Triple H therapy is done in?
1). Vasospasm is the leading cause of morbidity and mortality following aneurysmal SAH.
2). Treatment with the calcium channel antagonist nimodipine improves outcome, perhaps by preventing ischemic injury due to vasospasm.
3). Symptomatic cerebral vasospasm can also be treated by increasing the cerebral perfusion pressure by raising mean arterial pressure through plasma volume expansion and the judicious use of IV vasopressor agents, usually phenylephrine or norepinephrine.
4). Raised perfusion pressure has been associated with clinical improvement in many patients, but high arterial pressure may promote rebleeding in unprotected aneurysms.
5). Treatment with induced hypertension and hypervolemia generally requires monitoring of arterial and central venous pressures; it is best to infuse pressors through a central venous line as well.
6). Volume expansion helps prevent hypotension, augments cardiac output, and reduces blood viscosity by reducing the hematocrit.
7). This method is called "triple-H" (Ref. Hariypertension, hemodilution, and hypervolemic) therapy.