"Triple-H" therapy for cerebral vasospasm following subarachnoid hemorrhage

Kendall H. Lee, Timothy Lukovits, Jonathan A. Friedman

Research output: Contribution to journalReview articlepeer-review

118 Scopus citations


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). Although this paradigm has gained widespread acceptance over the past 20 years, the efficacy of triple-H therapy and its precise role in the management of the acute phase of SAH remains uncertain. In addition, triple-H therapy may carry significant medical morbidity, including pulmonary edema, myocardial ischemia, hyponatremia, renal medullary washout, indwelling catheter-related complications, cerebral hemorrhage, and cerebral edema. This review examines the evidence underlying the implementation of triple-H therapy, and makes practical recommendations for the use of this therapy in patients with aneurysmal SAH.

Original languageEnglish (US)
Pages (from-to)68-76
Number of pages9
JournalNeurocritical care
Issue number1
StatePublished - Feb 1 2006


  • Aneurysm
  • Cerebrovascular disease
  • Subarachnoid hemorrhage
  • Triple-H therapy
  • Vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine


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