Triple H-Therapy: Nicole Durrance

What is Triple H-Therapy Treatment used for cerebral vasospasm after a subarachnoid hemorrhage. Inducing the following in a patient: Hypertensive Hypervolemic Hemodilution

Purpose of article Triple H-Therapy has serious side effects, mainly from hypervolemic therapy It is not clear which components of this therapy are crucial for the treatment of cerebral hypoperfusion and hypoxia. The study investigates the influence hypertention, hypervolemic, and hemodilution have on regional cerebral blood flow and brain tissue oxygenation

Method Experiments carried out on 5 healthy female pigs followed by clinical investigation of 10 patients with subarachnoid hemorrhage Effects of the three H’s on regional cerebral blood flow and oxygen supply was investigated under physiologic conditions in pig models. Applied study protocol to patients after an aneurysmal subarachnoid hemorrhage.

Results Pigs: hypertension and hypervolemia had no effect on intracranial pressure, brain tissue oxygenation, or regional cerebral blood flow. Patients: Induced hypertension- increase of regional cerebral blood flow & brain tissue oxygenation Induced hypervolemia/hemodilution- gave only a slight increase in regional cerebral blood flow & brain tissue oxygenation did not improve. Overall: Triple-H Therapy failed to improve regional cerebral blood flow more than hypertension alone.

Key Points Vasopressor-induced elevation of mean arterial pressure (hypertension) caused a significant increase in regional cerebral blood flow and brain tissue oxygenation in all patients. Volume expansion gave slight effect on regional cerebral blood flow only but reversed brain tissue oxygenation Hypervolemic therapy applied with caution

Relevance to Nursing Practice Nurses advocate for the best possible care for their patients Nurses use evidence based interventions to care for their patients and when they change nurses need to be aware Nurses need to understand the effects of therapies in order to provide proper education

How can you benefit right now? This information benefits nursing students not only in the way that they are increasing their awareness and knowledge but that it is an example of how interventions can change overtime. It brings awareness that evidence based interventions have the potential to change

Further study It was a nonrandomized, observational protocol. Was conducted over a short period of time so could not evaluate the cerebral hemodynamics over a long period of time or the consequences of sustained hypervolemia/ hypertension administration. Did not observe different effects between patients with and without vasospasm or between vasospacitic and nonvasospacitic hemispheres Incorporate a larger sample size, different demographic patients, etc. in order to apply it to a large population.

Thought Provoking Questions 1. What are the H’s in Triple H-Therapy? A: Hypertension, hypervolemia, and hemodilution 2. What H in Triple-H Therapy causes the main negative side affects? A: Hypervolemia- decreased brain tissue oxygenation

Reference Muench, E., Horn, P., Bauhuf, C., Roth, H., Philipps, M., Hermann, P., Quintel, M., Schmiedek, P., & Vajkoczy, P. (2007). Effects of hypervolemia and hypertenstion on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation after subarachnoid hemorrhage. Critical Care Medicine, 35(8),