{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T20:20:13Z","timestamp":1780086013058,"version":"3.54.0"},"reference-count":15,"publisher":"AACN Publishing","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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, \u03b3-aminobutyric acid agents, dopaminergic agents, and \u03b2 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate all relevant literature on pharmacological therapies used to manage patients with paroxysmal sympathetic hyperactivity to help elucidate possible best practices.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Of the 27 studies evaluated for inclusion, 10 studies received full review: 4 retrospective cohort studies, 5 single case studies, and 1 case series.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Monotherapy is usually not effective in the management of paroxysmal sympathetic hyperactivity and multiple agents with different mechanisms of action should be considered. \u03b12-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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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)<\/jats:p>\n               <\/jats:sec>","DOI":"10.4037\/ccn2020348","type":"journal-article","created":{"date-parts":[[2020,6,1]],"date-time":"2020-06-01T00:02:46Z","timestamp":1590969766000},"page":"e9-e16","source":"Crossref","is-referenced-by-count":21,"title":["Pharmacological Treatment for Paroxysmal Sympathetic Hyperactivity"],"prefix":"10.4037","volume":"40","author":[{"given":"Elizabeth A.","family":"Shald","sequence":"first","affiliation":[{"name":"At the time of submission, Elizabeth A. Shald was a fourth-year pharmacy student at the University of Florida College of Pharmacy, Jacksonville, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Reeder","sequence":"first","affiliation":[{"name":"Jacob Reeder is a critical care clinical pharmacy specialist, Wesley Medical Center, Wichita, Kansas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Finnick","sequence":"first","affiliation":[{"name":"At the time of submission, Michael Finnick, Ishani Patel, and Kyle Evans were fourth-year pharmacy students at the University of Flor-ida College of Pharmacy, Jacksonville, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishani","family":"Patel","sequence":"first","affiliation":[{"name":"At the time of submission, Michael Finnick, Ishani Patel, and Kyle Evans were fourth-year pharmacy students at the University of Flor-ida College of Pharmacy, Jacksonville, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Evans","sequence":"first","affiliation":[{"name":"At the time of submission, Michael Finnick, Ishani Patel, and Kyle Evans were fourth-year pharmacy students at the University of Flor-ida College of Pharmacy, Jacksonville, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca K.","family":"Faber","sequence":"first","affiliation":[{"name":"Rebecca K. Faber is Assistant Director of Nursing, Wesley Medical Center."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian W.","family":"Gilbert","sequence":"first","affiliation":[{"name":"Brian W. Gilbert is an emergency medicine\/critical care clinical pharmacy specialist, Wesley Medical Center."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2471","reference":[{"key":"2020053120051830400_b1-04000e9","first-page":"412","article-title":"Autonomic seizures","volume-title":"Epilepsy and Functional Anatomy of the Human Brain","author":"Penfield","year":"1954"},{"issue":"17","key":"2020053120051830400_b2-04000e9","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1089\/neu.2013.3301","article-title":"Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria","volume":"31","author":"Baguley","year":"2014","journal-title":"J Neurotrauma"},{"issue":"7","key":"2020053120051830400_b3-04000e9","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1089\/neu.2011.2033","article-title":"Paroxysmal sympathetic hyperactivity after traumatic brain injury: clinical and prognostic implications","volume":"29","author":"Fernandez-Ortega","year":"2012","journal-title":"J Neurotrauma"},{"issue":"5","key":"2020053120051830400_b4-04000e9","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1136\/jnnp.2006.096388","article-title":"Gabapen-tin in the management of dysautonomia following severe traumatic brain injury: a case series","volume":"78","author":"Baguley","year":"2007","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"1","key":"2020053120051830400_b5-04000e9","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1136\/jnnp.67.1.39","article-title":"Dysautonomia after traumatic brain injury: a forgotten syndrome?","volume":"67","author":"Baguley","year":"1999","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"5","key":"2020053120051830400_b6-04000e9","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1097\/HTR.0000000000000084","article-title":"Paroxysmal sympathetic hyperactivity in pediatric rehabilitation: clinical factors and acute pharmacological management","volume":"30","author":"Pozzi","year":"2015","journal-title":"J Head Trauma Rehabil"},{"issue":"40","key":"2020053120051830400_b7-04000e9","doi-asserted-by":"crossref","first-page":"69012","DOI":"10.18632\/oncotarget.16920","article-title":"Dexmedetomidine attenuates acute paroxysmal sympathetic hyperactivity","volume":"8","author":"Peng","year":"2017","journal-title":"Oncotarget"},{"key":"2020053120051830400_b8-04000e9","doi-asserted-by":"publisher","first-page":"e2986","DOI":"10.7717\/peerj.2986","article-title":"The preventive effect of dexmedetomidine on paroxysmal sympathetic hyperactivity in severe traumatic brain injury patients who have undergone surgery: a retrospective study","volume":"5","author":"Tang","year":"2017","journal-title":"PeerJ"},{"issue":"2","key":"2020053120051830400_b9-04000e9","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/HTR.0000000000000255","article-title":"Paroxysmal sympathetic hyperactivity in pediatric rehabilitation: pathological features and scheduled pharmacological therapies","volume":"32","author":"Pozzi","year":"2017","journal-title":"J Head Trauma Rehabil"},{"key":"2020053120051830400_b10-04000e9","doi-asserted-by":"crossref","first-page":"358182","DOI":"10.1155\/2013\/358182","article-title":"Prolonged paroxysmal sympathetic storming associated with spontaneous subarachnoid hemorrhage","volume":"2013","author":"Liu","year":"2013","journal-title":"Case Rep Med"},{"issue":"1","key":"2020053120051830400_b11-04000e9","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4037\/ccn2007.27.1.30","article-title":"Sympathetic storming after severe traumatic brain injury","volume":"27","author":"Lemke","year":"2007","journal-title":"Crit Care Nurse"},{"issue":"4","key":"2020053120051830400_b12-04000e9","first-page":"335","article-title":"Morphine: an effective abortive therapy for pediatric paroxysmal sympathetic hyperactivity after hypoxic brain injury","volume":"20","author":"Raithel","year":"2015","journal-title":"J Pediatr Pharmacol Ther"},{"key":"2020053120051830400_b13-04000e9","first-page":"421563","article-title":"Propranolol for paroxysmal sympathetic hyperactivity with lateralizing hyperhidrosis after stroke","volume":"2015","author":"Siefferman","year":"2015","journal-title":"Case Rep Neurol Med"},{"issue":"2","key":"2020053120051830400_b14-04000e9","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s11940-008-0016-y","article-title":"Treatment of paroxysmal sympathetic hyperactivity","volume":"10","author":"Rabinstein","year":"2008","journal-title":"Curr Treat Options Neurol"},{"issue":"4","key":"2020053120051830400_b15-04000e9","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.1002\/phar.1568","article-title":"Rectal propranolol controls paroxysmal sympathetic hyperactivity: a case report","volume":"35","author":"May","year":"2015","journal-title":"Pharmacotherapy"}],"container-title":["Critical Care Nurse"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/aacnjournals.org\/ccnonline\/article-pdf\/40\/3\/e9\/127814\/e9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/aacnjournals.org\/ccnonline\/article-pdf\/40\/3\/e9\/127814\/e9.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,6,1]],"date-time":"2020-06-01T00:05:32Z","timestamp":1590969932000},"score":1,"resource":{"primary":{"URL":"https:\/\/aacnjournals.org\/ccnonline\/article\/40\/3\/e9\/30985\/Pharmacological-Treatment-for-Paroxysmal"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,1]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,6,1]]}},"URL":"https:\/\/doi.org\/10.4037\/ccn2020348","relation":{},"ISSN":["0279-5442","1940-8250"],"issn-type":[{"value":"0279-5442","type":"print"},{"value":"1940-8250","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,1]]}}}