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Neurocritical Care

, Volume 4, Issue 1, pp 68–76 | Cite as

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

  • Kendall H. Lee
  • Timothy Lukovits
  • Jonathan A. FriedmanEmail author
Review

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.

Key Words

Subarchnoid hemorrhage cerebrovascular disease vasospasm aneurysm triple-H therapy 

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Copyright information

© Humana Press Inc. 2006

Authors and Affiliations

  • Kendall H. Lee
    • 1
  • Timothy Lukovits
    • 2
  • Jonathan A. Friedman
    • 1
    Email author
  1. 1.Section of NeurosurgeryDartmouth Hitchcock Medical CenterLebanon
  2. 2.Department of NeurologyDartmouth Hitchcock Medical CenterLebanon

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