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Paroxysmal sympathetic hyperactivity: Autonomic instability and muscle over-activity following severe brain injury
Lisa Letzkus1,2, Jessica Keim-Malpass1, Christine Kennedy1
1a University of Virginia School of Nursing.
Insights
Paroxysmal sympathetic hyperactivity (PSH) in children with brain injury is poorly understood. More research is needed to determine if PSH impacts pediatric outcomes differently than in adults.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Autonomic Dysfunction
Background:
- Children with moderate-to-severe brain injury may develop paroxysmal sympathetic hyperactivity (PSH).
- PSH is characterized by autonomic instability and symptoms like fever, hypertension, tachycardia, and agitation.
- Adult studies link PSH to poorer clinical outcomes, but pediatric data is limited.
Purpose of the Study:
- To conduct a literature review on PSH following severe brain injury.
- To identify research gaps concerning PSH in pediatric populations.
Main Methods:
- A comprehensive search of electronic databases was performed.
- Included CINAHL, Ovid Medline, Web of Science, and Google Scholar.
- Thirty-one research articles were selected for review.
Main Results:
- Key themes identified include nomenclature, symptoms, management, and pediatric-adult differences.
- Most existing research on PSH is descriptive.
- Few studies specifically investigate PSH in pediatric brain injury.
Conclusions:
- There is a significant knowledge gap regarding PSH in children with brain injury.
- Further research is essential to understand if PSH affects pediatric outcomes differently.
- Clarifying the impact of PSH on children's long-term function is a critical research need.
Background:
Children who suffer from moderate-to-severe brain injury can develop a complicating phenomenon known as paroxysmal sympathetic hyperactivity (PSH), characterized by autonomic instability and identified clinically as a cluster of symptoms that can include recurrent fever without a source of infection, hypertension, tachycardia, tachypnea, agitation, diaphoresis and dystonia. Studies with adults have demonstrated that this cluster of symptoms is associated with poorer clinical outcomes (prolonged hospitalizations, poorer cognitive and motor function). However, there have been limited studies in children with PSH.
Objective:
To present a literature review regarding PSH following severe brain injury and highlight research needs in children with PSH.
Methodology:
Electronic databases (CINAHL, Ovid Medline, Web of Science and Google Scholar) were searched.
Results:
Thirty-one research articles met the criteria for inclusion. Several themes emerged regarding the phenomenon of interest during the review: nomenclature, symptoms, management and differences between children and adults.
Implications:
The majority of the research regarding PSH following severe brain injury has been descriptive in nature. Few studies, however, have explored PSH in children with brain injury; therefore, little is known about whether the outcomes of children with PSH are different and, if so, in what ways.
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