Vitamin D to Prevent Lung Injury Following Esophagectomy-A Randomized, Placebo-Controlled Trial.

Parekh, Dhruv and Dancer, Rachel C A and Scott, Aaron and D'Souza, Vijay K and Howells, Phillip A and Mahida, Rahul Y and Tang, Jonathan C Y and Cooper, Mark S and Fraser, William D and Tan, LamChin and Gao, Fang and Martineau, Adrian R and Tucker, Olga and Perkins, Gavin D and Thickett, David R (2018) Vitamin D to Prevent Lung Injury Following Esophagectomy-A Randomized, Placebo-Controlled Trial. Critical care medicine. ISSN 1530-0293. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: https://insights.ovid.com/pubmed?pmid=30222631

Abstract

OBJECTIVES

Observational studies suggest an association between vitamin D deficiency and adverse outcomes of critical illness and identify it as a potential risk factor for the development of lung injury. To determine whether preoperative administration of oral high-dose cholecalciferol ameliorates early acute lung injury postoperatively in adults undergoing elective esophagectomy.

DESIGN

A double-blind, randomized, placebo-controlled trial.

SETTING

Three large U.K. university hospitals.

PATIENTS

Seventy-nine adult patients undergoing elective esophagectomy were randomized.

INTERVENTIONS

A single oral preoperative (3-14 d) dose of 7.5 mg (300,000 IU; 15 mL) cholecalciferol or matched placebo.

MEASUREMENTS AND MAIN RESULTS

Primary outcome was change in extravascular lung water index at the end of esophagectomy. Secondary outcomes included PaO2:FIO2 ratio, development of lung injury, ventilator and organ-failure free days, 28 and 90 day survival, safety of cholecalciferol supplementation, plasma vitamin D status (25(OH)D, 1,25(OH)2D, and vitamin D-binding protein), pulmonary vascular permeability index, and extravascular lung water index day 1 postoperatively. An exploratory study measured biomarkers of alveolar-capillary inflammation and injury. Forty patients were randomized to cholecalciferol and 39 to placebo. There was no significant change in extravascular lung water index at the end of the operation between treatment groups (placebo median 1.0 [interquartile range, 0.4-1.8] vs cholecalciferol median 0.4 mL/kg [interquartile range, 0.4-1.2 mL/kg]; p = 0.059). Median pulmonary vascular permeability index values were significantly lower in the cholecalciferol treatment group (placebo 0.4 [interquartile range, 0-0.7] vs cholecalciferol 0.1 [interquartile range, -0.15 to -0.35]; p = 0.027). Cholecalciferol treatment effectively increased 25(OH)D concentrations, but surgery resulted in a decrease in 25(OH)D concentrations at day 3 in both arms. There was no difference in clinical outcomes.

CONCLUSIONS

High-dose preoperative treatment with oral cholecalciferol was effective at increasing 25(OH)D concentrations and reduced changes in postoperative pulmonary vascular permeability index, but not extravascular lung water index.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WB Practice of medicine > WB400 Intensive care
Divisions: Clinical Support > Critical Care
Related URLs:
Depositing User: Mr Philip O'Reilly
Date Deposited: 24 Sep 2018 13:22
Last Modified: 24 Sep 2018 13:22
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1745

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