Clinical Practice Guidelines: Paroxysmal Sympathetic Hyperactivity


Paroxysmal Sympathetic Hyperactivity (CPG)

Paroxysmal sympathetic hyperactivity (PSH) is a phenomenon where patients develop episodes of sympathetic overdrive primarily manifesting as vital sign instability (tachycardia, tachypnea, hyperthermia, and hypertension), increased tone, and posturing in the setting of recent brain injury.  One of the difficulties institutionally has been lack of broadly known diagnostic guidelines as well as a cohesive structured plan to manage this condition.  This has led to heterogeneous time to diagnosis and management, which may have led to increased use of resources as well as worsened outcomes. It is known from prior studies that PSH is associated with increased length of stay in the ICU, increased in-hospital mortality, and decreased functional outcome.

The purpose of this clinical practice guideline is to assist with earlier time to diagnosis, decreased use of resources (in terms of consultations, RRTs, PICU and overall hospital LOS), and decreased incidence of unnecessary polypharmacy, all of which could lead to improved functional outcomes.

PSH guideline team

  • Contacts: Lindsay Pagano, MD, Neurology, Michael Wolf, MD Critical Care
  • Deep Mohanty, MD, Neurology
  • Richard Carozza, MD, Neurology
  • Ashley Jones, RN, CCRN, Critical Care
  • Lydia Colley, RN, BSN, CNML, Critical Care
  • Elizabeth Martin, MD, Physical Medicine and Rehabilitation
  • Tracy Hills, DO, Palliative Care
  • Michaela Ibach, MD, Palliative Care
  • Allysa Kehring, MD, Complex Care
  • Katherine Freundlich, MD, Complex Care
  • Karisa Grizzle, MD, Hospital Medicine
  • Barron Frazier, MD, Emergency Medicine
  • Jessica Anderson, PharmD, Pharmacy