Abstract
The traditional axiom that vasospasm induced reduction of blood flow leads to poor tissue oxygenation and ischaemic cellular injury culminating in delayed neurological deficits has been challenged and the efficacy of triple H therapy in reversal of the above is debated. In this study we assess cerebral physiology before and during onset of DIND and with application of triple H therapy with real time neuro-monitoring tools. Patients with Fisher grade 3/4/3 + 4/rebleed were consented. Probes for measuring rCBF, pTiO2, and Microdialysis parameters – glucose, glycerol, lactate, and pyruvate were inserted at time of coiling/clipping. Subsequent monitoring was done in HDU/ITU setting. Return of parameters to baseline was regarded as effective triple H therapy. Study is ongoing and the current paper presents our experience with first five patients. The results suggest safety and feasibility of multimodal monitoring in clinical setting to establish an understanding of relationship between clinical symptoms, brain perfusion, oxygenation, and metabolism in real time to test and guide therapy in future.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bederson JB, Sander Connolly E Jr, Hunt Batjer H, Dacey RG, Dion JE, Diringer MN, et al. American Heart Association. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2009;40(3):994–1025.
Pluta RM, Hansen-Schwartz J, Dreier J, Vajkoczy P, Loch Macdonald R, Nishizawa S, et al. Cerebral vasospasm following subarachnoid hemorrhage: time for a new world of thought. Zhang Neurol Res. 2009;31(2):151–158.
Treggiari MM, Walder B, Suter PM, Romand JA. Systematic review of the prevention of delayed ischaemic neurological deficits with hypertension, hypervolaemia and haemodilution therapy following subarachnoid haemorrhage. J Neurosurg. 2003;98(5):978–984. Review.
Unterberg AW, Sakowitz OW, Sarrafzadeh AS, Benndorf G, Lanksch WR. Role of bedside microdialysis in the diagnosis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2001;94:5.
Muench E, Horn P, Bauhuf C, Roth H, Philipps M, Hermann P, et al. Effects of hypervolemia and hypertension on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation after subarachnoid hemorrhage. Crit Care Med. 2007;35(8):1844–1851.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag/Wien
About this paper
Cite this paper
Bhargava, D., Al-Tamimi, Y., Quinn, A., Ross, S. (2011). New Modalities to Assess Efficacy of Triple-H Therapy: Early Experience. In: Feng, H., Mao, Y., Zhang, J.H. (eds) Early Brain Injury or Cerebral Vasospasm. Acta Neurochirurgica Supplements, vol 110/2. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0356-2_37
Download citation
DOI: https://doi.org/10.1007/978-3-7091-0356-2_37
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-0355-5
Online ISBN: 978-3-7091-0356-2
eBook Packages: MedicineMedicine (R0)