Marco Pozzi1, Valentino Conti, Federica Locatelli, Sara Galbiati, Sonia Radice, Giuseppe Citerio, Emilio Clementi, Sandra Strazzer. 1. Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy (Drs Pozzi, Locatelli, Galbiati, Clementi, and Strazzer); Regional Centre for Pharmacovigilance of Lombardy, Milan, Italy (Dr Conti); Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Milan, Italy (Dr Radice); Neuroreanimation, AO San Gerardo, Monza, Italy (Dr Citerio); Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Milan, Italy (Dr Clementi) M.P. and V.C. contributed equally to the work.
Abstract
OBJECTIVE: Paroxysmal sympathetic hyperactivity (PSH) is widely described as occurring during intensive care, but in a number of patients it may last longer into the rehabilitation phase. Furthermore, drug therapy has been based on isolated observations. In this study, our aims are to describe a group of 26 pediatric rehabilitation patients with PSH and to quantify the effect of several drugs used to suppress PSH episodes. SETTING: Neurorehabilitation unit of IRCCS Eugenio Medea, Bosisio Parini (LC), Italy. PARTICIPANTS: A total of 407 pediatric patients with postacute acquired brain injury, 26 of which had PSH. DESIGN: Retrospective cohort study. MAIN MEASURES: Descriptive demographic and clinical data. Odds ratios quantification of the efficacy of drug therapies administered acutely to suppress PSH episodes. RESULTS: PSH was associated with a longer duration of coma and a greater incidence of death. When administered acutely to suppress PSH episodes, the best drugs were clonazepam, hydroxyzine, and delorazepam, while analgesic drugs showed little efficacy. CONCLUSIONS: PSH, whether causative or not, is associated with a worse long-term course in rehabilitation. Clinical management of PSH may be helped by a number of acutely administered drug therapies.
OBJECTIVE:Paroxysmal sympathetic hyperactivity (PSH) is widely described as occurring during intensive care, but in a number of patients it may last longer into the rehabilitation phase. Furthermore, drug therapy has been based on isolated observations. In this study, our aims are to describe a group of 26 pediatric rehabilitation patients with PSH and to quantify the effect of several drugs used to suppress PSH episodes. SETTING: Neurorehabilitation unit of IRCCS Eugenio Medea, Bosisio Parini (LC), Italy. PARTICIPANTS: A total of 407 pediatric patients with postacute acquired brain injury, 26 of which had PSH. DESIGN: Retrospective cohort study. MAIN MEASURES: Descriptive demographic and clinical data. Odds ratios quantification of the efficacy of drug therapies administered acutely to suppress PSH episodes. RESULTS: PSH was associated with a longer duration of coma and a greater incidence of death. When administered acutely to suppress PSH episodes, the best drugs were clonazepam, hydroxyzine, and delorazepam, while analgesic drugs showed little efficacy. CONCLUSIONS: PSH, whether causative or not, is associated with a worse long-term course in rehabilitation. Clinical management of PSH may be helped by a number of acutely administered drug therapies.