Document Detail


Which H is the most important in triple-H therapy for cerebral vasospasm?
MedLine Citation:
PMID:  19276798     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: To summarize the recent literature of the hemodynamic management of subarachnoid hemorrhage and cerebral vasospasm, also designated as 'triple-H' therapy, and discuss each component of this management approach individually. RECENT FINDINGS: Following the publication of a review on circulatory volume expansion in the Cochrane Registry database in 2004 and a meta-analysis in 2003, there are no new randomized trials of triple-H therapy to prevent or treat cerebral vasospasm. However, physiological studies have been reported that contribute to the understanding of some of the components of triple-H therapy. SUMMARY: There remains a paucity of information regarding the efficacy and safety of triple-H therapy. The complexity in exploring this topic derives not only from the interdependence of the different components of triple-H therapy but also by the limitation in the assessment of hemodynamic variables. However, there is some emerging physiologic data suggesting that normovolemic hypertension may be the component most likely to increase cerebral blood flow after subarachnoid hemorrhage. In contrast, hypervolemic hemodilution is associated with increased complications and might also lower the hemoglobin to excessively low levels.
Authors:
Miriam M Treggiari; Steven Deem
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in critical care     Volume:  15     ISSN:  1531-7072     ISO Abbreviation:  Curr Opin Crit Care     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-20     Completed Date:  2009-10-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9504454     Medline TA:  Curr Opin Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  83-6     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA. treggmm@u.washington.edu
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MeSH Terms
Descriptor/Qualifier:
Blood Circulation
Blood Volume*
Cerebrovascular Circulation / physiology
Hemodilution*
Hemodynamics
Humans
Hypertension*
Subarachnoid Hemorrhage / physiopathology,  therapy
Vasospasm, Intracranial / physiopathology,  therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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