What is hemodilution therapy?
Hemodilution is the practice of intentionally removing red blood cells to lower the hematocrit. This has the obvious result that the red cells can be replaced later if needed.
What is Triple-H therapy for vasospasm?
The combination of induced hypertension, hypervolemia, and hemodilution (triple-H therapy) is often utilized to prevent and treat cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH).
How is vasospasm treated after SAH?
Nimodipine has been recommended as first-line medical treatment for preventing post-aSAH cerebral vasospasm. It is usually given orally at a dosage of 60 mg every 4 hours for 21 days after the initial subarachnoid hemorrhage.
What is Hypervolemic hypertensive hemodilution therapy?
Hypervolemic hypertensive hemodilution (3H-therapy) applied to patients operated on in the acute period of aneurysmal SAH was effective in increasing cardiac output, central venous pressure, systemic arterial pressure and hence cerebral perfusion with the minimum number of complications unassociated with the use of …
When is hemodilution used?
Acute normovolemic hemodilution is one of the strategies used to reduce the need for blood transfusion. The current approach to reducing blood transfusion during major surgery can be broadly divided into methods that decrease operative blood loss and methods that provide autologous red cells.
How do you test for hemodilution?
Haemodilution due to volume overload in our clinical practice is assessed by: monitoring weight gain, changes in serum sodium and urine output (if available) along with clinical examination findings.
What is HHH therapy?
Hyperdynamic therapy, also called triple-H therapy, is the standard treatment and prophylaxis for aneurysmal-associated vasospasm. In patients who are able to tolerate cardiopulmonary stressors induced by this therapy, it is of benefit as a modality for prevention and treatment of delayed ischemic neurologic deficit.
What is a normal Lindegaard ratio?
A Lindegaard ratio of 3–6 is indicative of mild to moderate vasospasm, and a ratio greater than 6.0 is indicative of severe vasospasm (Fig 10). Elevated flow velocities with a Lindegaard ratio of less than 3.0 are suggestive of hyperemia or another physiologic or induced state (1,6,12).
Why is nimodipine used in SAH?
Nimodipine is used to decrease problems due to a certain type of bleeding in the brain (subarachnoid hemorrhage-SAH). Nimodipine is called a calcium channel blocker. The body naturally responds to bleeding by narrowing the blood vessel to slow blood flow.
What is Triple H therapy?
How does hemodilution happen?
It involves removing some of a patient’s own blood and replacing it with fluids, to maintain normal volume. This process ensures that the blood that is lost during the operation is diluted, ie fewer red blood cells are in it.
How is Triple H therapy used to treat Sah?
Triple H therapy The combination of induced hypertension, hypervolemia, and hemodilution (triple-H therapy) is often utilized to prevent and treat cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH).
What are the side effects of Triple H therapy?
In addition, triple-H therapy may carry significant medical morbidity, including pulmonary edema , myocardial infarction , hyponatremia, renal medullary washout, indwelling catheter-related complications, cerebral hemorrhage, and cerebral edema 1). This practice is based on low level evidence. see Induced hypertension for vasospasm.
How is Triple H therapy used to treat cerebral vasospasm?
The combination of induced hypertension, hypervolemia, and hemodilution (triple-H therapy) is often utilized to prevent and treat cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH).
How often should you titrate Triple H therapy?
Use fluids to maintain euvolemia. Administer pressors to increase SBP in 15% increments until neurologically improved or SBP of 220 mm Hg is reached. ○ titrate every 2–5 minutes: double the rate up to 64 mcg/min, then increase by 10 mcg/min