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Paroxysmal Sympathetic Hyperactivity in Neurocritical Children: A Pilot Study
Shipra Agrwal1, Pallavi2, Urmila Jhamb2
1Department of Pediatrics, Army College of Medical Sciences, New Delhi, India.
Insights
Paroxysmal sympathetic hyperactivity (PSH) affects 9.2% of neurocritical children, leading to longer intensive care unit stays and mechanical ventilation. Early diagnosis and management are crucial for improving outcomes in these pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Neurocritical care
- Sympathetic nervous system disorders
Background:
- Paroxysmal sympathetic hyperactivity (PSH) is a condition of excessive sympathetic response following acute brain injury.
- Data on PSH in pediatric populations is limited.
- This study aimed to determine the incidence and outcomes of PSH in children admitted to the pediatric intensive care unit (PICU).
Observation:
- The study included 54 children (age 1 month to 12 years) admitted to a tertiary care PICU with neurocritical illnesses.
- The diagnostic criteria for PSH by Moeller et al. were used.
- Children declared brain dead were excluded.
Findings:
- The incidence of PSH was 9.2% (5/54 children).
- Children meeting all four PSH criteria experienced significantly longer mechanical ventilation durations, PICU stays, and higher PRISM III scores.
- Children with incomplete PSH also showed prolonged ventilation and PICU stay, without a significant difference in mortality.
Implications:
- PSH is a notable condition in children with neurological illnesses requiring PICU admission.
- PSH is associated with increased illness severity and resource utilization.
- Prompt diagnosis and targeted management of PSH are essential to potentially improve outcomes for critically ill children.
Background:
Paroxysmal sympathetic hyperactivity (PSH) is characterized by the abnormal excessive sympathetic response to acute cerebral insult. There is a paucity of data about this condition in children. This study was planned to analyze the incidence of PSH among children requiring neurocritical care and its association with the outcome.
Materials And Methods:
The study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital over a period of 10 months. Children of age 1 month to 12 years admitted with neurocritical illnesses were included. Children who were declared brain dead after initial resuscitation were excluded from the study. The criterion laid by Moeller et al. was used for the diagnosis for PSH.
Results:
During the study period, 54 children requiring neurocritical care were included in the study. The incidence of PSH was 5/54 (9.2%). Additionally, 30 (55.5%) children had less than four criteria for PSH and were termed as "incomplete PSH." Children with all four criteria for PSH had a significantly longer duration of mechanical ventilation, PICU stay, and higher PRISM III scores. Children with less than four criteria for PSH also had a longer duration of mechanical ventilation and stay. However, there was no significant difference in mortality.
Conclusion:
Paroxysmal sympathetic hyperactivity is common in children with neurological illnesses admitted to the PICU and is associated with longer mechanical ventilation and stay in PICU. They also had higher illness severity scores. Timely diagnosis of the condition and appropriate management is required to improve the outcome of these children.
How To Cite This Article:
Agrwal S, Pallavi, Jhamb U, Saxena R. Paroxysmal Sympathetic Hyperactivity in Neurocritical Children: A Pilot Study. Indian J Crit Care Med 2022;26(11):1204-1209.
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