At the time of submission, Elizabeth A. Shald was a fourth-year pharmacy student at the University of Florida College of Pharmacy, Jacksonville, Florida.
Jacob Reeder is a critical care clinical pharmacy specialist, Wesley Medical Center, Wichita, Kansas.
Crit Care Nurse. 2020 Jun 1;40(3):e9-e16. doi: 10.4037/ccn2020348.
Paroxysmal sympathetic hyperactivity, which affects up to 10% of all acquired brain injury survivors, is characterized by elevated heart rate, blood pressure, respiratory rate, and temperature; diaphoresis; and increased posturing. Pharmacological agents that have been studied in the management of this disorder include opiates, γ-aminobutyric acid agents, dopaminergic agents, and β blockers. Although paroxysmal sympathetic hyperactivity is a relatively common complication after acquired brain injury, there is a paucity of recommendations or comparisons of agents for the management of this disorder.
To evaluate all relevant literature on pharmacological therapies used to manage patients with paroxysmal sympathetic hyperactivity to help elucidate possible best practices.
Of the 27 studies evaluated for inclusion, 10 studies received full review: 4 retrospective cohort studies, 5 single case studies, and 1 case series.
Monotherapy is usually not effective in the management of paroxysmal sympathetic hyperactivity and multiple agents with different mechanisms of action should be considered. α2-Agonists such as dexmedetomidine may hold some slight clinical efficacy over agents like propofol, and with respect to oral medications, propranolol might convey some slight advantage compared to others. However, with the limited data available, these results must be interpreted with caution.
As the treatment of paroxysmal sympathetic hyperactivity is reactive to symptomatic evolution over time, critical care nurses play a vital role in the monitoring and treatment of these patients. Limited data exist on the management of paroxysmal sympathetic hyperactivity and larger robust data sets are needed to guide decision-making. (Critical Care Nurse. 2020;40[3]:e9-e16).
阵发性交感神经过度兴奋影响高达 10%的所有获得性脑损伤幸存者，其特征是心率、血压、呼吸频率和体温升高；出汗；姿势增加。在管理这种疾病时研究过的药物包括阿片类药物、γ-氨基丁酸药物、多巴胺能药物和β受体阻滞剂。尽管阵发性交感神经过度兴奋是获得性脑损伤后的一种相对常见的并发症，但对于这种疾病的管理药物，建议或比较很少。
评估所有关于用于治疗阵发性交感神经过度兴奋患者的药理学治疗的相关文献，以帮助阐明可能的最佳实践。
在评估纳入的 27 项研究中，有 10 项研究进行了全面审查：4 项回顾性队列研究、5 项单病例研究和 1 项病例系列研究。
单药治疗通常不能有效治疗阵发性交感神经过度兴奋，应考虑使用具有不同作用机制的多种药物。α2-激动剂，如右美托咪定，可能比丙泊酚等药物具有稍好的临床疗效，而在口服药物方面，与其他药物相比，普萘洛尔可能具有稍好的优势。然而，由于可用数据有限，这些结果必须谨慎解释。
由于阵发性交感神经过度兴奋的治疗是对随时间变化的症状演变的反应，因此重症监护护士在这些患者的监测和治疗中起着至关重要的作用。阵发性交感神经过度兴奋的管理数据有限，需要更大的稳健数据集来指导决策。（危重病护士。2020；40[3]：e9-e16）。
