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Higher vitamin D levels linked with reduced mechanical ventilation duration in critically ill

Life Extension Update

Tuesday, January 13, 2015. A study published online on January 6, 2015 in the Journal of Parenteral and Enteral Nutrition found that critically ill surgical patients whose vitamin D levels were higher needed less respiratory support via the use of mechanical ventilation in comparison with those with lower levels.

Sadeq A. Quraishi, MD, and colleagues analyzed data from 94 men and women admitted to Massachusetts General Hospital's surgical intensive care units who required at least 48 hours of ventilation and survived more than 24 hours after its discontinuation. Blood samples collected upon admission were analyzed for plasma 25-hydroxyvitamin D [25(OH)D] levels.

Respiratory support was needed for an average of 6 days among the 57 subjects whose plasma vitamin D levels were lower than 20 ng/mL, in comparison with 3 days among the remainder of the group. The researchers estimated that each 10 ng/mL increase in vitamin D was associated with a 34% reduction in mechanical ventilation duration. Ninety-two percent of those with higher vitamin D levels survived for at least 90 days, compared to 67% of those with low levels.

"We hypothesize that ideal 25(OH)D levels are associated with optimal musculoskeletal health, effective regulation of innate as well as adaptive immunity, and expression of endogenous antimicrobial peptides," the authors write. "In turn, this may attenuate the effect of respiratory muscle weakness, systemic inflammation, and infections, which majorly impact the duration of respiratory support during critical illness."

"Further prospective studies are needed to validate our findings, to assess the potential benefit of optimizing 25(OH)D levels, and to identify the mechanism by which vitamin D may reduce the duration of MV in critically ill surgical patients," they conclude.

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Deficient vitamin D levels associated with greater risk of dying from sepsis or septic shock
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Researchers at Detroit's Henry Ford Hospital report a protective effect for having sufficient vitamin D levels against the risk of dying from sepsis or septic shock within thirty days of intensive care unit (ICU) admission. The findings were reported in the September, 2014 issue of the American Journal of Critical Care, a publication of the American Association of Critical Care Nurses.

The study included 121 men and women admitted to the hospital's ICU with severe sepsis or septic shock, an inflammatory state resulting from infection in the bloodstream. Blood samples obtained before or during admission were analyzed for serum 25-hydroxyvitamin D levels. Vitamin D deficiency, categorized in this study as a level of 15 nanograms per milliliter (ng/mL) or less, was uncovered in 54% of total patients, and among African Americans, the rate was 77%.

Thirty percent of vitamin D-deficient subjects died from any cause within thirty days of admission, in comparison with 20% of those who were not deficient. When the ninety days following admission was examined, the percentage of those with vitamin D deficiency who died climbed to 51% in comparison with 25% of the nondeficient group. Intensive care unit stay averaged six days longer in deficient patients in comparison with those who were not deficient.

"Mortality may be decreased by ensuring adequate vitamin D concentrations through supplementation with ergocalciferol or cholecalciferol within 30 days of hospitalization," the authors write. "This finding has important implications because sepsis is a leading cause of mortality in critically ill patients."

"Further evaluation in a larger sample of patients or through randomized controlled trials is necessary to further explore our results," they conclude.

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Health Concern

Trauma and wound healing

Trauma is a stressful event caused by either a mechanical or chemical injury. Depending on its level, trauma can have serious short-term and long-term consequences. The role of healthy nutrition, both in promoting healing and avoiding complications associated with trauma, has long been acknowledged in trauma recovery.

Trauma varies in intensity, ranging from serious burns or traffic accidents to the gradual, cumulative trauma that occurs with repetitive overuse of muscles and joints (such as strenuous weight lifting). Minor injuries, often no more than minor irritants, are relatively frequent. However, any traumatic event, even a minor one, affects the body's natural metabolic balance and initiates a cascade of reactions aimed at repair and restoration of function.

Population studies indicate that 9 to 44% of people with wound and surgical trauma are malnourished (Reid 2004). The condition often goes unrecognized and untreated in hospitals, and some studies have explored the increased risk of malnutrition during hospital stays, based on the common occurrence of clinically significant weight loss observed in hospitalized surgical patients (Fettes 2002).

Biologically, it is difficult to achieve usual levels of nutrition after major trauma because many important nutrients are channeled into the healing effort. In addition, many trauma patients suffer from altered levels of consciousness, poor appetite, reduced digestive function, compromised blood circulation, and a radical alteration of normal daily routines.

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