Triple-H therapy in the management of aneurysmal subarachnoid haemorrhage

  title={Triple-H therapy in the management of aneurysmal subarachnoid haemorrhage},
  author={Jon Sen and Antonio Belli and H Albon and Laleh Morgan and Axel Petzold and Neil Kitchen},
  journal={The Lancet Neurology},
Update on subarachnoid haemorrhage
The mortality of SAH has decreased in the last two decades due to better neurosurgical techniques and neurocritical care and to advances in interventional neuroradiological procedures.
"Triple h" therapy for aneurysmal subarachnoid haemorrhage: real therapy or chasing numbers?
  • J. Myburgh
  • Medicine
    Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine
  • 2005
Despite technological and medical advances for the treatment of SAH, there is little or no evidence to justify the aggressive use of anti-vasospastic therapies as a preventative manner with exception of oral nimodipine in patients with low-grade aneurysmal subarachnoid haemorrhage.
Aneurysmal subarachnoid haemorrhage and the anaesthetist.
  • H. Priebe
  • Medicine
    British journal of anaesthesia
  • 2007
Effective measures to prevent or attenuate increases in intracranial pressure, brain swelling, and cerebral vasospasm throughout all phases of anaesthesia are prerequisite for optimal outcome.
Effective headache management in the aneurysmal subarachnoid haemorrhage patient
Treatment of aneurysmal SAH (aSAH) includes prevention of re-bleeding, evacuation of space-occupying haematomas, management of hydrocephalus and prevention of secondary cerebral insult.
Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: An Overview of Pharmacologic Management
The pathophysiology of vasospasm is poorly understood, which directly contributes to the inconsistency of management and creates a formidable challenge in clinical practice.
Management of subarachnoid haemorrhage in a non‐neurosurgical centre
While awaiting transfer to a neurological centre, active management of the patient must be instituted, which should include confirmation of the diagnosis with CT imaging, lumbar puncture or both, and recognition of the complications of subarachnoid haemorrhage, which include hydrocephalus, further haem orrhage and cerebral vasospasm.
Effec tive headache management in the aneurysmal subarachnoid patient: a literature review
This paper summarises the findings of a literature review conducted as part of a research study to examine existing practices in the assessment and management of headache in patients with aSAH in an Irish Neurosciences Centre, and demonstrates that despite a wealth of published literature on the diagnosis and management, evaluation andmanagement of its main symptom, headache, remains suboptimal and under-researched.
Blood Pressure Management in Subarachnoid Hemorrhage: The Role of Blood Pressure Manipulation in Prevention of Rebleeding and the Management of Vasospasm
Previous recommendations advocated for Triple-H therapy (consisting of hypertension, hemodilution, and hypervolemia); however, the risks associated with excessive hyperVolemia have been shown to outweigh the benefits and consequently, euvolemia is now the recommended management strategy.
A review of medical treatments of cerebral vasospasm
Large-scale randomized clinical trials are needed to determine whether therapies such as magnesium, statins, nitric oxide modulators, endothelin antagonists and others will become standard of care in the prevention and/or treatment of CV.


Haemodynamic considerations in the management of patients with subarachnoid haemorrhage
Cerebral vasospasm may decrease cerebral blood flow, disturb autoregulation and place the patient at risk for delayed cerebral ischaemia, and there is a need for randomized clinical trials to assess the efficacy of these latter treatments.
Cerebral vasospasm and calcium channel blockade. Nimodipine treatment in patients with aneurysmal subarachnoid hemorrhage.
In patients with aneurysmal subarachnoid hemorrhage (SAH), delayed ischemic cerebral dysfunction (DID or symptomatic vasospasm) with subsequent fixed neurological dysfunction (FND) is a frequent and
Cerebral vasospasm after SAH
The introduction and worldwide application of the concept of early surgery after the rupture of an intracranial aneurysm as well as an improved intensive care management in the last two decades have
Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial.
Oral nimodipine 60 mg four hourly is well tolerated and reduces cerebral infarction snd improves outcome after subarachnoid haemorrhage, a double blind, placebo controlled, randomised trial.
Early aneurysm surgery and prophylactic hypervolemic hypertensive therapy for the treatment of aneurysmal subarachnoid hemorrhage.
In this group of 56 patients at risk for delayed ischemia from vasospasm, 5 patients had significant intraoperative complications and 41 patients returned to their premorbid occupations without neurological deficit.
Barbiturate coma for severe, refractory vasospasm following subarachnoid haemorrhage
The results are better than previously published outcomes and suggest formal evaluation of barbiturate coma in the treatment of severe resistant symptomatic vasospasm following SAH is warranted.
Postoperative hypertension in the management of patients with intracranial arterial aneurysms.
Elevation of systemic arterial pressure in seven patients with intracranial arterial aneurysms has been shown to be effective in alleviating ischemic symptoms attributed to cerebral vasospasm, and blood volume expansion was used to augment vasopressors in maintenance of systemic hypertension.
Hyponatremia and cerebral infarction in patients with ruptured intracranial aneurysms: Is fluid restriction harmful?
This retrospective study studied retrospectively the relationship between hyponatremia and cerebral infarction in 134 consecutive patients with aneurysmal subarachnoid hemorrhage to find out whether these patients fulfilled the criteria for the syndrome of inappropriate secretion of antidiuretic hormane.
Clinical vasospasm after subarachnoid hemorrhage: response to hypervolemic hemodilution and arterial hypertension.
Over the course of treatment, 60% of patients with clinical vasospasm had sustained improvement by at least 1 neurologic grade, 24% maintained a stable neurologic status, and 16% continued to worsen, while one patient rebled and died while on hypervolemic hemodilution therapy.