Understanding and Managing Autonomic Disorders in the Neurocritical Care Unit: A Comprehensive review

Neurol India. 2022 Mar-Apr;70(2):485-490. doi: 10.4103/0028-3886.344657.

Abstract

Background: For a favorable outcome, patients admitted to critical care units require continuous monitoring and swift decision-making ability regarding management. One of the biggest challenges in neurocritical care units is the identification and management of autonomic dysfunction and in the worst-case scenario, autonomic storms.

Objective: Most of the literature available focuses mainly on autonomic storms following traumatic brain injury. However, due to the myriad neurological presentations in a critical care setting, it is particularly important for physicians and intensivists to suspect and manage autonomic dysfunction in various neurological scenarios.

Methods: Understanding the mechanism of paroxysmal sympathetic hyperactivity (PSH) is essential for early recognition and treatment. PSH-AM is an assessment measurement scale to diagnose and assess the severity of PSH in traumatic brain injury. However, this is not yet standardized across all neurological settings.

Conclusion: We present a comprehensive report on understanding the mechanism of autonomic storms across various neurological disorders and outline the management.

Keywords: Autonomic dysfunction; autonomic storm; neurocritical care.

Publication types

  • Review

MeSH terms

  • Autonomic Nervous System Diseases* / diagnosis
  • Autonomic Nervous System Diseases* / etiology
  • Autonomic Nervous System Diseases* / therapy
  • Brain Injuries, Traumatic*
  • Hospitalization
  • Humans
  • Intensive Care Units
  • Magnetic Resonance Imaging