Triple-H therapy

 Q: "Triple-H Therapy" continues to be a mainstay of treatment to prevent cerebral ischemia (vasospasm) after subarachnoid hemorrhage?

A) True

B) False

Answer: B

For a long period of time 

• Hypervolemia 
• Hemodilution, and 
• Hypertension

popularly known as Triple H therapy continue to be the mainstay preventive measure to prevent cerebral ischemia from vasospasm. In the last few years, it has been determined that hypervolemia is not helpful, rather harmful in this matter. 

For hypotension, pressors can be used, and if needed inotropes can be added.

#neurology

References:

1. Francoeur CL, Mayer SA. Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care 2016; 20:277.

2. Muench E, Horn P, Bauhuf C, 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; 35:1844.

3. Dankbaar, J. W., Slooter, A. J., Rinkel, G. J., & Schaaf, I. C. (2010). Effect of different components of triple-H therapy on cerebral perfusion in patients with aneurysmal subarachnoid haemorrhage: a systematic review. Critical care (London, England), 14(1), R23. https://doi.org/10.1186/cc8886