Triple H therapy and ICP question....please

  1. Hi,
    I have a question for all the Neuro ICU nurses.I have heard some of you guys speak of triple h therapy....what is triple h therapy and why is it used?

    And the second part of my question is on ICP monitoring.At what reading/range do you get "worried" about your patients?I know any type of prolonged elevated icp can cause injury...but I am talking about being worried over immediate /possible significant sentinel event type of worried?

    For the elevated icps what drugs are typicall ordered on your unit...decadron,mannitol,dilantin.....anything else?thanks!
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  2. 23 Comments

  3. by   NeuroICURN
    Quote from TNNURSE
    Hi,
    I have a question for all the Neuro ICU nurses.I have heard some of you guys speak of triple h therapy....what is triple h therapy and why is it used?

    And the second part of my question is on ICP monitoring.At what reading/range do you get "worried" about your patients?I know any type of prolonged elevated icp can cause injury...but I am talking about being worried over immediate /possible significant sentinel event type of worried?

    For the elevated icps what drugs are typicall ordered on your unit...decadron,mannitol,dilantin.....anything else?thanks!
    Ok...I answered the triple H therapy question in the thread about needing insight from neuro nurses.

    Textbook normal ICP is 0-10. Anything up to 15 is acceptable. Most facilities use the following rule of thumb..."Call for ICP >20 sustained for more than 5 minutes". Now, obviously if my patient's ICP is 19 and they are having changes, then I'm gonna call.

    Drugs: Dilantin is an antiseizure medication. Decadron is a steroid used to decrease swelling, but doesn't really do anything for ICP.

    Yes, they use Mannitol, but that gets kind of tricky. First of all, you have to monitor serum osmo and sodium (hold parameters are usually Na >150 and Osmo >320). Also, Mannitol is a drug that the more times you use it, the less effective it becomes.

    Some other drugs that you may want to look into that can be used are propofol (for sedation) and pentobarb.

    Other things that may be done to decrease ICP: lower the gradient on the drainage bag, keep the persons head straight to facilitate drainage (sounds simple, yes, but it helps), bone flap removal.

    Just a few things to help you get started on your way...hope it helps!

    NeuroICURN
  4. by   DustinRN
    Drugs: [...]Decadron is a steroid used to decrease swelling, but doesn't really do anything for ICP.

    NeuroICURN this confuses me. Does Decadron not decrease the swelling of the brain and therefore decrease ICP as well? :uhoh21: I've been under the impression that it does. Just when I thought I had it all figured out!

    :chuckle
  5. by   NeuroICURN
    Quote from DustinRN
    NeuroICURN this confuses me. Does Decadron not decrease the swelling of the brain and therefore decrease ICP as well? :uhoh21: I've been under the impression that it does. Just when I thought I had it all figured out!

    :chuckle
    Ok, well, I stated that wrong and it's my fault. Steroids do help with ICP, but in certain cases.

    In the case of a TBI (traumatic brain injury), steroids do little. Now, steroids do help in the case of decreasing edema around a tumor, therefore decreasing ICP. Steroids are also useful in cases of spinal and/or cord injury.

    But in terms of sudden increase of ICP and trying to prevent herniation, then no, steroids don't do a whole heck of a lot.

    So I guess what I'm trying to say is this....it just depends on the case and why the ICP is increasing.
    Last edit by NeuroICURN on Jun 3, '04
  6. by   DustinRN
    Quote from NeuroICURN
    Ok, well, I stated that wrong and it's my fault. Steroids do help with ICP, but in certain cases.

    In the case of a TBI (traumatic brain injury), steroids do little. Now, steroids do help in the case of decreasing edema around a tumor, therefore decreasing ICP. Steroids are also useful in cases of spinal and/or cord injury.

    But in terms of sudden increase of ICP and trying to prevent herniation, then no, steroids don't do a whole heck of a lot.

    So I guess what I'm trying to say is this....it just depends on the case and why the ICP is increasing.

    I see what you're saying. Depends on the situation.

    Thanks for the clarification.
  7. by   mbrian46
    In the NSICU where I used to work Decadron was mainly used on brain tumors, not for ICP control. Opioids, benzodiazapines, along with paralytics were used mainly for ICP control. Steroids have undesirable side effects, such as delayed wound healing, increased blood glucose, etc.
  8. by   gwenith
    We were trialling hypertonic saline and keeping the Na level at around 150 - seemed to work.

    BTW the only "triple H therapy I had heard of outside of this thread was in relation to the old fashioned enema and it stood for

    "High, hot and heck of a lot"
  9. by   NeuroICURN
    Quote from gwenith
    We were trialling hypertonic saline and keeping the Na level at around 150 - seemed to work.

    BTW the only "triple H therapy I had heard of outside of this thread was in relation to the old fashioned enema and it stood for

    "High, hot and heck of a lot"

    Gwenith,

    You guys just started using 3%??? We've been using it for quite some time now....actually, they've even found other uses for it.

    P.S. No matter what some resident tries to tell you, this canNOT go through a peripheral IV!! Silly residents! LOL
  10. by   gwenith
    We had been using it since the 1990's but they were actually researching the effects - I never did see the outcome article.
  11. by   NeuroICURN
    Quote from gwenith
    We had been using it since the 1990's but they were actually researching the effects - I never did see the outcome article.
    Oh, ok! LOL For a second there, I couldn't believe that you were THAT behind the times! :chuckle
  12. by   Hawaii RN
    Quote from gwenith
    We were trialling hypertonic saline and keeping the Na level at around 150 - seemed to work.

    BTW the only "triple H therapy I had heard of outside of this thread was in relation to the old fashioned enema and it stood for

    "High, hot and heck of a lot"
    HHH therapy is not used for increased ICP but for cerebral vasospasm s/p SAH. Caution if the aneursym is unsecured.
    Hypervolemia
    HTN
    Hemodilution
  13. by   NeuroICURN
    Quote from Hawaii RN
    HHH therapy is not used for increased ICP but for cerebral vasospasm s/p SAH. Caution if the aneursym is unsecured.
    Hypervolemia
    HTN
    Hemodilution
    No one ever said it was used for increased ICP. Perhaps you are confusing this thread with the one about treating increased ICP?
  14. by   gwenith
    Actually I was just commenting on the different language usage between countires.

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