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“Triple-H” therapy for cerebral vasospasm following subarachnoid hemorrhage

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Abstract

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.

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  1. Section of Neurosurgery, Dartmouth Hitchcock Medical Center, 03756, Lebanon, NH

    Kendall H. Lee & Jonathan A. Friedman

  2. Department of Neurology, Dartmouth Hitchcock Medical Center, Lebanon, NH

    Timothy Lukovits

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Lee, K.H., Lukovits, T. & Friedman, J.A. “Triple-H” therapy for cerebral vasospasm following subarachnoid hemorrhage. Neurocrit Care 4, 68–76 (2006). https://doi.org/10.1385/NCC:4:1:068

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