Autonomic function, postprandial hypotension and falls in older adults at one year after critical illness

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    Author
    Ali Abdelhamid, Y; Weinel, LM; Hatzinikolas, S; Summers, M; Nguyen, TAN; Kar, P; Phillips, LK; Horowitz, M; Deane, AM; Jones, KL
    Date
    2020-03
    Source Title
    Critical Care and Resuscitation
    Publisher
    College of Intensive Care Medicine of Australia and New Zealand
    University of Melbourne Author/s
    Deane, Adam; Ali Abdelhamid, Yasmine
    Affiliation
    Medicine (RMH)
    Critical Care
    Metadata
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    Document Type
    Journal Article
    Citations
    Ali Abdelhamid, Y., Weinel, L. M., Hatzinikolas, S., Summers, M., Nguyen, T. A. N., Kar, P., Phillips, L. K., Horowitz, M., Deane, A. M. & Jones, K. L. (2020). Autonomic function, postprandial hypotension and falls in older adults at one year after critical illness. Critical Care and Resuscitation, 22 (1), pp.53-62. https://doi.org/10.51893/2020.1.oa6.
    Access Status
    This item is currently not available from this repository
    URI
    http://hdl.handle.net/11343/257785
    DOI
    10.51893/2020.1.oa6
    Abstract
    OBJECTIVE: Postprandial hypotension occurs frequently in older survivors of critical illness at 3 months after discharge. We aimed to determine whether postprandial hypotension and its predictors - gastric dysmotility and cardiovascular autonomic dysfunction - persist or resolve as older survivors of critical illness recover, and whether postprandial hypotension after intensive care unit (ICU) discharge is associated with adverse outcomes at 12 months. DESIGN: Prospective observational study. SETTING: Tertiary medical-surgical ICU. PARTICIPANTS: Older adults (aged ≥ 65 years) who had been studied 3 months after ICU discharge and who returned for a follow-up study at 12 months after discharge. MAIN OUTCOME MEASURES: On both occasions after fasting overnight, participants consumed a 300 mL drink containing 75 g glucose, radiolabelled with 20 MBq 99mTcphytate. Blood pressure, heart rate, blood glucose concentration and gastric emptying rate were measured concurrently before and after ingestion of the drink. Falls, quality of life, hospitalisation and mortality rates were also quantified. RESULTS: Out of 35 older adults studied at 3 months, 22 returned for the follow-up study at 12 months. Postprandial hypotension was evident in 29% of participants (95% CI, 14-44%) at 3 months and 10% of participants (95% CI, 1-30%) at 12 months. Postprandial hypotension at 3 months was associated with a more than threefold increase in the risk of falls in the year after ICU discharge (relative risk, 3.7 [95% CI, 1.6-8.8]; P = 0.003). At 12 months, gastric emptying was normal (mean time taken for 50% of gastric contents to empty, 101.6 [SD, 33.3] min) and cardiovascular autonomic dysfunction prevalence was low (9% [95% CI, 1-29%]). CONCLUSIONS: In older adults who were evaluated 3 and 12 months after ICU discharge, postprandial hypotension at 3 months was associated with an increased risk of subsequent falls, but the prevalence of postprandial hypotension decreased with time.

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