How does dysautonomia influence the outcome of traumatic brain injured patients admitted in a neurorehabilitation unit?

Abstract

Functional status is similar and PSH does not appear to influence recovery during the rehabilitation, although PSH patients are more likely to undergo psychoactive medications and special care is needed to approach their caregivers that perceive PSH as a complication for rehabilitation.

Paroxysmal sympathetic hyperactivity: the storm after acute brain injury

“…7 In a dedicated institute for patients in a vegetative state, a diagnosis of 'dysautonomia' was associated with a worse Glasgow Outcome Scale (GOS) in both TBI and non-TBI patients in two studies separated by 5 years. 21,27 A similar association with prolonged hospitalization and worse clinical outcome was described in a Chinese study, 26 but other studies reported less consistent impact on hospitalization outcomes, such as duration of mechanical ventilation, or ICU, hospital, or rehabilitation length of stay (LoS); and no effect on long-term neurological outcome 8,9,30,31 . The results of these studies are summarized in Table 2.…”

Association between Paroxysmal Sympathetic Hyperactivity and tracheostomy weaning in Traumatic Brain Injury

“…These episodes can occur either spontaneously or triggered by stimulus such as touch, pain or constipation (Perkes, 2010). The incidence of PSH is thought to be around 10 -30% in severe brain injury (Laxe, 2013, Hughes, 2013and Fernandez-Orlego, 2012. The diagnosis can be chal- lenging; a recent consensus statement has attempted to clarify nomenclature and diagnostic criteria (Baguley, 2014).…”

Paroxysmal Sympathetic Hyperactivity

“…Rates ranging from 8 to 33% have been reported among various cohorts of patients with severe TBI. 5,8,[11][12][13][14][15] These studies have varied in the type of population included, the time of the clinical assessment, the diagnostic criteria used to make the diagnosis of PSH, and the specific clinical setting (intensive care unit [ICU] vs. rehabilitation unit). A consistent finding has been that PSH is more frequent in young and comatose patients.…”

“…Use of antipsychotic medications typically used for agitation can be detrimental and should be avioded. 13 Mechanical measures and antipyretics should be used to mitigate the fever, which may be refractory to these interventions. The tachypnea during the episodes of PSH can produce hyperventilation and hypocapnia, which in turn may provoke cerebral vasoconstriction and hypoperfusion.…”

“…35 Yet, it is unclear whether this association of PSH with worse prognosis is due to the preferential occurrence of PSH in patients with more severe brain injury (in which case PSH would be only a surrogate marker for disease severity rather than a factor influencing the prognosis per se) or to a direct detrimental effect of PSH on prognosis. Patients with PSH have longer lengths of hospital stay 13,36 and higher rates of tracheostomy. 36 They also have increased risks of delayed complications, including profound weight loss, 28 heterotopic ossification, 37 and muscle contractures that may hamper rehabilitation efforts.…”