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Effect of different components of triple-H therapy on cerebral perfusion in patients with aneurysmal subarachnoid haemorrhage: a systematic review.

Dankbaar JW, Slooter AJ, Rinkel GJ, Schaaf IC - Crit Care (2010)

Bottom Line: We summarized study design, patient and intervention characteristics, and calculated differences in mean CBF before and after intervention.The large heterogeneity in interventions and study populations prohibited meta-analyses.There is no good evidence from controlled studies for a positive effect of triple-H or its separate components on CBF in SAH patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, Netherlands. j.w.dankbaar@umcutrecht.nl

ABSTRACT

Introduction: Triple-H therapy and its separate components (hypervolemia, hemodilution, and hypertension) aim to increase cerebral perfusion in subarachnoid haemorrhage (SAH) patients with delayed cerebral ischemia. We systematically reviewed the literature on the effect of triple-H components on cerebral perfusion in SAH patients.

Methods: We searched medical databases to identify all articles until October 2009 (except case reports) on treatment with triple-H components in SAH patients with evaluation of the treatment using cerebral blood flow (CBF in ml/100 g/min) measurement. We summarized study design, patient and intervention characteristics, and calculated differences in mean CBF before and after intervention.

Results: Eleven studies (4 to 51 patients per study) were included (one randomized trial). Hemodilution did not change CBF. One of seven studies on hypervolemia showed statistically significant CBF increase compared to baseline; there was no comparable control group. Two of four studies applying hypertension and one of two applying triple-H showed significant CBF increase, none used a control group. The large heterogeneity in interventions and study populations prohibited meta-analyses.

Conclusions: There is no good evidence from controlled studies for a positive effect of triple-H or its separate components on CBF in SAH patients. In uncontrolled studies, hypertension seems to be more effective in increasing CBF than hemodilution or hypervolemia.

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Mean CBF difference between start of intervention and follow-up within 5-7 days and 12-14* days.
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Figure 3: Mean CBF difference between start of intervention and follow-up within 5-7 days and 12-14* days.

Mentions: Cerebral perfusion measurement details are summarized in Table 3. Different perfusion measurement techniques were used: five (45%) studies used an external scintillation counter (e.s.c.) technique, one (9%) used single photon emission computed tomography (SPECT), three (27%) used Xenon-CT (XeCT), one used (9%) PET and one (9%) study thermal diffusion microprobes (validated by XeCT). Four (36%) studies did not report whole brain perfusion measurements, but only measurements from the hemisphere ipsilateral to craniotomy or in the flow territory distal to the aneurysm [14,19-21]. Nine (82%) studies measured CBF within 24 hours after the start of the intervention and two at a later time. These two studies both measured after five to seven days and one also after 12 to 14 days. Differences in mean CBF before and after intervention with their 95% confidence intervals are plotted in Figures 2 and 3. Weighted total effects could not be calculated due to the large heterogeneity in the used intervention, the studied populations and the applied methods.


Effect of different components of triple-H therapy on cerebral perfusion in patients with aneurysmal subarachnoid haemorrhage: a systematic review.

Dankbaar JW, Slooter AJ, Rinkel GJ, Schaaf IC - Crit Care (2010)

Mean CBF difference between start of intervention and follow-up within 5-7 days and 12-14* days.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875538&req=5

Figure 3: Mean CBF difference between start of intervention and follow-up within 5-7 days and 12-14* days.
Mentions: Cerebral perfusion measurement details are summarized in Table 3. Different perfusion measurement techniques were used: five (45%) studies used an external scintillation counter (e.s.c.) technique, one (9%) used single photon emission computed tomography (SPECT), three (27%) used Xenon-CT (XeCT), one used (9%) PET and one (9%) study thermal diffusion microprobes (validated by XeCT). Four (36%) studies did not report whole brain perfusion measurements, but only measurements from the hemisphere ipsilateral to craniotomy or in the flow territory distal to the aneurysm [14,19-21]. Nine (82%) studies measured CBF within 24 hours after the start of the intervention and two at a later time. These two studies both measured after five to seven days and one also after 12 to 14 days. Differences in mean CBF before and after intervention with their 95% confidence intervals are plotted in Figures 2 and 3. Weighted total effects could not be calculated due to the large heterogeneity in the used intervention, the studied populations and the applied methods.

Bottom Line: We summarized study design, patient and intervention characteristics, and calculated differences in mean CBF before and after intervention.The large heterogeneity in interventions and study populations prohibited meta-analyses.There is no good evidence from controlled studies for a positive effect of triple-H or its separate components on CBF in SAH patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, Netherlands. j.w.dankbaar@umcutrecht.nl

ABSTRACT

Introduction: Triple-H therapy and its separate components (hypervolemia, hemodilution, and hypertension) aim to increase cerebral perfusion in subarachnoid haemorrhage (SAH) patients with delayed cerebral ischemia. We systematically reviewed the literature on the effect of triple-H components on cerebral perfusion in SAH patients.

Methods: We searched medical databases to identify all articles until October 2009 (except case reports) on treatment with triple-H components in SAH patients with evaluation of the treatment using cerebral blood flow (CBF in ml/100 g/min) measurement. We summarized study design, patient and intervention characteristics, and calculated differences in mean CBF before and after intervention.

Results: Eleven studies (4 to 51 patients per study) were included (one randomized trial). Hemodilution did not change CBF. One of seven studies on hypervolemia showed statistically significant CBF increase compared to baseline; there was no comparable control group. Two of four studies applying hypertension and one of two applying triple-H showed significant CBF increase, none used a control group. The large heterogeneity in interventions and study populations prohibited meta-analyses.

Conclusions: There is no good evidence from controlled studies for a positive effect of triple-H or its separate components on CBF in SAH patients. In uncontrolled studies, hypertension seems to be more effective in increasing CBF than hemodilution or hypervolemia.

Show MeSH
Related in: MedlinePlus