumonia death rate cut in half by Vitamin D injection (300,000 IU) – RCT July 2017
- ICU cost reduced by at least 27,000 dollars if get high dose vitamin D in first week - April 2017
- Vitamin D and Glutamine reduced Trauma Center deaths by half – Matthews March 2017
- Hospital ICU added high dose vitamin D - malpractice lawsuit costs dropped from 26 million dollars to ZERO - Oct 2016
- Vitamin D and exercise after hip fracture surgery – far fewer deaths – July 2016
- 18 fewer hospital days if given 500,000 IU of vitamin D while ventilated in ICU – RCT June 2016
- ICU death rate reduced 3X when a vitamin D injection changed the PTH – Nov 2015
- Heart Attack ICU costs reduced $37,000 by $20 of Vitamin D – Nov 2015
- Vitamin D intervention increased by 20 percent the survival of critically ill patients- RCT June 2014
- Vitamin D aided progesterone in reducing traumatic brain injury – RCT Dec 2012
- Sepsis is both prevented and treated by Vitamin D - many studies
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Purpose of review
To summarize the recent evidence on the role of vitamin D deficiency in critically ill patients and emerging data claiming a role of vitamin D in COVID-19.
Recent findings
Vitamin D is a strong predictor for worse outcomes in critically ill patients, and as well in COVID-19. The vitamin D content in typical nutrition regimes is lower than what is recommended for the general population. Although its supplementation has been shown to reduce respiratory tract infections, asthma exacerbations and mortality risk in noncritically ill patients, its role in the acute setting is not yet clear. Several small intervention trials have shown interesting results in COVID-19, and larger studies are ongoing.
Summary
Although research on this topic is still ongoing, it appears reasonable to recommend at least the standard vitamin dose for the healthy population (600 - 800 IU of native vitamin D3). Many questions remain on the actual role, the best metabolite, regime, and so forth. However, the role for vitamin D in bone health is clear. Elderly ICU survivors have a high risk for osteoporosis/fractures, so at least in this population, an optimal vitamin D status should be targeted.