title: Effect of triple-h prophylaxis on global end-diastolic volume and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Although prophylactic triple-H therapy has been used in a number of institutions globally to prevent delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH), limited evidence is available for the effectiveness of triple-H therapy on hemodynamic variables. Recent studies have suggested an association between low global end-diastolic volume index (GEDI), measured using a transpulmonary thermodilution method, and DCI onset. The current study aimed at assessing the effects of prophylactic triple-H therapy on GEDI.
  
  
  METHODS
  This prospective multicenter study included aneurysmal SAH patients admitted to 9 hospitals in Japan. The decision to administer prophylactic triple-H therapy and the management protocols were left to the physician in charge (physician-directed therapy) of each participating institution. The primary endpoints were the changes in the hemodynamic variables as analyzed using a generalized linear mixed model.
  
  
  RESULTS
  Of 178 patients, 62 (34.8 %) received prophylactic triple-H therapy and 116 (65.2 %) did not. DCI was observed in 35 patients (19.7 %), with no significant difference between the two groups [15 (24.2 %) vs. 20 (17.2 %), p = 0.27]. Although a greater amount of fluid (p < 0.001) and a higher mean arterial pressure (p = 0.005) were observed in the triple-H group, no significant difference was observed between the groups in GEDI (p = 0.81) or cardiac output (p = 0.62).
  
  
  CONCLUSIONS
  Physician-directed prophylactic triple-H administration was not associated with improved clinical outcomes or quantitative hemodynamic indicators for intravascular volume. Further, GEDI-directed intervention studies are warranted to better define management algorithms for SAH patients with the aim of preventing DCI.
authors.affiliation: Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan, t-tagami@nms.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tagami
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kuwamoto
authors.forename: Akihiro
authors.initials: A
authors.lastname: Watanabe
authors.forename: Kyoko
authors.initials: K
authors.lastname: Unemoto
authors.forename: Shoji
authors.initials: S
authors.lastname: Yokobori
authors.forename: Gaku
authors.initials: G
authors.lastname: Matsumoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Igarashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokota
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D002302:Cardiac Output; D002544:Cerebral Infarction / Q000209:etiology / Q000517:prevention & control; D015331:Cohort Studies; D003971:Diastole; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006438:Hemodilution / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*; D013815:Thermodilution; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000517:prevention & control*
chemical_list: D014662:Vasoconstrictor Agents