https://orcid.org/0000-0002-1749-2780The Association Between Preoperative Single High-Dose Vitamin D3 Supplementation and Acute Respiratory Distress Syndrome Incidence In Patients After Oesophageal Resection For Carcinoma: A Randomised, Placebo-Contr

This randomised controlled trial (RCT) evaluated whether preoperative supplementation with 300,000 IU of cholecalciferol could reduce the risk of acute respiratory distress syndrome (ARDS) in patients undergoing oesophagectomy for carcinoma. Oesophagectomy carries substantial postoperative morbidity, particularly respiratory complications, with ARDS as the most severe form. Vitamin D has anti-inflammatory and endothelial-protective effects that may mitigate such injury. From January 2019 to June 2022, we conducted a single-centre RCT including 80 patients scheduled for oesophagectomy. Participants were randomly assigned to receive 300,000 IU of oral cholecalciferol or placebo before surgery. The primary outcome was whether supplementation reduced ARDS, assessed using the extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) at three time points: preoperatively after catheter insertion, within 1 h postoperatively, and on postoperative day one. Mean EVLWI differences between the cholecalciferol and placebo groups after catheterisation, within one hour postoperatively, and on postoperative day one were 0.3 (95% CI − 0.3 to 0.9, P = 0.384), 0.3 (95% CI − 0.5 to 0.9, P = 0.442), and 0.2 (95% CI − 1.1 to 0.7, P = 0.739). Corresponding PVPI differences were 0.1 (95% CI − 0.1 to 0.2, P = 0.240), 0 (95% CI − 0.2 to 0.2, P = 0.757), and − 0.1 (95% CI − 0.3 to 0.1, P = 0.438). A single high dose of cholecalciferol safely improved preoperative vitamin D status but did not reduce ARDS incidence. Nonetheless, potential immunological benefits associated with improved 25(OH)D levels remain plausible and warrant further investigation.