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Peng L, Zhao L, Zhang X, Zhang Y, Ding M, Lin Z, Jiang H, Huang Y, Gao B, Wei W. Feasibility and accuracy of noninvasive continuous hemoglobin monitoring using transesophageal photoplethysmography in porcine model. BMC Anesthesiol 2024; 24:53. [PMID: 38321377 PMCID: PMC10845655 DOI: 10.1186/s12871-024-02435-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Continuous and noninvasive hemoglobin (Hb) monitoring during surgery is essential for anesthesiologists to make transfusions decisions. The aim of this study was to investigate the feasibility and accuracy of noninvasive and continuous Hb monitoring using transesophageal descending aortic photoplethysmography (dPPG) in porcine model. METHODS Nineteen landrace pigs, aged 3 to 5 months and weighing 30 to 50 kg, were enrolled in this study. A homemade oximetry sensor, including red (660 nm) and infrared (940 nm) lights, was placed in the esophagus for dPPG signal detection to pair with the corresponding reference Hb values (Hbi-STAT) measured by blood gas analysis. The decrease and increase changes in Hb concentration were achieved by hemodilution and transfusion. Metrics, including alternating current (AC), direct current (DC), and AC/DC for both red and infrared light were extracted from the dPPG signal. A receiver operating characteristic (ROC) curve was built to evaluate the performance of dPPG metrics in predicting the Hb "trigger threshold" of transfusion (Hb < 60 g/L and Hb > 100 g/L). Agreement and trending ability between Hb measured by dPPG (HbdPPG) and by blood gas analysis were analyzed by Bland-Altman method and polar plot graph. Error grid analysis was also performed to evaluate clinical significance of HbdPPG measurement. RESULTS The dPPG signal was successfully detected in all of the enrolled experimental pigs, without the occurrence of a continuous loss of dPPG signal for 2 min during the entire measurement. A total of 376 pairs of dPPG signal and Hbi-STAT were acquired. ACred/DCred and ACinf/DCinf had moderate correlations with Hbi-STAT, and the correlation coefficients were 0.790 and 0.782, respectively. The areas under the ROC curve for ACred/DCred and ACinf/DCinf in predicting Hbi-STAT < 60 g/L were 0.85 and 0.75, in predicting Hbi-STAT > 100 g/L were 0.90 and 0.83, respectively. Bland-Altman analysis and polar plot showed a small bias (1.69 g/L) but a wide limit of agreement (-26.02-29.40 g/L) and a poor trend ability between HbdPPG and Hbi-STAT. Clinical significance analysis showed that 82% of the data lay within the Zone A, 18% within the Zone B, and 0% within the Zone C. CONCLUSION It is feasible to establish a noninvasive and continuous Hb monitoring by transesophageal dPPG signal. The ACred/DCred extracted from the dPPG signal could provide a sensitive prediction of the Hb threshold for transfusion. The Hb concentration measured by dPPG signal has a moderate correlation with that measured by blood gas analysis. This animal study may provide an experimental basis for the development of bedside HbdPPG monitoring in the future.
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Affiliation(s)
- Ling Peng
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Long Zhao
- Department of Cardiovascular Surgery, The Third People's Hospital of Chengdu, 82 Qing Long Xiang, Chengdu, 610041, China
| | - Xue Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Yi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Meng Ding
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Zhibin Lin
- Department of Physics, Sichuan University, Chengdu, 610064, China
| | - Hao Jiang
- Department of Physics, Sichuan University, Chengdu, 610064, China
| | - Yuchen Huang
- Department of Physics, Sichuan University, Chengdu, 610064, China
| | - Bo Gao
- Department of Physics, Sichuan University, Chengdu, 610064, China
| | - Wei Wei
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China.
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Ahn H(S, Lenet T, Gilbert RWD, Mallick R, Shaw JLV, Fergusson DA, McIsaac DI, Martel G. Accuracy of point-of-care testing devices for haemoglobin in the operating room: meta-analysis. BJS Open 2024; 8:zrad148. [PMID: 38266123 PMCID: PMC10807999 DOI: 10.1093/bjsopen/zrad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/24/2023] [Accepted: 10/29/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Point-of-care tests (POCT) for haemoglobin are increasingly used to guide intraoperative transfusion. However, their accuracy compared to central laboratory tests is unknown. The objective was to perform a systematic review and meta-analysis of method comparison studies assessing the accuracy of POCT versus central laboratory haemoglobin tests in patients undergoing surgery. METHODS Electronic databases were searched from inception to April 2020 (updated August 2023). Any methodological approach comparing haemoglobin measurements between POCT and central laboratory in patients undergoing surgery under anaesthesia in the operating room were included. Data abstraction was guided by PRISMA and risk of bias was assessed by QUADAS-2. Data were extracted independently and in duplicate by two reviewers. Outcomes included mean differences between POCT and central laboratory haemoglobin with associated standard deviations and 95% limits of agreement (LOA). RESULTS Of 3057 citations, 34 studies were included (n = 2427, 6857 paired measurements). Several devices were compared (pulse co-oximetry, n = 25; HemoCue, n = 10; iSTAT, n = 6; blood gas analysers, n = 10; haematology analyser, n = 2). Median sample size was 41 patients, and 11 studies were funded by device manufacturers. Fifteen of 34 studies had low risk of bias. Pooled mean differences (95% LOA) were: pulse co-oximeters 2.3 g/l (-25.2-29.8), HemoCue -0.3 g/l (-11.1-10.5), iSTAT -0.3 g/l (-8.4-7.8) and blood gas analysers -2.6 g/l (-17.8-12.7). CONCLUSION All POCT examining intraoperative haemoglobin measurement yielded pooled mean difference LOAs larger than the allowable limit difference of ±4 g/dl. Intraoperative haemoglobin measured by POCT should not be considered interchangeable with central laboratory values and caution is necessary when using these tests to guide intraoperative transfusion.
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Affiliation(s)
- Hilalion (San) Ahn
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Tori Lenet
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Richard W D Gilbert
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Julie L V Shaw
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Guillaume Martel
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Mills K, Vermeer JM, Berry WE, Karreman E, Lett CD. Determining the validity of non-invasive spot-check hemoglobin co-oximetry testing to detect anemia in postpartum women at a tertiary care centre, a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:479. [PMID: 37386388 DOI: 10.1186/s12884-023-05783-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Spot-check hemoglobin co-oximetry analyzers measure hemoglobin transcutaneously and offer the benefit of a hemoglobin measurement without phlebotomy. The objective of this study was to determine the validity of non-invasive spot-check hemoglobin co-oximetry testing for the detection of postpartum anemia (hemoglobin < 10 g/dL). METHODS Five hundred eighty-four women aged 18 and over were recruited on postpartum day one following a singleton delivery. Two non-invasive spot-check hemoglobin co-oximetry monitors, Masimo Pronto Pulse CO-Oximeter (Pronto) and Masimo Rad-67 Pulse CO-Oximeter (Rad-67), were evaluated and compared to the postpartum phlebotomy hemoglobin value. RESULTS Of 584 participants, 31% (181) had postpartum anemia by phlebotomy hemoglobin measurement. Bland-Altman plots determined a bias of + 2.4 (± 1.2) g/dL with the Pronto and + 2.2 (± 1.1) g/dL with the Rad-67. Low sensitivity was observed: 15% for the Pronto and 16% for the Rad-67. Adjusting for the fixed bias, the Pronto demonstrated a sensitivity of 68% and specificity of 84%, while the Rad-67 demonstrated a sensitivity of 78% and specificity of 88%. CONCLUSION A consistent overestimation of hemoglobin by the non-invasive spot-check hemoglobin co-oximetry monitors compared to phlebotomy hemoglobin result was observed. Even after adjusting for the fixed bias, the sensitivity for detecting postpartum anemia was low. Detection of postpartum anemia should not be based on these devices alone.
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Affiliation(s)
- Kienna Mills
- Health Science Building, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
| | - Julie M Vermeer
- Department of Obstetrics and Gynecology, University of Saskatchewan, Reginal General Hospital, 1440 14 Ave, ReginaRegina, Saskatchewan, S4P 0W5, Canada
| | - Warren E Berry
- Saskatchewan Health Authority, 2180 23rd Avenue, Regina, SK, S4S 0A5, Canada
| | - Erwin Karreman
- Saskatchewan Health Authority, 2180 23rd Avenue, Regina, SK, S4S 0A5, Canada
| | - Christine D Lett
- Department of Obstetrics and Gynecology, University of Saskatchewan, Reginal General Hospital, 1440 14 Ave, ReginaRegina, Saskatchewan, S4P 0W5, Canada.
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Nakamori E, Shigematsu K, Higashi M, Yamaura K. Postoperative Noninvasive Hemoglobin Monitoring Is Useful to Prevent Unnoticed Postoperative Anemia and Inappropriate Blood Transfusion in Patients Undergoing Total Hip or Knee Arthroplasty: A Randomized Controlled Trial. Geriatr Orthop Surg Rehabil 2021; 12:21514593211060575. [PMID: 34820147 PMCID: PMC8606913 DOI: 10.1177/21514593211060575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 01/28/2023] Open
Abstract
Introduction Postoperative nadir hemoglobin (Hb) is related to a longer length of stay for geriatric patients undergoing orthopedic surgery. We investigated whether postoperative pulse Hb (SpHb) measurement is useful for avoiding anemia and inappropriate blood transfusion after total hip arthroplasty and total knee arthroplasty. Material and Methods This prospective randomized controlled study included 150 patients randomly assigned to receive blood transfusion, either guided by SpHb monitoring (SpHb group) or based on the surgeons’ experience (control group). The target laboratory Hb value was set to >8 g/dL at postoperative day 1 (POD1). The primary endpoints were the product of total time and degree of SpHb <8 g/dL (area under SpHb 8 g/dL) during the period up to POD1 and the incidence of laboratory Hb <8 g/dL at POD1. The secondary endpoints were the amount of blood transfusion and inappropriate blood transfusion, which was defined as allogeneic blood transfusion unnecessary in a case of SpHb >12 g/dL or delayed transfusion in a case of SpHb <8 g/dL. Results The area under SpHb 8 g/dL was 37.6 ± 44.1 g/dL-min (5 patients) in the control group and none in the SpHb group (P = .0281). There was 1 patient with Hb <8 g/dL at POD1 in the control group. There was no difference in laboratory Hb levels and the amount of blood transfusion. Forty-one patients (19 in the control group and 22 in the SpHb group) received an allogeneic blood transfusion. Among these patients, 7 in the control group and none in the SpHb group received inappropriate blood transfusion (P = .0022). Discussion The SpHb monitoring could reduce unnoticed anemia, which may prevent complications and be useful in avoiding unnecessary and excessive blood transfusion. Conclusion Postoperative SpHb monitoring decreased the incidence of transient, unnoticed anemia during the period up to POD1 and inappropriate blood transfusion.
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Affiliation(s)
- Erisa Nakamori
- Department of Anesthesiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Kenji Shigematsu
- Department of Anesthesiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Midoriko Higashi
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Tayari H, Flaherty D, Schauvliege S, La Rosa L, Auckburally A. Accuracy and trending capability of haemoglobin measurement by noninvasive pulse co-oximetry in anaesthetized horses. Vet Anaesth Analg 2021; 49:76-84. [PMID: 34801406 DOI: 10.1016/j.vaa.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/21/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the accuracy and trending capability of continuous measurement of haemoglobin concentration [Hb], haemoglobin oxygen saturation (SaO2) and oxygen content (CaO2) measured by the Masimo Radical-7 pulse co-oximeter in horses undergoing inhalational anaesthesia. STUDY DESIGN Prospective observational clinical study. ANIMALS A group of 23 anaesthetized adult horses. METHODS In 23 healthy adult horses undergoing elective surgical procedures, paired measurements of pulse co-oximetry-based haemoglobin concentration (SpHb), SaO2 (SpO2), and CaO2 (SpOC) and simultaneous arterial blood samples were collected at multiple time points throughout anaesthesia. The arterial samples were analysed by a laboratory co-oximeter for total haemoglobin (tHb), SaO2 and manually calculated CaO2. Bland-Altman plots, linear regression analysis, error grid analysis, four-quadrant plot and Critchley polar plot were used to assess the accuracy and trending capability of the pulse co-oximeter. Data are presented as mean differences and 95% limits of agreement (LoA). RESULTS In 101 data pairs analysed, the pulse co-oximeter slightly underestimated tHb (bias 0.06 g dL-1; LoA -1.0 to 1.2 g dL-1), SaO2 (bias 1.4%; LoA -2.0% to 4.8%), and CaO2 (bias 0.3 mL dL-1; LoA -2.1 to 2.7 mL dL-1). Zone A of the error grid encompassed 99% of data pairs for SpHb. Perfusion index (PI) ≥ 1% was recorded in 58/101 and PI < 1% in 43/101. The concordance rate for consecutive changes in SpHb and tHb with PI ≥ 1% and < 1% was 80% and 91% with four-quadrant plot, and 45.8% and 66.6% with Critchley polar plot. CONCLUSIONS Pulse co-oximetry has acceptable accuracy for the values measured, even with low PI, whereas its trending ability requires further investigation in those horses with a higher [Hb] variation during anaesthesia.
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Affiliation(s)
- Hamaseh Tayari
- Southern Counties Veterinary Specialists, Anaesthesia Department, Ringwood, UK.
| | - Derek Flaherty
- Southern Counties Veterinary Specialists, Anaesthesia Department, Ringwood, UK
| | - Stijn Schauvliege
- Department of Surgery and Anaesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Lavinia La Rosa
- Department of Surgery and Anaesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Adam Auckburally
- Southern Counties Veterinary Specialists, Anaesthesia Department, Ringwood, UK
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Non-invasive monitoring is coming the full circle, making our patients safer! J Clin Monit Comput 2020; 34:869-870. [DOI: 10.1007/s10877-020-00462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 11/26/2022]
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