The Effect of Vitamin D Supplementation on Clinical Outcomes for Critically Ill Patients: A Systemic Review and Meta-Analysis of Randomized Clinical Trials
Front Nutr. 2021 May 4;8:664940. doi: 10.3389/fnut.2021.664940
Hejuan Shen 1 2, Yijun Mei 1 2, Kai Zhang 3, Xiaoya Xu 1 2
58% less mortality vs 8% for oral (Note: 8% was not statistically significant)
ICU patients are often are unable to get nutrients orally
However, ICU patients need to get the benefit of Vitamin D as soon as possible
restoring Vitamin D levels BEFORE the ICU would be ideal,
Fewer days in hospital if 300,000 IU of vitamin D before brain surgery - RCT Feb 2021
and sometimes will eliminate having to go to the ICU
Injection of vitamin D into muscle does avoid a poor gut,
but at the expense of a somewhat slow response
Good options for vitamin D in the ICU appear to be:
1) Vitamin D water if a patient can sip
2) Vitamin D nanoemulsion if a person can swish it in mouth
3) Vitamin D nanoemulsion applied topically (face and/or arms)
Note: nanoemulsion form is new and is starting to be used in ICU and elsewhere
COVID-19 inflammation extinguished by Vitamin D nanoemulsion
Vitamin D levels might be raised very quickly summary by VitaminDWiki
Note: The founder of VitamDWiki planned to have nanoemulsion trials (swished in mouth, topical, and inhaled) in 2020, but COVID-19 happened
Poor guts need different forms of vitamin D has the following
Guesses of Vitamin D response if poor gut
| Bio | Form | Speed | Duration |
| 10 | Injection ($$$) or Calcidiol or Calcitriol | D - Slow C -Fast | Long |
| 10 | Sun/UVB | Slow | Long |
| 10 | Topical (skin patch/cream, vagina) | Slow Fast nano | Normal |
| 9 | Nanoemulsion -mucosal perhaps activates VDR | Fast | Normal |
| 9? | Inhaled (future) | Fast | Normal |
| 8 | Bio-D-Mulsion Forte | Normal | Normal |
| 6 | Water soluble (Bio-Tech) | Normal | Normal |
| 4 | Sublingual/spray (some goes into gut) | Fast | Normal |
| 3 | Coconut oil based | Slow | Normal |
| 2 | Food (salmon etc.) | Slow | Normal |
| 2 | Olive oil based (majority) | Slow | Normal |
10= best bioavailable, 0 = worst, guesses have a range of +-2
Speed: Fast ~2-6 hours, Slow ~10-30 hours
Duration: Long ~3-6 months, Normal = ~2 months
Getting Vitamin D into your body has the following chart
Items in both categories Trauma-surgery and Loading Dose:
- Surgery complications cut in half by 300,000 IU of vitamin D 2 weeks before (hip and knee) – RCT May 2024
- Some ICU patients got 540,000 IU of Vitamin D: good responders lived longer than controls or poor responders – RCT June 2024
- Large dose Vitamin D before surgery was found to help by 35 studies
- Vitamin D is needed before most surgeries – many studies and RCTs
- Half as much AFIB after bypass if 600,000 IU of vitamin D before surgery – RCT April 2022
- 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
- Half as many problems if take Vitamin D (300,000 IU) before thyroidectomy – RCT Jan 2021
- Fewer days in hospital if 300,000 IU of vitamin D before brain surgery - RCT Feb 2021
- 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
Injection category listing has 65 items
Items in both categories Trauma-surgery and injection:
-
TBI reduced 5X by 300,000 IU of vitamin D (injection) – RCT Oct 2024
-
Oral Vitamin D much better than injection (after Knee Arthroplasty in this case) – Sept 2021
-
ICU mortality reduced by non-oral vitamin D – meta-analysis May 2021
-
Fewer days in hospital if 300,000 IU of vitamin D before brain surgery - RCT Feb 2021
-
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
-
10 fewer days of ICU Mechanical Ventilation 300,000 IU injection of vitamin D – RCT March 2019
-
Following brain surgery Vitamin D injections did not raise blood levels much – RCT June 2019
-
Traumatic Brain Injury recovery helped by injection of 100,000 IU of Vitamin D – March 2019
-
Vitamin D levels might be raised very quickly
-
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
-
300,000 IU Vitamin D injection before brain tumor surgery – RCT to finish Dec 2017
-
600,000 IU intramuscular D3 helped BMD after pancreatic surgery – June 2010
Download the PDF from VitaminDWiki
Purpose: Vitamin D deficiency is a common scenario in critically ill patients and has been proven to be associated with poor outcomes. However, the effect of vitamin D supplementation for critically ill patients remains controversial. Thus, we conducted a meta-analysis to evaluate the effect of vitamin D supplementation among critically ill patients.
Methods: Electronic databases PubMed, Embase, Scopus, and the Cochrane Library were searched for eligible randomized controlled trials between 2000 and January 2021. The primary outcome was overall mortality, and the secondary ones were the length of intensive care unit stay, the length of hospital stay, as well as the duration of mechanical ventilation. Subgroup analyses were performed to explore the treatment effect by type of admission, route of administration, dose of supplemented vitamin D, and the degree of vitamin D deficiency.
Results: A total of 14 studies involving 2,324 patients were finally included. No effect on overall mortality was found between vitamin D supplementation and control group [odds ratio (OR), 0.73; 95% CI, 0.52-1.03; I 2 = 28%]. The vitamin D supplementation reduced the length of intensive care unit stay [mean difference (MD), -2.25; 95% CI, -4.07 to -0.44, I 2 = 71%] and duration of mechanical ventilation (MD, -3.47; 95% CI, -6.37 to -0.57, I 2 = 88%).
In the subgroup analyses, the vitamin D supplementation for surgical patients (OR, 0.67; 95% CI, 0.47-0.94; I 2 = 0%) or through parenteral way (OR, 0.42; 95% CI, 0.22-0.82, I 2 = 0%) was associated with reduced mortality.
Conclusion: In critically ill patients, the supplementation of vitamin D has no effect on overall mortality compared to placebo but may decrease the length of intensive care unit stay and mechanical ventilation. Further trials are necessary to confirm our findings.
ICU mortality reduced by non-oral vitamin D – meta-analysis May 2021
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Items in both categories Trauma-surgery and injection:
- TBI reduced 5X by 300,000 IU of vitamin D (injection) – RCT Oct 2024
- Oral Vitamin D much better than injection (after Knee Arthroplasty in this case) – Sept 2021
- ICU mortality reduced by non-oral vitamin D – meta-analysis May 2021
- Fewer days in hospital if 300,000 IU of vitamin D before brain surgery - RCT Feb 2021
- 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
- 10 fewer days of ICU Mechanical Ventilation 300,000 IU injection of vitamin D – RCT March 2019
- Following brain surgery Vitamin D injections did not raise blood levels much – RCT June 2019
- Traumatic Brain Injury recovery helped by injection of 100,000 IU of Vitamin D – March 2019
- Vitamin D levels might be raised very quickly
- 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
- 300,000 IU Vitamin D injection before brain tumor surgery – RCT to finish Dec 2017
- 600,000 IU intramuscular D3 helped BMD after pancreatic surgery – June 2010
Download the PDF from VitaminDWiki
Purpose: Vitamin D deficiency is a common scenario in critically ill patients and has been proven to be associated with poor outcomes. However, the effect of vitamin D supplementation for critically ill patients remains controversial. Thus, we conducted a meta-analysis to evaluate the effect of vitamin D supplementation among critically ill patients.
Methods: Electronic databases PubMed, Embase, Scopus, and the Cochrane Library were searched for eligible randomized controlled trials between 2000 and January 2021. The primary outcome was overall mortality, and the secondary ones were the length of intensive care unit stay, the length of hospital stay, as well as the duration of mechanical ventilation. Subgroup analyses were performed to explore the treatment effect by type of admission, route of administration, dose of supplemented vitamin D, and the degree of vitamin D deficiency.
Results: A total of 14 studies involving 2,324 patients were finally included. No effect on overall mortality was found between vitamin D supplementation and control group [odds ratio (OR), 0.73; 95% CI, 0.52-1.03; I 2 = 28%]. The vitamin D supplementation reduced the length of intensive care unit stay [mean difference (MD), -2.25; 95% CI, -4.07 to -0.44, I 2 = 71%] and duration of mechanical ventilation (MD, -3.47; 95% CI, -6.37 to -0.57, I 2 = 88%).
In the subgroup analyses, the vitamin D supplementation for surgical patients (OR, 0.67; 95% CI, 0.47-0.94; I 2 = 0%) or through parenteral way (OR, 0.42; 95% CI, 0.22-0.82, I 2 = 0%) was associated with reduced mortality.
Conclusion: In critically ill patients, the supplementation of vitamin D has no effect on overall mortality compared to placebo but may decrease the length of intensive care unit stay and mechanical ventilation. Further trials are necessary to confirm our findings.
| 4873 visitors, last modified 23 May, 2021, |
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| 15626 | Parenteral.jpg | admin 23 May, 2021 | 39.58 Kb | 373 | |
| 15625 | Critically ill meta - perenteral better than oral_compressed.pdf | admin 23 May, 2021 | 588.76 Kb | 336 |