For those you work in neurosurgery units, do you still strictly follow the combo triple-H therapy (hypertension, hypervolemia, haemodilution) as part of managing SAH? Some research studies I've read no longer support this practice (due to its consequences) but some units still do this.
It would be awesome to know from the perspectives of others.
We do the following:
- MAP between 80-130 mm Hg.
- Normovolemia (we regard hypo- and hypervolemia both as potentially harmful).
- Start with 3 liter/24H fluid infusion.
- Oral nimodipine.
We have gotten away from the triple H therapy. Systolic 140 to 180 with close monitoring for symptoms of vasospasm, Euvolemia and serial lab to monitor for cerebral salt wasting.
Nimodipine is part of the guidelines, however my surgeons do not use nimodipine, because of the effect on the blood pressure.
Hi, we are not following strict triple H any longer because evidence suggests it is rather harmful than beneficial. We suggest also MAP > 75 and BP systolic < 180, daily TCD and prophylactic nimodipine, unless you would need vasopressors because of low BP due to nimodipine.
In our department the trend in prevention of vasospasm is made on individual basis. Hypertension could be benificial in patients without cardial comorbidities but recent evidence suggest that hypervolemia is more harmful than benificial in SAH patients. We perform daily TCD measurments and recommend Normovolemia. The effect of nimodipine in the prevention of is still controversially but it is part of the current guidlines for SAH.
- Badges
- Science topic
- Similar topics
- Solid State Physics
- Devices