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

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dc.contributor.authorAli Abdelhamid, Y.
dc.contributor.authorWeinel, L.M.
dc.contributor.authorHatzinikolas, S.
dc.contributor.authorSummers, M.
dc.contributor.authorNguyen, T.A.N.
dc.contributor.authorKar, P.
dc.contributor.authorPhillips, L.K.
dc.contributor.authorHorowitz, M.
dc.contributor.authorDeane, A.M.
dc.contributor.authorJones, K.L.
dc.date.issued2020
dc.description.abstractObjective: 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.
dc.description.statementofresponsibilityYasmine Ali Abdelhamid, Luke M. Weinel, Seva Hatzinikolas, Matthew Summers, Thu Anh Ngoc Nguyen, Palash Kar, Liza K. Phillips, Michael Horowitz, Adam M. Deane, and Karen L. Jones
dc.identifier.citationCritical Care and Resuscitation, 2020; 22(1):53-62
dc.identifier.doi10.51893/2020.1.oa6
dc.identifier.issn1441-2772
dc.identifier.issn1441-2772
dc.identifier.orcidAli Abdelhamid, Y. [0000-0002-3340-1965]
dc.identifier.orcidWeinel, L.M. [0000-0001-7713-1170]
dc.identifier.orcidPhillips, L.K. [0000-0002-9066-717X]
dc.identifier.orcidHorowitz, M. [0000-0002-0942-0306]
dc.identifier.orcidDeane, A.M. [0000-0002-7620-5577]
dc.identifier.orcidJones, K.L. [0000-0002-1155-5816]
dc.identifier.urihttps://hdl.handle.net/2440/145899
dc.language.isoen
dc.publisherCollege of Intensive Care Medicine of Australia and New Zealand
dc.rights© 2020 College of Intensive Care Medicine of Australia and New Zealand. CC BY-NC-ND 4.0 Attribution-NonCommercial-NoDerivatives 4.0 International
dc.source.urihttps://doi.org/10.51893/2020.1.oa6
dc.subjectPostprandial hypotension; critical illness; gastric dysmotility; cardiovascular autonomic dysfunction; critical illness recovery; intensive care unit
dc.subject.meshAutonomic Nervous System
dc.subject.meshHumans
dc.subject.meshAutonomic Nervous System Diseases
dc.subject.meshHypotension
dc.subject.meshCritical Illness
dc.subject.meshFollow-Up Studies
dc.subject.meshProspective Studies
dc.subject.meshAccidental Falls
dc.subject.meshBlood Pressure
dc.subject.meshPostprandial Period
dc.subject.meshQuality of Life
dc.subject.meshAged
dc.subject.meshFemale
dc.subject.meshMale
dc.titleAutonomic function, postprandial hypotension and falls in older adults at one year after critical illness.
dc.typeJournal article
pubs.publication-statusPublished

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