Pharmacological Treatment for Paroxysmal Sympathetic Hyperactivity.

BACKGROUND: 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 ß 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. OBJECTIVE: To evaluate all relevant literature on pharmacological therapies used to manage patients with paroxysmal sympathetic hyperactivity to help elucidate possible best practices. METHODS: Of the 27 studies evaluated for inclusion, 10 studies received full review: 4 retrospective cohort studies, 5 single case studies, and 1 case series. RESULTS: 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. CONCLUSIONS: 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).

Comparison of Sepsis-3 Criteria Versus SIRS Criteria in Screening Patients for Sepsis in the Emergency Department.

The objective of our study was to assess the percentage of patients who met qSOFA criteria, SIRS criteria, both, or none of either criterion and received an International Classification of Diseases, Tenth Revision (ICD-10) code for sepsis after admission from the emergency department (ED). This was a single-center retrospective chart review of medical patients admitted through the ED. Patients were included if they were older than 18 years, were admitted to an inpatient unit through the ED, and received antibiotics within 48 hr of admission. All patients included were evaluated for the presence of SIRS and qSOFA criteria and then stratified into 1 of 4 groups. Group 1 consisted of patients who exhibited neither SIRS criteria nor qSOFA criteria (fewer than 2 of both SIRS and qSOFA criteria). Group 2 consisted of patients with only SIRS criteria (more than 2 SIRS criteria but fewer than 2 qSOFA criteria). Group 3 consisted of patients with only qSOFA criteria (more than 2 qSOFA criteria but fewer than 2 SIRS criteria), and Group 4 consisted of patients with both qSOFA and SIRS criteria (more than 2 qSOFA and SIRS criteria). A of total 100 patients were included, with 49 patients stratified into Group 1, 37 into Group 2, 2 into Group 3, and 12 into Group 4. With respect to the primary endpoint, Group 1 had a total of 7 patients (14.3%) who received an ICD-10 code for sepsis or septic shock, Group 2 had 15 patients (40.5%), Group 3 had 1 patient (50%), and Group 4 had 9 patients (75%). The utilization of both qSOFA and SIRS criteria resulted in a higher percentage of patients who were designated an ICD-10 code for sepsis whereas patients who did not exhibit either criterion still had roughly 15% of patients designated an ICD-10 code for sepsis.