Pharmacological Treatment for Paroxysmal Sympathetic Hyperactivity

Abstract

Background Paroxysmal sympathetic hyperactivity, which affects up to 10% of all acquired brain injury survivors, is characterized by elevated heart rate, blood pressure, respiratory rate, and temperature; diaphoresis; and increased posturing. Pharmacological agents that have been studied in the management of this disorder include opiates, γ-aminobutyric acid agents, dopaminergic agents, and β blockers. Although paroxysmal sympathetic hyperactivity is a relatively common complication after acquired brain injury, there is a paucity of recommendations or comparisons of agents for the management of this disorder. Objective To evaluate all relevant literature on pharmacological therapies used to manage patients with paroxysmal sympathetic hyperactivity to help elucidate possible best practices. Methods Of the 27 studies evaluated for inclusion, 10 studies received full review: 4 retrospective cohort studies, 5 single case studies, and 1 case series. Results Monotherapy is usually not effective in the management of paroxysmal sympathetic hyperactivity and multiple agents with different mechanisms of action should be considered. α2-Agonists such as dexmedetomidine may hold some slight clinical efficacy over agents like propofol, and with respect to oral medications, propranolol might convey some slight advantage compared to others. However, with the limited data available, these results must be interpreted with caution. Conclusions As the treatment of paroxysmal sympathetic hyperactivity is reactive to symptomatic evolution over time, critical care nurses play a vital role in the monitoring and treatment of these patients. Limited data exist on the management of paroxysmal sympathetic hyperactivity and larger robust data sets are needed to guide decision-making. (Critical Care Nurse. 2020;40[3]:e9-e16)

Effectiveness of Pharmacological Agents and Validation of Diagnostic Scales for the Management of Paroxysmal Sympathetic Hyperactivity in Hispanics

“…The patients presented here ranged from five (5) to seventy (70) years old. Similar to what has been recently reported in the literature ( 12 , 15 ), the effectiveness of pharmacological agents to treat PSH symptoms was heterogeneous across patients. Additionally, the number of medications used did not correlate to the severity of PSH, as contrasted against the PSH likelihood score.…”

“…In addition, there might be a significant lack of recognition of PSH by medical personnel ( 28 ). Increased education to critical care nurses ( 15 ), and doctors involved in the treatment of patients at risk of developing PSH should prove effective in regards to identification and treatment. Early identification and treatment could lead to reduced morbidity and mortality ( 28 ).…”

“…Previous research has discussed the inefficacy of monotherapy for the management of PSH ( 15 ). The main indication of opioids is for pain management, but it also helps in controlling hypertension and tachycardia in patients with PSH.…”

Methods of Labor Analgesia by Determing the Level of Childbirth Satisfaction

“…Якщо морфін неефективний для припинення епізоду, це повинно свідчити про можливість альтернативного діагнозу. Фентаніл може запропонувати перевагу швидшого початку в дозах 25-100 мкг внутрішньовенно [6].…”

Paroxysmal Sympathetic Hyperactivity Syndrome (Review)

“…Медикаментозное лечение, по данным зарубежных авторов, начинается, как правило, с симптоматической терапии: β-адреноблокаторы (β-АБ), габапентин, бензодиазепины, вальпроаты [10,19,33,[54][55][56][57][58][59][60][61]. При отсутствии эффекта предлагается переход к непрерывному введению опиоидов и пропофола.…”