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The use of the PSH-AM in patients with diffuse axonal injury and autonomic dysregulation: A cohort study and review.

Abstract：

PURPOSE:1) To determine the clinical expression and consequences of autonomic dysregulation in patients with diffuse axonal injury (DAI), and 2) to study the use of the "paroxysmal sympathetic hyperactivity assessment measure" (PSH-AM). METHODS:Patients clinically diagnosed with autonomic dysregulation were selected from a cohort involving 116 patients with DAI. We studied the incidence of autonomic features, treatment, and outcome. In addition a systematic review was performed. RESULTS:Autonomic dysregulation was diagnosed in 19 of 116 (16.4%). Lower age (OR 0.95) and higher DAI grade (OR 7.2) were risk factors for autonomic dysregulation. Autonomic dysregulation was associated with an unfavourable outcome (OR 5.6) and a longer ICU and hospital stay. On the PSH-AM 57.9% (n = 11) scored a probable paroxysmal sympathetic hyperactivity (PSH), 36.8% (n = 7) scored possible, and 5.2% (n = 1) scored unlikely. The review yielded 30 articles. The incidence of autonomic dysregulation after TBI varied from 7.7-32.6% (mean 13.5%). TBI patients with autonomic dysregulation had a longer ICU stay and poorer outcome. CONCLUSION:Patients with DAI and autonomic dysregulation had a longer ICU stay and a poorer outcome compared to patients without autonomic dysregulation. The PSH-AM is a potential valuable tool to determine the likelihood of autonomic dysregulation.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

van Eijck MM,Sprengers MOP,Oldenbeuving AW,de Vries J,Schoonman GG,Roks G

doi

10.1016/j.jcrc.2018.10.018

subject

Has Abstract

pub_date

2019-02-01 00:00:00

pages

110-117

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(18)30514-8

journal_volume

49

pub_type

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