Trauma and surgery category listing with associated searches
Search VitaminDWiki for ICU OR “critical care” OR “intensive care” OR “acute care” 494 items as of Nov 2014
The TOP (most read) articles in Trauma and Surgery and Vitamin D are listed here:
- Large dose Vitamin D before surgery was found to help by 35 studies
- Vitamin D is needed before most surgeries – many studies and RCTs
- Intensive Care (ICU) helped by Vitamin D – review of past and on-going studies – Dec 2018
- Vitamin D, trauma, and blacks - Dr. Matthews interview with transcript - Jan 2019
- Rapidly restore Vitamin D levels with 10,000 IU per kg for children in ICU – RCT 2024
- Micronutrients (such as Vitamin D) for critically ill children – review Oct 2017
- ICU cost reduced by at least 27,000 dollars if get high dose vitamin D in first week - April 2017
- 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
- Hospitalized cats 8X more likely to die if low vitamin D (Vit. D helps humans too) – May 2015
- Surgical outcomes are better for higher levels of Vitamin D – systematic review May 2015
- Vitamin D intervention increased by 20 percent the survival of critically ill patients- RCT June 2014
- 5 out of 6 children who died in pediatric critical care unit had low vitamin D – May 2014
- 3X more likely to die within 3 months of being in ICU for 2 days if less than 20 ng vitamin D – Sept 2013
- 2X more likely to get hospital infection if low vitamin D (10 ng) when enter – Oct 2013
- More sepsis deaths when active vitamin D (Calcitrol) was low – May 2013
- Almost 6X more likely to die after coronary bypass if vitamin D deficient – Dec 2012
- With just 200 IU vitamin D in intravenous feeds, deficiency results
Vitamin D as a modifiable risk factor in critical illness: questions and answers provided by observational studies
Vitamina D como um fator de risco modificável em doenças graves: perguntas e respostas de estudos observacionais
Jornal de Pediatria; Volume 90, Issue 2, March–April 2014, Pages 99–101
J. Dayre McNally
Refers To
Vitamin D deficiency at pediatric intensive care admission
Download the PDF from VitaminDWiki.
Corsino Rey, David Sánchez‐Arango, Jesús López‐Herce, Pablo Martínez‐Camblor, Irene García‐Hernández, Belén Prieto, Zamir Pallavicini
Jornal de Pediatria, Volume 90, Issue 2, March–April 2014, Pages 135-142 PDF (502 K)
Referred to by
J. Dayre McNally
Vitamin D as a modifiable risk factor in critical illness: questions and answers provided by observational studies
Download the PDF from VitaminDWiki.
Jornal de Pediatria (Versão em Português), Volume 90, Issue 2, March–April 2014, Pages 99-101, PDF (157 K)
Vitamin D is essential to optimal health. Studies dating back to the early 1900's convincingly demonstrate that a state of vitamin D deficiency, acquired through limited sun exposure and avoidance of vitamin D-rich foods can lead to stunted growth, bone disease, and hypocalcemic seizures. Over the past few decades, a rising body of epidemiological literature has also suggested that vitamin D deficiency predisposes to a wide variety of disease states outside of the musculoskeletal system. For example, vitamin D status has been associated with diseases involving dysregulation of the immune (type I diabetes, cancer), cardiovascular (heart failure, cardiomyopathy), and respiratory systems (bronchiolitis, pneumonia). Strong biological plausibility supporting these epidemiological findings has been provided, including basic science studies showing the presence of vitamin D receptors on a large number of diverse cell types (e.g. white blood cells, myocytes), and animal studies demonstrating disease occurrence in genetically- (vitamin D receptor knockout) or nutritionally-induced vitamin D deficiency states.
As the pathophysiology of the immune, cardiovascular, respiratory, and renal systems is central to critical illness, it is not surprising that clinicians and researchers have also hypothesized that vitamin D may be a modifiable risk factor in the intensive care setting. Since the initial NEJM publication in 2009 by Lee et al.,1 there have been dozens of adult epidemiological studies on this subject, and the overwhelming majority reported high vitamin D deficiency rates and statistical relationships with illness severity. In the adult realm, interventional studies are underway, with the publication of two pilot phase II studies evaluating rapid restoration regimens2 and 3 and the initiation of a large randomized controlled trial.4
In comparison, the importance of vitamin D in pediatric critical illness is significantly less studied, and the publication by Rey et al. in this issue5 adds to this emerging body of literature. Notwithstanding the publication by Rey et al. the pediatric literature on vitamin D in critically ill children was summarized in a recent review.6 The initial pediatric studies addressing this question were published in late 2012.7 and 8 Including the publication by Rey et al., there are now two studies on mixed medical/surgical populations, two on isolated medical populations, and two on isolated cardiac surgery populations.5, 7, 8, 9, 10 and 11 Although some variability was observed, all studies report clinically significant vitamin D deficiency prevalence rates (30% to 80%). The four studies involving post-operative cardiac surgery patients reported statistically significant relationships between low 25-hydroxyvitamin D (25OHD) and greater illness severity. The picture is less clear for the studies on pediatric intensive care unit populations, with only two of the four studies documenting such a statistically significant association. Although the most recent study by Rey et al. did not present any statistically significant associations, there were some potential trends noted, and the study was at risk for type II error given the small sample size and unadjusted analysis.
Does the optimization of vitamin D status prevent or speed recovery from pediatric critical illness? Multiple research groups, most recently Rey et al., have performed the standard initial studies used to answer research questions of this variety. An evaluation of the available studies demonstrates that, regardless of geography, many critically ill children are vitamin D deficient. This observation would appear to present an opportunity. The missing information is whether and to what extent the natural history of disease is modified by raising vitamin D levels. Observational studies on nutrients and hormones are often used to predict the potential magnitude of effect by comparing illness course in groups of patients with different levels. Regardless of whether the results show the desired associations, clinicians and researchers struggle to interpret and compare the findings from both singular and groups of observational studies. This is due to small sample size, patient heterogeneity (within and between studies), measurement error, confounding factors, outcome selection, statistical analysis, and reporting biases. In addition to the standard problems associated with PICU studies of this nature, there are other problems specific to vitamin D that further complicates the issue. First, although recognized as the appropriate marker of vitamin D status in most populations, 25OHD levels may not accurately reflect body stores in critically ill patients (those with hypoparathyroidism, renal dysfunction, interstitial leak of binding proteins, fluid shifts, dialysis). It has been suggested that blood concentrations of the active vitamin D hormone might better reflect vitamin D axis function, a question that will require further studies, which will also suffer from the abovementioned problems. Second, association studies intended to evaluate and demonstrate that higher vitamin D levels prevent illness or speed recovery suffer from a lack of patients with blood 25OHD levels that represent the target. Stated differently, it is not possible to estimate the benefits of a 25OHD level of 100 nmol/L when few of the study participants achieve this target.
What advice should be given regarding vitamin D supplementation to clinicians who care for patients who are either at risk for critical illness or are critically ill? For now, it would appear prudent to provide pre-illness supplementation in a range known to safely maintain 25OHD at 100 nmol/L (1,000 to 2,000 IU/day).12 and 13 There are specific populations that deserve special attention and may require higher supplementation doses to achieve desired vitamin D status (patients with renal dysfunction, malabsorption syndromes, anti-seizure medications, cardiopulmonary bypass).14 and 15 With good compliance, a daily intake in the 1,000 to 4,000 IU range for two to three months should achieve target vitamin D levels. An alternative approach is required to optimize vitamin D status in the actively critically ill patients who are vitamin D deficient. What is clear is that daily administration of low dose vitamin supplementation (400 to 4,000 IU/day) will not restore levels in a beneficial time frame. Instead, clinicians will need to consider loading doses (or stoss therapy) ranging from 50,000 to 600,000 IU, depending on starting level and weight.16, 17 and 18 Given evidence (albeit largely from case reports/series) that high doses may cause hypercalcemia, hypercalciuria, or nephrocalcinosis, vitamin D loading doses cannot be recommended in critically ill children without clinical trial data.19 and 20 As such, the next steps in this emerging field are patience (results of the adult stoss therapy randomized clinical trials) and completion of smaller phase II dose-evaluation studies in children.
References
1
P. Lee, J.A. Eisman, J.R. Center
Vitamin D deficiency in critically ill patients
N Engl J Med, 360 (2009), pp. 1912–1914; View Record in Scopus | Full Text via CrossRef | Citing articles (86)
2
K. Amrein, H. Sourij, G. Wagner, A. Holl, T.R. Pieber, K.H. Smolle, et al.
Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study
Crit Care, 15 (2011), p. R104; Full Text via CrossRef
3
J.M. Mata-Granados, J. Vargas-Vasserot, C. Ferreiro-Vera, M.D. Luque de Castro, R.G. Pavón, J.M. Quesada Gómez
Evaluation of vitamin D endocrine system (VDES) status and response to treatment of patients in intensive care units (ICUs) using an on-line SPE-LC-MS/MS method
J Steroid Biochem Mol Biol, 121 (2010), pp. 452–455; Article | PDF (194 K) | View Record in Scopus | Citing articles (30)
4
K. Amrein, C. Schnedl, A. Berghold, T.R. Pieber, H. Dobnig
Correction of vitamin D deficiency in critically ill patients - VITdAL@ICU study protocol of a double-blind, placebo-controlled randomized clinical trial
BMC Endocr Disord, 12 (2012), p. 27; Full Text via CrossRef
5
C. Rey, D. Sánchez-Arango, J. López-Herce, P. Martínez-Camblor, I. García-Hernández, B. Prieto, et al.
Vitamin D deficiency at pediatric intensive care admission
J Pediatr (Rio J), 90 (2014), pp. 135–142; Article | PDF (502 K) | View Record in Scopus | Citing articles (1)
6
J.D. McNally, K. Menon
Vitamin D deficiency in surgical congenital heart disease: prevalence and relevance
Transl Pediatr, 2 (2013), pp. 99–111; View Record in Scopus | Citing articles (1)
7
J.D. McNally, K. Menon, P. Chakraborty, L. Fisher, K.A. Williams, O.Y. Al-Dirbashi, et al.
The association of vitamin D status with pediatric critical illness
Pediatrics, 130 (2012), pp. 429–436; View Record in Scopus | Full Text via CrossRef | Citing articles (17)
8
K. Madden, H.A. Feldman, E.M. Smith, C.M. Gordon, S.M. Keisling, R.M. Sullivan, et al.
Vitamin D deficiency in critically ill children; Pediatrics, 130 (2012), pp. 421–428
View Record in Scopus | Full Text via CrossRef | Citing articles (13)
9
C. Rippel, M. South, W.W. Butt, L.S. Shekerdemian
Vitamin D status in critically ill children
Intensive Care Med, 38 (2012), pp. 2055–2062; View Record in Scopus | Full Text via CrossRef | Citing articles (10)
10
E.M. Graham, S.N. Taylor, S.C. Zyblewski, B. Wolf, S.M. Bradley, B.W. Hollis, et al.
Vitamin D status in neonates undergoing cardiac operations: relationship to cardiopulmonary bypass and association with outcomes
J Pediatr, 162 (2013), pp. 823–826; Article | PDF (117 K) | View Record in Scopus | Citing articles (2)
11
J.D. McNally, K. Menon, P. Chakraborty, L. Fisher, K.A. Williams, O.Y. Al-Dirbashi, et al.
Impact of anesthesia and surgery for congenital heart disease on the vitamin D status of infants and children: a prospective longitudinal study
Anesthesiology, 119 (2013), pp. 71–80; View Record in Scopus | Full Text via CrossRef | Citing articles (2)
12
S. Gallo, K. Comeau, C. Vanstone, S. Agellon, A. Sharma, G. Jones, et al.
Effect of different dosages of oral vitamin D supplementation on vitamin D status in healthy, breastfed infants: a randomized trial
JAMA, 309 (2013), pp. 1785–1792; View Record in Scopus | Full Text via CrossRef | Citing articles (22)
13
E. Holmlund-Suila, H. Viljakainen, T. Hytinantti, C. Lamberg-Allardt, S. Andersson, O. Mäkitie
High-dose vitamin d intervention in infants--effects on vitamin d status, calcium homeostasis, and bone strength
J Clin Endocrinol Metab, 97 (2012), pp. 4139–4147; View Record in Scopus | Full Text via CrossRef | Citing articles (9)
14
M. Goncerzewicz, J. Ryzko, R. Lorenc, K. Kozlowski, J. Socha
Vitamin D metabolism in children with malabsorption syndrome
Klin Padiatr, 197 (1985), pp. 30–34; View Record in Scopus | Full Text via CrossRef | Citing articles (2)
15
N. Collins, J. Maher, M. Cole, M. Baker, N. Callaghan
A prospective study to evaluate the dose of vitamin D required to correct low 25-hydroxyvitamin D levels, calcium, and alkaline phosphatase in patients at risk of developing antiepileptic drug-induced osteomalacia
Q J Med, 78 (1991), pp. 113–122; View Record in Scopus | Citing articles (58)
16
T. Emel, D.A. Doğan, G. Erdem, O. Faruk
Therapy strategies in vitamin D deficiency with or without rickets: efficiency of low-dose stoss therapy
J Pediatr Endocrinol Metab, 25 (2012), pp. 107–110; View Record in Scopus | Citing articles (6)
17
A.T. Soliman, M. Eldabbagh, A. Elawwa, R. Ashour, W. Saleem
The effect of vitamin D therapy on hematological indices in children with vitamin D deficiency
J Trop Pediatr, 58 (2012), pp. 523–524; View Record in Scopus | Full Text via CrossRef | Citing articles (1)
18
C. Munns, M.R. Zacharin, C.P. Rodda, J.A. Batch, R. Morley, N.E. Cranswick, et al.
Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement
Med J Aust, 185 (2006), pp. 268–272; View Record in Scopus | Citing articles (123)
19
T. Markestad, V. Hesse, M. Siebenhuner, G. Jahreis, L. Aksnes, W. Plenert, et al.
Intermittent high-dose vitamin D prophylaxis during infancy: effect on vitamin D metabolites, calcium, and phosphorus
Am J Clin Nutr, 46 (1987), pp. 652–658; View Record in Scopus | Citing articles (39)
20
R. Joshi
Hypercalcemia due to hypervitaminosis D: report of seven patients
J Trop Pediatr, 55 (2009), pp. 396–398; Full Text via CrossRef