Posted in Med Surg

Triple H Therapy used to be commonly utilized to prevent vasospasm in patients with subarachnoid hemorrhage. The H’s stand for hypertension, hypervolemia, and hemodilution. The evidence has shown that this treatment modality is associated with increased complications, namely pulmonary edema and resulting hypoxia. Current management for vasospasm prevention includes:

  • Nimodipine, a dihydropyridine calcium channel blocker that acts as a vasodilator is administered four times a day for 21 days
  • Maintenance of euvolemia
  • Induced hypertension
  • Endovascular therapy, which involves insertion of a catheter into the narrowed artery to delivery medication or inflate a balloon. This treatment is used to treat symptomatic vasospasm that has not responded to medical therapy.

References

Ashley, W. W. (2024). Cerebral vasospasm After subarachnoid hemorrhage treatment & management: https://emedicine.medscape.com/article/2500045-treatment
Dankbaar, J. W., Slooter, A. J., Rinkel, G. J., & Schaaf, I. C. van der. (2010). Effect of different components of triple-H therapy on cerebral perfusion in patients with aneurysmal subarachnoid haemorrhage: A systematic review. Critical Care, 14(1), R23. https://doi.org/10.1186/cc8886
Openanesthesia. (n.d.). Cerebral Vasospasm. OpenAnesthesia. Retrieved January 27, 2025, from https://www.openanesthesia.org/keywords/cerebral-vasospasm/
Park, E.-S., Kim, D.-W., & Kang, S.-D. (2017). Endovascular Treatment of Symptomatic Vasospasm after Aneurysmal Subarachnoid Hemorrhage: A Three-year Experience. Journal of Cerebrovascular and Endovascular Neurosurgery, 19(3), 155–161. https://doi.org/10.7461/jcen.2017.19.3.155

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Last Updated on January 27, 2025 by Maureen Osuna, MSN, RN