Postprandial hypotension in older survivors of critical illness

J Crit Care. 2018 Jun;45:20-26. doi: 10.1016/j.jcrc.2018.01.012. Epub 2018 Jan 31.

Abstract

Purpose: In older people postprandial hypotension occurs frequently; and is an independent risk factor for falls, cardiovascular events, stroke and death. The primary aim of this pilot study was to estimate the frequency of postprandial hypotension and evaluate the mechanisms underlying this condition in older survivors of an Intensive Care Unit (ICU).

Materials and methods: Thirty-five older (>65 years) survivors were studied 3 months after discharge. After an overnight fast, participants consumed a 300 mL drink containing 75 g glucose, labelled with 20 MBq 99mTc-calcium phytate. Patients had concurrent measurements of blood pressure, heart rate, blood glucose and gastric emptying following drink ingestion. Proportion of participants is presented as percent (95% CI) and continuous variables as mean (SD).

Results: Postprandial hypotension was evident in 10 (29%; 95% CI 14-44), orthostatic hypotension in 2 (6%; 95% CI 0-13) and cardiovascular autonomic dysfunction in 2 (6%; 95% CI 0-13) participants. The maximal postprandial nadir for systolic blood pressure and diastolic blood pressures were -29 (14) mmHg and -18 (7) mmHg.

Conclusions: In this cohort of older survivors of ICU postprandial hypotension occurred frequently . This suggests that postprandial hypotension is an unrecognised issue in older ICU survivors.

Keywords: Aged; Critical illness; Frail elderly; Gastrointestinal motility; Hypotension; Postprandial period.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Autonomic Nervous System / physiopathology*
  • Critical Illness / rehabilitation*
  • Female
  • Gastric Emptying / physiology*
  • Humans
  • Hypotension / etiology*
  • Hypotension / physiopathology
  • Male
  • Pilot Projects
  • Postprandial Period / physiology*
  • Risk Factors
  • Survivors / statistics & numerical data*