Abstract
BackgroundParoxysmal Sympathetic Hyperactivity (PSH) is a frequently observed condition among critically ill patients on intensive care units. According to different studies, PSH is associated with worse recovery and increased mortality in acute-care facilities. In this monocentric, retrospective case-control study, we investigated whether this association also applies to post-acute neurological early rehabilitation.MethodsThe study included n = 387 patients, admitted to an intensive care or intermediate care unit within 1 year (2016). Among these, 97 patients showed clinical signs of PSH. For each patient with PSH, a patient without PSH was identified, controlling for age, gender, functional and respiratory status upon admission. However, for 25 patients with PSH, there was no suitable control patient fulfilling all defined matching criteria. Primary outcome was type of discharge, dichotomized into favorable (follow-up rehabilitation) and unfavorable outcome (all others). Secondary outcome measures were functional and respiratory status, number of secondary diagnoses, duration of treatment interruptions and length of stay at discharge.ResultsAbout 25% of neurological early rehabilitation patients showed clinical signs of PSH. A young age (OR = 0.94; CI = 0.91–0.97) and less severe PSH symptoms (OR = 0.79; CI = 0.69–0.90) were independent predictors of a favorable outcome. In addition, severity of PSH symptoms was associated with weaning duration, while the occurrence of PSH symptoms alone had no influence on most secondary outcome variables. The treatment on intermediate care units proved to be longer for patients with PSH symptoms, only.ConclusionsPatients with PSH represent a large group of neurological early rehabilitation patients. Overall, we did not find PSH-related differences in most of the examined outcome measures. However, severe PSH symptoms seem to be associated with poorer outcome and longer treatment on intermediate care units, in order to prevent possible complications.
Highlights
Paroxysmal Sympathetic Hyperactivity (PSH) is a frequently observed condition among critically ill patients on intensive care units
While more patients without PSH symptoms were diagnosed with stroke (χ2 = 8.180, p = .004) or assigned to the category “other” (χ2 = 4.211, p = .040), patients with PSH symptoms tended to suffer more frequently from traumatic brain injuries (χ2 = 3.330, p = .068)
One hundred twenty patients were admitted to the intensive care unit (83.3%) and 24 patients (16.7%) to an intermediate care unit
Summary
Paroxysmal Sympathetic Hyperactivity (PSH) is a frequently observed condition among critically ill patients on intensive care units. Further minor symptoms such as myoclonus [1, 2], mydriasis [3], abdominal disorders (constipation or diarrhea) [4], hypersalivation, increased bronchial secretion, hyperactivity, psychomotor agitation [5], blood sugar and metabolic fluctuations [6], as well as flush and goose skin may be observed [2]. Due to this variety of symptoms, various terms have been used to describe this pathology over the last 25 years. The unifying term “Paroxysmal Sympathetic Hyperactivity” is used, which was proposed by an expert consensus group [1]
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