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Sympathetic Activation

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The sympathetic division can influence tissues and organs by releasing norepinephrine at peripheral synapses and distributing epinephrine and norepinephrine through the bloodstream. In times of crisis or stress, sympathetic activation occurs, which is regulated by sympathetic centers in the hypothalamus. As a result, sympathetic activation prepares the body for physical exertion, rapid ATP production, and heightened alertness, allowing individuals to respond effectively to challenging or...

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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.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine

|March 6, 2023

Summary

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.

Keywords:

Autonomic dysfunction Incomplete paroxysmal sympathetic hyperactivity Neurocritical illness Paroxysmal sympathetic hyperactivity Traumatic brain injury

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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.