Ask an answerable question (PICO)：
It is common for critically ill patients with Vitamin D deficiency in the intensive care unit. Vitamin D is the endocrine hormone for human immune regulation, antibacterial, inflammatory suppression, and balance of calcium and phosphorus. Vitamin D deficiency in critically ill patients may be related to in-hospital mortality and prognosis. In order to find out whether high dosage Vitamin D administration reduce the mortality of critically ill patients in intensive care unit, we searched for empirical literature to investigate whether high-dose vitamin D administration in critically ill patients can improve mortality.
The Method and Analysis of Literature Review：
Based on the evidence, the five steps form an answerable question: “Does Vitamin D Administration improve Mortality in Critically ill patient?” The PICOs as below are P: Critically ill, I: Vitamin D, C: none or placebo and O: Mortality. PICO keywords, synonyms, MeSH term and Boolean logic were used to search for Chinese and English data before August 31, 2022 in, PubMed, CINAHL/MEDLINE, Cochrane library and Hua Yi online library. The literature was based on systematic review (SR) and randomized controlled trials (RCT) with English and Chinese literature. Initially, 182 studies were searched, duplicates were removed, titles and abstracts were read, and 3 RCTs were finally included for review.
Critical Appraisal：
The new version of CASP was used for literature review. and the CEBM evidence level of the three RCTs was 2B (therapeutic type). All three articles were met the settings of PICO. High-dose vitamin D was given through gastrointestinal tract after intervention group transfer to ICU, and the control group was given placebo. Three studies were conducted with no selection bias or attrition bias in their study designs, while only one study did not mention any relevant discussions on implementing double-blind procedures. The p-value of mortality rates were p >.05, showing that taking vitamin D in critically ill patients did not significantly reduce mortality.
Results, Conclusions and Recommendations：
There is no significant differences for critically ill patient taking Vitamin D as soon as possible after admitted in the ICU to improve mortality but significantly increased the serum 25(OH)D level. It was significant difference in need for tracheostomy for patient with severe Vitamin D deficiency <12ng/dl taking high-dose Vitamin D. Also, high-dose Vitamin D administration could result in gastrointestinal uncomfortable and economic burden. We suggest Self–paid Vitamin D given when poor response by treating as Clinical guideline and protocol.
Therefore, through empirical literature search, there is not enough evidence to support that Vitamin D can improve mortality. We look forward to more rigorous clinical randomized trials for our reference in the future.
