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World J Crit Care Med. Feb 4, 2017; 6(1): 28-36
Published online Feb 4, 2017. doi: 10.5492/wjccm.v6.i1.28
Nutrient stimulation of mesenteric blood flow - implications for older critically ill patients
Thu AN Nguyen, Yasmine Ali Abdelhamid, Liza K Phillips, Leeanne S Chapple, Michael Horowitz, Karen L Jones, Adam M Deane
Thu AN Nguyen, Yasmine Ali Abdelhamid, Leeanne S Chapple, Adam M Deane, Discipline of Acute Care Medicine, University of Adelaide, Adelaide 5005, Australia
Liza K Phillips, Michael Horowitz, Karen L Jones, Adam M Deane, National Health and Medical Research Council Centre for Research Excellence in Translating Nutritional Science to Good Health, Adelaide 5000, Australia
Liza K Phillips, Michael Horowitz, Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, Australia
Liza K Phillips, Michael Horowitz, Karen L Jones, Discipline of Medicine, University of Adelaide, Adelaide 5005, Australia
Adam M Deane, Intensive Care Unit, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050, Australia
Author contributions: All authors equally contributed to this paper including conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Adam M Deane, MBBS, PhD, Intensive Care Unit, Royal Melbourne Hospital, University of Melbourne, 300 Grattan Street, Parkville, Victoria 3050, Australia. adam.deane@adelaide.edu.au
Telephone: +61-3-93429234
Received: August 26, 2016
Peer-review started: August 27, 2016
First decision: December 13, 2016
Revised: December 16, 2016
Accepted: January 2, 2017
Article in press: January 3, 2017
Published online: February 4, 2017
Processing time: 149 Days and 4.3 Hours
Abstract

Nutrient ingestion induces a substantial increase in mesenteric blood flow. In older persons (aged ≥ 65 years), particularly those with chronic medical conditions, the cardiovascular compensatory response may be inadequate to maintain systemic blood pressure during mesenteric blood pooling, leading to postprandial hypotension. In older ambulatory persons, postprandial hypotension is an important pathophysiological condition associated with an increased propensity for syncope, falls, coronary vascular events, stroke and death. In older critically ill patients, the administration of enteral nutrition acutely increases mesenteric blood flow, but whether this pathophysiological response is protective, or precipitates mesenteric ischaemia, is unknown. There are an increasing number of older patients surviving admission to intensive care units, who are likely to be at increased risk of postprandial hypotension, both during, and after, their stay in hospital. In this review, we describe the prevalence, impact and mechanisms of postprandial hypotension in older people and provide an overview of the impact of postprandial hypotension on feeding prescriptions in older critically ill patients. Finally, we provide evidence that postprandial hypotension is likely to be an unrecognised problem in older survivors of critical illness and discuss potential options for management.

Keywords: Postprandial hypotension; Enteral nutrition; Critical care; Aged; Mesenteric ischaemia

Core tip: In older ambulatory persons, postprandial hypotension is an important pathophysiological condition associated with an increased propensity to coronary vascular events, stroke and death. In older critically ill patients, the administration of enteral nutrition acutely increases mesenteric blood flow, but whether this pathophysiological response is protective, or precipitates mesenteric ischaemia, is unknown. We herein describe the prevalence, impact and mechanisms and management of postprandial hypotension in older people. We finally provide an overview of the impact of postprandial hypotension on feeding prescriptions in and evidence that postprandial hypotension is likely to be an unrecognised problem in older survivors of critical illness.