ICU update- Sympathetic Storming

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Brain injury is one of the most common types of traumatic injury. In critical care units, patients with moderate to severe brain injury are often intubated and sedated in an effort to diminish the workload of the brain. Agitation or restlessness is common in these patients and can be associated with fever, posturing, tachycardia, hypertension, and diaphoresis. This exaggerated stress response, known as sympathetic storming, occurs in 15% to 33% of patients with severe traumatic brain injury who are comatose (score on Glasgow coma scale [GCS] ≤ 8).

Signs and symptoms of sympathetic storming:
Posturing, dystonia, hypertension, tachycardia, pupillary dilatation, diaphoresis, hyperthermia, and tachypnea. The episodes appear unprovoked and can last for hours or end abruptly. Sympathetic storming often occurs after discontinuation of administration of sedatives and narcotics in the intensive care unit (ICU).

Sympathetic storming can occur within the first 24 hours after injury or up to weeks later. Precise mechanism for the increase in activity of the sympathetic nervous system is unknown, but the increased activity is thought to be a stage of recovery from severe traumatic brain injury.

Original Author:
Denise M. Lemke, MSN, APNP-BC, CNRN

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