• Ali AbdelhamidYasmineYDiscipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia. yasmine.aliabdelhamid@mh.org.au., 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.
• Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia. yasmine.aliabdelhamid@mh.org.au.
• Crit Care Resusc. 2020 Mar 1; 22 (1): 536253-62.

ObjectivePostprandial 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.DesignProspective observational study.SettingTertiary medical-surgical ICU.ParticipantsOlder 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 MeasuresOn 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.ResultsOut 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%]).ConclusionsIn 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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