[BostonCard]

This article: https://www.nejm.org/doi/full/10.1056/NE...%200pubmed is a bit of why I am skeptical.



Vitamin D insufficiency has been theorized to make critical illness worse, and in fact, the article notes that "Observational data and initial clinical trial data indicate that vitamin D deficiency is common among critically ill patients and constitutes a potentially modifiable risk factor associated with longer lengths of stay in the hospital and intensive care unit (ICU), lung and other organ injury, prolonged mechanical ventilation, and death.8-14"



(note that is 7 references on vitamin D insufficiency and critical care illness)



So, it was theorized that if you give critically ill patients with vitamin D insufficiency supplemental vitamin D, they might do better.  Unfortunately, "Early administration of high-dose enteral vitamin D3 did not provide an advantage over placebo with respect to 90-day mortality or other, nonfatal outcomes among critically ill, vitamin D–deficient patients."



Now, to be fair, critical care illness is a very heterogeneous disease, and the participants in the trial were in the ICU for a variety of reasons: pneumonia, shock, sepsis, acute respiratory failure, aspiration, lung contusion, pancreatitis and smoke inhalation.  It is possible that vitamin D helps a subset of those patients but not others.  That being said, if you look at the survival curve, although not significant, the patients who got placebo actually did better than those who got vitamin D.




There are lots of other considerations, of course, including the timing (maybe you have to give it before someone goes into the ICU), or maybe you  need to give more than one dose.  Still, I'll remain skeptical until I see evidence that vitamin D repletion will actually help.


BC

[BostonCard]

This article: https://www.nejm.org/doi/full/10.1056/NE...%200pubmed is a bit of why I am skeptical.



Vitamin D insufficiency has been theorized to make critical illness worse, and in fact, the article notes that "Observational data and initial clinical trial data indicate that vitamin D deficiency is common among critically ill patients and constitutes a potentially modifiable risk factor associated with longer lengths of stay in the hospital and intensive care unit (ICU), lung and other organ injury, prolonged mechanical ventilation, and death.8-14"



(note that is 7 references on vitamin D insufficiency and critical care illness)



So, it was theorized that if you give critically ill patients with vitamin D insufficiency supplemental vitamin D, they might do better.  Unfortunately, "Early administration of high-dose enteral vitamin D3 did not provide an advantage over placebo with respect to 90-day mortality or other, nonfatal outcomes among critically ill, vitamin D–deficient patients."



Now, to be fair, critical care illness is a very heterogeneous disease, and the participants in the trial were in the ICU for a variety of reasons: pneumonia, shock, sepsis, acute respiratory failure, aspiration, lung contusion, pancreatitis and smoke inhalation.  It is possible that vitamin D helps a subset of those patients but not others.  That being said, if you look at the survival curve, although not significant, the patients who got placebo actually did better than those who got vitamin D.




There are lots of other considerations, of course, including the timing (maybe you have to give it before someone goes into the ICU), or maybe you  need to give more than one dose.  Still, I'll remain skeptical until I see evidence that vitamin D repletion will actually help.


BC