"Triple-H" therapy for cerebral vasospasm following subarachnoid hemorrhage.
The combination of induced hypertension, hypervolemia, and hemodilution (triple-H therapy) is often utilized to prevent and treat cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Although this paradigm has gained widespread acceptance over the past 20 years, the efficacy of triple-H therapy and its precise role in the management of the acute phase of SAH remains uncertain. In addition, triple-H therapy may carry significant medical morbidity, including pulmonary edema, myocardial ischemia, hyponatremia, renal medullary washout, indwelling catheter-related complications, cerebral hemorrhage, and cerebral edema. This review examines the evidence underlying the implementation of triple-H therapy, and makes practical recommendations for the use of this therapy in patients with aneurysmal SAH.
Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA.
Kendall H
KH
Lee
Timothy
T
Lukovits
Jonathan A
JA
Friedman
D001810:Blood Volume; D002560:Cerebrovascular Circulation / Q000502:physiology; D006438:Hemodilution; D006801:Humans; D006973:Hypertension; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*