Hypertensive, hypervolemic hemodilutional therapy for aneurysmal subarachnoid hemorrhage - Is it efficacious? Yes

Vasospasm is an important contributor to death and disability after aneurysmal subarachnoid hemorrhage (SAH), with delayed ischemic deficits (DID) occurring in as much as 30% of patients with angiographic spasm. There is strong evidence that hypertensive, hypervolemic, hemodilutional (HHH) therapy reverses the signs of DID and that its prophylactic use reduces the incidence of DID and subsequent infarction. Improvement of outcome in even the poorest-grade patients has been demonstrated. Literature supporting the use of HHH therapy in aneurysmal SAH is reviewed.