Hypertensive, hypervolemic, hemodilutional therapy for aneurysmal subarachnoid hemorrhage. Is it efficacious? Yes.
Vasospasm is an important contributor to death and disability after aneurysmal SAH. CBF is decreased after SAH and correlates inversely with the severity of the clinical grade. It is necessary to avoid hypotension and hypovolemia, which can exacerbate an already reduced CBF, resulting in critically low perfusion. There have been no human, prospective, randomized trials of HHH therapy. This is attributable, perhaps, to the fact that such trials are difficult to blind. Nevertheless, there is strong evidence that HHH therapy can reverse the delayed onset of profound neurologic deficits by restoring blood flow to ischemic regions, and its prophylactic use can reduce the incidence and severity of DID.
Ullman
J S
JS
Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, USA.
Bederson
J B
JB
D001794:Blood Pressure; D003422:Critical Care; D005440:Fluid Therapy / Q000592:standards*; D006438:Hemodilution / Q000592:standards*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012422:Rupture, Spontaneous; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome