Paroxysmal Sympathetic Hyperactivity in Neurocritical Children: A Pilot Study

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.