Important topic
More to come here.
Paroxysmal Sympathetic Hyperactivity (PSH) or “Autonomic Storming”
Treatments include:
Pharmacological
Propanolol – for the tachycardia e.g. 40 mg BD
Dexmedetomidine infusion – can be effective, not a long term solution
Clonidine – for agitation and sympathetic symptoms. Used in high doses e.g. 300 mcg hourly until symptoms controlled; BP monitoring essential. Not with Dexmed. Can be converted to oral. Surprisingly effective for many
Olanzapine – for agitation. e.g. 5-10 mg TDS. Can be sublingual and IM and IV (though not licensed for IV use)
Quetiapine – for agitation. e.g. 25-100 mg BD.
Paracetamol for pain and fevers
Conscious low dose propofol infusion – careful airway monitoring and experienced nurse essential
Non-Pharmacological
Extubation
Expert nursing (this is not easy, experienced nurses can make a massive difference here)
Consider low bed to reduce risk of falls)
Removal of unnecessary lines / tubes
Trying to do no harm whilst giving time for delirium / symptoms to subside
If all fails, re-sedate and try again later.