ASSOCIATION OF VITAMIN D STATUS AND WEANING FROM MECHANICAL VENTILATION IN CRITICALLY ILL PATIENTS

Rocky Das Gupta*, Manas Kanti Mazumder, Shahadat Hossain Polash, Sheikh Ul Alam, Mirza Nahiduzzaman, Nafiza Afroz, Mst. Nurjahan Begum and Suman Kundu

ABSTRACT

Background: Mechanical ventilation is a supportive measure for patients with respiratory failure which has several complications especially when needed for a long period of time. Vitamin D deficiency has been reported to be associated with myopathy and decreased muscle strength especially respiratory muscles in intensive care unit patients. So, it is logical to think that there might be an association of prolonged mechanical ventilation and difficulties in weaning from ventilatory support in patients with vitamin D deficiency. Due to a scarcity of related studies in Bangladesh context, this study was aimed to investigate the association between plasma vitamin D level and weaning from prolonged mechanical ventilation in critically ill ICU admitted patients. Objective: To evaluate the association of vitamin D status with weaning success and weaning failure patients. Methods: This prospective observational study was conducted at the ICU, Department of Anesthesia, Analgesia and Intensive Care medicine, BSMMU, Dhaka for a period of one year from 1st September, 2019 to 31st August, 2020. After ethical approval from Institutional Review Board (IRB), BSMMU; fifty (50) ICU patients receiving mechanical ventilation via endotracheal tube were enrolled according to inclusion and exclusion criteria. Informed written consents were taken before commencing the study. Patient demographics and clinical information were recorded in separate Case Record Form (CRF). The cumulative duration of mechanical ventilation after ICU admission was calculated and selected patients were observed for a maximum period of 28 days according to their length of mechanical ventilation and ICU stay. The patients who were successfully weaned and those who failed weaning trials or could not be weaned within 21 days of mechanical ventilation were recorded and their plasma 25-hydroxyvitamin D levels were measured. After collection of data, all data were compiled and analyzed in SPSS version 23. Results: Mean age of the study population was 49.44 (±11.63) years with a majority in the age group 46-60 years (48%). Among the total study population 56% patients were male and 44% patients were female. Mean value of vitamin D was 17.62 ±7.09 ng/mL and 54% of total patients had deficient vitamin D level. Of all the fifty patients, eighteen (36%) patients were successfully weaned and thirty two (64%) patients were failed to wean within 21 days. Thirteen (72.22%) patients from weaning successful group and ten (31.25%) patients from weaning unsuccessful group had sufficient vitamin D level whereas twenty two (68.75%) patients of weaning unsuccessful group and five (27.78%) patients from weaning successful group had deficient vitamin D level. Statistical significance was found in vitamin D level between two groups (p<0.05). Mean Vitamin D level was also significantly higher in patients who were successfully weaned (23.67±5.27) compared to those who failed to wean (14.22±5.57) (p value <0.05). Multivariate logistic regression analysis to determine the independent predictors of weaning failure showed that vitamin-D deficiency (<20 ng/mL) was the most powerful and independent predictors of weaning failure as it had highest odds ratio (OR=49.259, p value 0.005) compared age ≥40 years (OR=1.23, p value 0.825), male sex (OR=2.41, p value 0.355), DM (OR=3.46, p value 0.183) and HTN (OR=11.08, p value 0.042). Conclusion: In this study, plasma vitamin D level was found to be associated with the weaning status among critically ill patients who underwent prolonged mechanical ventilation. Patients with lower level of vitamin D tended towards weaning failure.

Keywords: Vitamin D, mechanical ventilation, immunomodulation, anti-proliferation.