gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Effects of hypervolemia, hemodilution and hypertension on regional cerebral blood flow and brain tissue oxygenation

Einfluss von "triple-H" Therapie auf zerebralen Blutfluss und zerebrale Oxygenierung

Meeting Abstract

  • E. Muench - Institut für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg
  • P. Horn - Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg
  • C. Bauhuf - Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg
  • M. Phillips - Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg
  • P. Schmiedek - Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg
  • corresponding author P. Vajkoczy - Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSO.06.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc194.shtml

Published: May 8, 2006

© 2006 Muench et al.
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Outline

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Objective: Hypertensive, hypervolemic, hemodilution therapy (triple-H therapy) is a generally accepted treatment for cerebral vasospasm after subarachnoid hemorrhage (SAH). However, the particular role of the three components of triple-H therapy remains controversial. The aim of the study was to investigate the influence of triple-H therapy on regional cerebral blood flow (rCBF) and brain tissue oxygenation (PtiO2).

Methods: Ten intubated and ventilated patients (8 female, 2 male; mean age 52,3±11,6 yrs) with high-grade aneurysmal subarachnoid hemorrhage (aSAH) (H&H III-V) were examined on day 1,3 and 7 after bleeding. After baseline recordings of thermal diffusion rCBF (TD-rCBF), and brain tissue oxygenation (ptiO2), vasopressors and/or colloids and cristalloids were administered for the stepwise establishment of the three components of triple-H therapy.

Results: Elevations of MAP by noradrenalin infusion resulted in an increase of TD-rCBF from 29±16 to 39±19 ml/100g/min. Hypervolemia alone did not lead to a significant increase of MAP and resulted in a slight increase of TD-rCBF only on day one and seven after bleeding. Significant improvement of TD-rCBF (48±22 ml/100g/min) was achieved after restoration of hypervolemia and hypertension (MAP>130mmHg). None of the three components of triple-H therapy affected PtiO2 measurements significantly.

Conclusions: Vasopressor-induced elevation of MAP caused a significant increase of TD-rCBF in all SAH patients. Volume expansion resulted in a slight effect on TD-rCBF only. In view of the increased risk of complications due to hypervolemic therapy, the added benefit of hypervolemia remains questionable. However, these findings suggest that the effect of triple-H therapy should be monitored by direct CBF measurements.