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Mesenteric blood flow, glucose absorption and blood pressure responses to small intestinal glucose in critically ill patients older than 65 years

Jennifer A. Sim| M. Horowitz| M. J. Summers| L. G. Trahair| R. S. Goud| A. V. Zaknic| T. Hausken| J. D. Fraser| M. J. Chapman| K. L. Jones| A. M. Deane
Original
Volume 39, Issue 2 / February , 2013

Pages 258 - 266

Abstract

Purpose

To compare nutrient-stimulated changes in superior mesenteric artery (SMA) blood flow, glucose absorption and glycaemia in individuals older than 65 years with, and without, critical illness.

Methods

Following a 1-h ‘observation’ period (t0t60), 0.9 % saline and glucose (1 kcal/ml) were infused directly into the small intestine at 2 ml/min between t60t120, and t120t180, respectively. SMA blood flow was measured using Doppler ultrasonography at t60 (fasting), t90 and t150 and is presented as raw values and nutrient-stimulated increment from baseline (Δ). Glucose absorption was evaluated using serum 3-O-methylglucose (3-OMG) concentrations during, and for 1 h after, the glucose infusion (i.e. t120t180 and t120t240). Mean arterial pressure was recorded between t60t240. Data are presented as median (25th, 75th percentile).

Results

Eleven mechanically ventilated critically ill patients [age 75 (69, 79) years] and nine healthy volunteers [70 (68, 77) years] were studied. The magnitude of the nutrient-stimulated increase in SMA flow was markedly less in the critically ill when compared with healthy subjects [Δt150: patients 115 (−138, 367) versus health 836 (618, 1,054) ml/min; P = 0.001]. In patients, glucose absorption was reduced during, and for 1 h after, the glucose infusion when compared with health [AUC120–180: 4.571 (2.591, 6.551) versus 11.307 (8.447, 14.167) mmol/l min; P < 0.001 and AUC120–240: 26.5 (17.7, 35.3) versus 40.6 (31.7, 49.4) mmol/l min; P = 0.031]. A close relationship between the nutrient-stimulated increment in SMA flow and glucose absorption was evident (3-OMG AUC120–180 and ∆SMA flow at t150: r2 = 0.29; P < 0.05).

Conclusions

In critically ill patients aged >65 years, stimulation of SMA flow by small intestinal glucose infusion may be attenuated, which could account for the reduction in glucose absorption.

Keywords

References

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