The preventive effect of dexmedetomidine on paroxysmal sympathetic hyperactivity in severe traumatic brain injury patients who have undergone surgery: a retrospective study

Abstract

BackgroundParoxysmal sympathetic hyperactivity (PSH) results and aggravates in secondary brain injury, which seriously affects the prognosis of severe traumatic brain injury patients. Although several studies have focused on the treatment of PSH, few have concentrated on its prevention.MethodsNinety post-operation (post-op) severe traumatic brain injury (sTBI) patients admitted from October 2014 to April 2016 were chosen to participate in this study. Fifty of the post-op sTBI patients were sedated with dexmedetomidine and were referred as the “dexmedetomidine group” (admitted from May 2015 to April 2016). The other 40 patients (admitted from October 2014 to May 2015) received other sedations and were referred as the “control group.” The two groups were then compared based on their PSH scores and the scores and ratios of those patients who met the criteria of “probable,” “possible” and “unlikely” using the PSH assessment measure (PSH-AM) designed by Baguley et al. (2014). The durations of the neurosurgery intensive care unit (NICU) and hospital stays and the Glasgow outcome scale (GOS) values for the two groups were also compared to evaluate the therapeutic effects and the patients’ prognosis.ResultsThe overall PSH score for the dexmedetomidine group was 5.26 ± 4.66, compared with 8.58 ± 8.09 for the control group. The difference between the two groups’ PSH scores was significant (P = 0.017). The score of the patients who met the criterion of “probable” was 18.33 ± 1.53 in the dexmedetomidine group and 22.63 ± 2.97 in the control group, and the difference was statistically significant (P = 0.045). The ratio of patients who were classified as “unlikely” between the two groups was statistically significant (P = 0.028); that is, 42 (84%) in the dexmedetomidine group and 25 (62.5%) in the control group. The differences in NICU, hospital stays and GOS values between the two groups were not significant.ConclusionDexmedetomidine has a preventive effect on PSH in sTBI patients who have undergone surgery.

Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury

“…However, an entirely persuasive meta-analysis is not possible because of heterogeneity and poorly documented published data (3). There are several limitations of systematic pharmacologic studies: (1) the lack of advice on the distribution and metabolic effects of administration route, form, or dose, (2) few have concentrated on the prevention of PSH in TBI patients, and (3) results may not be generalizable due to heterogeneity of the sample population and the absence of adequate statistical power or long-term follow-up data after discharge (3,19,66,80). In view of the above, the focus of ongoing clinical trials is to increase data reliability through multicenter studies, balancing the effects and side effects of the different medications, thus providing results that are useful in clinical practice (3,4,87).…”

“…Widely used in the intensive care unit to alleviate pain and anxiety, maintain the stability of hemodynamics, with less respiratory depression without requirement for mechanical ventilation, easy to wake patients up to judge the consciousness state, can be used as a preventive drug for PSH in TBI patients (66,80,81).…”

Effects of dexmedetomidine vs sufentanil during percutaneous tracheostomy for traumatic brain injury patients

“…[24] Previous research on TBI patients treated with either DEX or propofol/midazolam found no significant between-group differences regarding the proportions of patients who met the “probable” or “possible” criteria, but more patients met the “unlikely” criteria in the DEX group compared to the propofol/midazolam group. [25] There have been no studies comparing the effect of DEX vs sufentanil on the alleviation of PSH episodes in TBI patients.…”

Paroxysmal Sympathetic Hyperactivity after Cardiac Arrest in a Young Male

“…Dexmedetomidine, another presynaptic alpha 2 agonist, has been shown to be effective and in some reports even more effective than propofol in acute attacks [ 18 ]. Tang et al showed that dexmedetomidine can prevent the occurrence of PSH after TBI [ 19 ].…”