Plasma 25‐Hydroxyvitamin D Levels at Initiation of Care and Duration of Mechanical Ventilation in Critically Ill Surgical Patients

Abstract

Objective Limited data exist regarding the relationship between plasma 25-hydroxyvitamin D levels and duration of respiratory support. Our goal was to explore whether vitamin D status at the time of intensive care unit (ICU) admission is associated with duration of mechanical ventilation in critically ill surgical patients. Materials and Methods We analyzed data from a prospective cohort study involving 210 critically ill surgical patients. To explore the relationship between admission plasma 25-hydroxyvitamin D levels and duration of mechanical ventilation, we performed a Poisson regression while controlling for clinically relevant covariates. Only patients who required ≥48 hours of mechanical ventilation and survived ≥24 hours after discontinuation of respiratory support were included in the analytic cohort. Results Ninety-four patients met inclusion criteria. Mean (standard deviation) plasma 25-hydroxyvitamin D level was 16 (7) ng/mL and median (interquartile range) duration of mechanical ventilation was 4 (2–7) days. Poisson regression analysis, adjusted for age, sex, race, body mass index, primary surgical service, Acute Physiology and Chronic Health Evaluation II score, and season of ICU admission, demonstrated an inverse association of plasma 25-hydroxyvitamin D levels with duration of mechanical ventilation (incident rate ratio per 10 ng/mL, 0.66; 95% confidence interval, 0.54–0.82). Conclusions In our cohort of critically ill surgical patients, plasma 25-hydroxyvitamin D levels measured on ICU admission were inversely associated with the duration of respiratory support. Randomized controlled trials are needed to assess whether vitamin D supplementation can influence duration of mechanical ventilation in surgical ICU patients.

Vitamin D Status Is Associated With Development of Hospital‐Acquired Pressure Injuries in Critically Ill Surgical Patients

“…Our analytic cohort was comprised of 402 adult surgical ICU patients. Of these patients, 100 have been described in previous manuscripts related to vitamin D status and duration of mechanical ventilation, readmission, LOS, and mortality . On admission to the ICU, the mean serum 25OHD was 18 (SD 8) ng/mL; the incidence of HAPI in our cohort was 11% (n = 44).…”

“…Accordingly, vitamin D, a nutrient and pleotropic prohormone, found to directly influence both local and systemic inflammation, is gaining increased clinical interest for its potential role in wound healing . Integral in maintaining musculoskeletal health, epithelial integrity, and immune function, vitamin D regulates the inflammatory process by upregulating the production of anti‐inflammatory cytokines, while concurrently inhibiting proinflammatory cytokine production . Moreover, vitamin D is essential for the production of cathelicidins and β‐defensins, both potent groups of antimicrobial peptides which provide innate defenses against pathogens, maintain the structural integrity of various epithelial barriers, and aid in wound re‐epithelialization .…”

“…For our second regression model, vitamin D status was treated as a dichotomous variable, while controlling for the same covariates. Vitamin D status was dichotomized based on conservative thresholds of 25OHD levels ≥20 ng/mL vs <20 ng/mL …”

Déficit de vitamina D y morbimortalidad en pacientes críticos pediátricos

“…En el estudio de Quraishi y colaboradores, los niveles de vitamina D al ingreso se correlacionaron inversamente con la duración de la ventilación mecánica, con una razón de tasas de incidencia de 0.66 (181) .…”

Outcomes of Vitamin D Supplementation in Adults Who are Deficient and Critically Ill: A Review of the Literature

“…48 In noncritically ill subjects, 25(OH)D deficiency has been associated with chronic obstructive pulmonary disease and respiratory symptoms. 50 In retrospective and prospective observational studies of ICU patients, 25(OH)D levels were inversely associated with mechanical ventilation days in medical ICU patients (10.04 6 1.97 days in vitamin D-deficient group vs. 3.15 6 0.15 days in vitamin D sufficient group, P 5 0.003) 45 and critically ill surgical patients (incident risk ratio per 10 ng/mL 5 0.66, 95% CI 5 0.39-0.66, P , 0.05) 48 ; however, in another study, there was no observed association between vitamin D deficiency and mechanical ventilation. 42 …”