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Vitamin D to prevent lung injury following esophagectomy – a randomized placebo controlled trial
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Birmingham Acute Care Research Group (Including: Parekh, Dhruv, Dancer, Rachel C. A., Scott, Aaron, D'Souza, Vijay K., Howells, Philip A., Mahida, Rahul Y., Tang, Jonathan C. Y., Cooper , Mark S., Fraser, William D., Tan, LamChin, Gao, Fang, Martineau, Adrian R., Tucker, Olga, Perkins, Gavin D. and Thickett, David R.). (2018) Vitamin D to prevent lung injury following esophagectomy – a randomized placebo controlled trial. Critical Care Medicine, 46 (12). e1128-e1135. doi:10.1097/CCM.0000000000003405 ISSN 0090-3493.
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Official URL: https://doi.org/10.1097/CCM.0000000000003405
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.
Item Type: | Journal Article | |||||||||||||||||||||
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Subjects: | R Medicine > RD Surgery | |||||||||||||||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Esophagectomy, Esophagus -- Surgery, Vitamin D | |||||||||||||||||||||
Journal or Publication Title: | Critical Care Medicine | |||||||||||||||||||||
Publisher: | Lippincott Williams & Wilkins | |||||||||||||||||||||
ISSN: | 0090-3493 | |||||||||||||||||||||
Official Date: | December 2018 | |||||||||||||||||||||
Dates: |
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Volume: | 46 | |||||||||||||||||||||
Number: | 12 | |||||||||||||||||||||
Page Range: | e1128-e1135 | |||||||||||||||||||||
DOI: | 10.1097/CCM.0000000000003405 | |||||||||||||||||||||
Status: | Peer Reviewed | |||||||||||||||||||||
Publication Status: | Published | |||||||||||||||||||||
Access rights to Published version: | Restricted or Subscription Access | |||||||||||||||||||||
Date of first compliant deposit: | 15 August 2018 | |||||||||||||||||||||
Date of first compliant Open Access: | 12 December 2018 | |||||||||||||||||||||
RIOXX Funder/Project Grant: |
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