Paroxysmal sympathetic hyperactivity in the neurological intensive care unit

Area of Science:

• Neurology
• Critical Care Medicine
• Neurocritical Care

Background:

• Febrile patients in neurological intensive care units (NICUs) may experience paroxysmal sympathetic hyperactivity (PSH).
• PSH is characterized by transient episodes of fever, tachycardia, hypertension, tachypnea, diaphoresis, and abnormal posturing.
• Understanding PSH incidence and associations is crucial for managing acute neurological conditions.

Purpose of the Study:

• To determine the incidence of PSH in febrile patients within a neurocritical care unit.
• To identify factors associated with PSH, particularly in patients with traumatic brain injury (TBI).

Main Methods:

• Prospective data collection from 93 patients admitted to an academic NICU for over 48 hours.
• Fever defined as temperature >38.3°C for two consecutive days.
• PSH diagnosed based on specific clinical criteria in the absence of other causes.

Main Results:

• PSH was diagnosed in 18% of patients (17/93).
• PSH occurred in 33% of TBI patients versus 6% of patients with other neurological conditions (p=0.01).
• PSH patients had a significantly longer duration of fever (mean 10.5 days vs. 5.1 days, p<0.001).

Conclusions:

• PSH episodes are common in TBI patients (one-third) but infrequent in other acute neurological conditions.
• PSH is more prevalent in younger patients and associated with prolonged fever.
• These findings highlight the importance of recognizing PSH in TBI management.