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It is associated with prolonged mechanical ventilation (MV), extended ICU and hospital stays, and worse outcomes. Current guidelines lack prophylactic recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>\n                      This single-center randomized controlled trial (NCT05427474) enrolled 90 adults with moderate-to-severe TBI glasgow coma scale (GCS 3\u201312). Participants were randomized to: standard care (Group I,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930); standard care plus propranolol (40\u00a0mg\/12\u00a0h, Group II,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930); or standard care plus propranolol (40\u00a0mg\/12\u00a0h) and gabapentin (100\u00a0mg\/8\u00a0h, Group III,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930). The primary endpoint was PSH incidence. Secondary endpoints included ventilator days, ICU and hospital length of stay (LOS), and mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PSH incidence was lowest in Group III (10%) vs. Group II (33.3%) and Group I (60%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Group II showed the shortest MV duration (5.92\u2009\u00b1\u20095.15 days) vs. Group III (9.42\u2009\u00b1\u20096.99 days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.047) and Group I (12.92\u2009\u00b1\u20095.98 days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). ICU LOS was shortest in Group II (9.6\u2009\u00b1\u20095.32 days) vs. Group III (14.69\u2009\u00b1\u20098.35 days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017) and Group I (19.5\u2009\u00b1\u20098.19 days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Mortality and GCS improvement did not differ significantly (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Prophylactic propranolol significantly reduces PSH incidence, shortens MV duration, and decreases ICU stay in moderate-to-severe TBI. Although adding gabapentin further reduces PSH, it prolongs recovery time, suggesting a trade-off between efficacy and sedative effects. These findings suggest that propranolol monotherapy is a promising prophylactic strategy, with gabapentin potentially reserved for refractory cases. However, given the study's limitations, these results should be considered hypothesis-generating and warrant confirmation in larger, multicenter trials. Mortality and neurological outcomes were comparable across groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>The trial was prospectively registered at ClinicalTrials.gov (NCT05427474) on June 22, 2022.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12871-026-03802-2","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T14:35:41Z","timestamp":1778250941000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Propranolol monotherapy versus combined propranolol-gabapentin for prevention of paroxysmal sympathetic hyperactivity after moderate-severe traumatic brain injury: a randomized controlled trial"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3303-6870","authenticated-orcid":false,"given":"Essamedin M.","family":"Negm","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7199-7480","authenticated-orcid":false,"given":"Ahmed M.","family":"Gouda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed El Mowafy","family":"Khatab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Essam Mohamed Elsayed","family":"Youssef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AnaSimon Alfred Foad","family":"Eskandr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola Mohammed","family":"Fathi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba Mohammed","family":"Fathi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"3802_CR1","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1136\/jnnp.67.1.39","volume":"67","author":"IJ Baguley","year":"1999","unstructured":"Baguley IJ, Nicholls JL, Felmingham KL, Crooks J, Gurka JA, Wade LD. 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