1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Farooq F, Smith ER, Pan Q, Glass Baumann S, Akelo V, Jehan F, Kasaro M, Nisar I, Ouma G, Vwalika B, Spelke MB, Price JT, Hoodbhoy Z. Comparison of Masimo Total Hemoglobin SpHb® continuous non-invasive hemoglobin monitoring device with laboratory complete blood count measurement using venous sample: Protocol for an observational substudy of the Pregnancy Risk and Infant Surveillance and Measurement Alliance Maternal and Newborn Health (PRISMA MNH) study. Gates Open Res 2024; 7:50. [PMID: 37868333 PMCID: PMC10587393 DOI: 10.12688/gatesopenres.14499.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 10/24/2023] Open
Abstract
Background The Masimo Total Hemoglobin SpHb® is a continuous and non-invasive handheld device to measure hemoglobin levels. Previous research has found that SpHb is able to accurately detect hemoglobin levels in adult patients with a similar degree of bias and standard deviation to point-of-care invasive method measurements. Generally, limited clinical evidence, lack of validation of Masimo at higher than and lower than hemoglobin threshold values, and scientific consensus supporting the use of Masimo for accurate hemoglobin testing for the diagnosis of anemia during pregnancy calls for further research. Methods and analysis The proposed prospective cohort will be nested within the ongoing Pregnancy Risk and Infant Surveillance and Measurement Alliance (PRISMA) Maternal and Newborn Health (MNH) study. Three study sites (located in Zambia, Kenya, and Pakistan) will participate and collect hemoglobin data at five time points (<20 weeks, 20 weeks, 28 weeks, 36 weeks' gestation, and six weeks postpartum). We will measure hemoglobin using a venous blood sample via hematology auto-analyzer complete blood count (gold standard) and the non-invasive device. The primary objective is to assess agreement between Masimo total hemoglobin and complete blood count and on a continuous scale using Intraclass Correlation Coefficient and Bland-Altman Analysis. The second objective is to assess agreement between the two measures on a binary scale using Positive Percentage Agreement and Negative Percentage Agreement, Cohen's Kappa, and McNemar Test. On an ordinal scale, agreement will be measured using Weighted Cohen's Kappa and Harrel's Concordance Index. Lastly, we will assess factors that might affect the accuracy of Masimo total hemoglobin using linear mixed models. Conclusions The primary aim of this study is to assess the validity of the non-invasive Masimo device compared to the gold standard method of invasive hemoglobin measurements during pregnancy and postpartum periods for the diagnosis of anemia.
Collapse
Affiliation(s)
- Fouzia Farooq
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Emily R. Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Qing Pan
- Department of Statistics, Columbian College of Arts & Sciences, George Washington University, Washington, DC, 20052, USA
| | - Sasha Glass Baumann
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Victor Akelo
- Centers for Disease Controls and Prevention - Kenya, Kisumu, Kenya
| | - Fyezah Jehan
- Aga Khan University Hospital, Karachi, Karachi, Sindh, Pakistan
| | - Margaret Kasaro
- UNC Global Projects Zambia, Lusaka, Zambia
- School of Medicine, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Imran Nisar
- Aga Khan University Hospital, Karachi, Karachi, Sindh, Pakistan
| | - Gregory Ouma
- Centre for Global Health Research (CGHR), Kenya Medical Research Institute, Kisumu, Kenya
| | | | - M. Bridget Spelke
- UNC Global Projects Zambia, Lusaka, Zambia
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, NC 27599, USA
| | - Joan T. Price
- UNC Global Projects Zambia, Lusaka, Zambia
- School of Medicine, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Zahra Hoodbhoy
- Aga Khan University Hospital, Karachi, Karachi, Sindh, Pakistan
| |
Collapse
|
3
|
Caulfield KC, McMahon O, Dennis AT. Baseline haemoglobin variability by measurement technique in pregnant people on the day of childbirth. Anaesthesia 2024; 79:178-185. [PMID: 37990621 DOI: 10.1111/anae.16174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/23/2023]
Abstract
Point-of-care haemoglobin measurement devices may play an important role in the antenatal detection of anaemia in pregnant people and may be useful in guiding blood transfusion during resuscitation in obstetric haemorrhage. We compared baseline haemoglobin variability of venous and capillary HemoCue® haemoglobin, and Masimo® Rad-67 Pulse CO-Oximeter haemoglobin with laboratory haemoglobin in people on the day of their planned vaginal birth. A total of 180 people undergoing planned vaginal birth were enrolled in this prospective observational study. Laboratory haemoglobin was compared with HemoCue and Masimo Rad-67 Pulse CO-Oximeter measurements using Bland-Altman analysis, calculating mean difference (bias) and limits of agreement. Five (2.8%) people had anaemia (haemoglobin < 110 g.l-1 ). Laboratory haemoglobin and HemoCue venous haemoglobin comparison showed an acceptable bias (SD) 0.7 (7.54) g.l-1 (95%CI -0.43-1.79), with limits of agreement -14.10-15.46 g.l-1 and acceptable agreement range of 29.6 g.l-1 . Laboratory and HemoCue capillary haemoglobin comparison showed an unacceptable bias (SD) 13.3 (14.12) g.l-1 (95%CI 11.17-15.34), with limits of agreement - 14.42-40.93 g.l-1 and unacceptable agreement range of 55.3 g.l-1 . Laboratory and Masimo haemoglobin comparison showed an unacceptable bias (SD) -14.0 (11.15) g.l-1 (95%CI -15.63 to -12.34), with limits of agreement to -35.85 to 7.87 g.l-1 and acceptable agreement range of 43.7 g.l-1 . Venous HemoCue, with its acceptable bias and limits of agreement, should be applied more widely in the antenatal setting to detect, manage and risk stratify pregnant people with anaemia. HemoCue capillary measurement under-estimated haemoglobin and Masimo haemoglobin measurement over-estimated, limiting their clinical use. Serial studies are needed to determine if the accuracy of venous HemoCue haemoglobin measurement is sustained in other obstetric settings.
Collapse
Affiliation(s)
- K C Caulfield
- Department of Anaesthesia, University Hospital Waterford, Waterford, Ireland
| | - O McMahon
- Department of Anaesthesia, Leicester Royal Infirmary, Infirmary Square, Leicester, UK
| | - A T Dennis
- Division of Obstetric Anesthesia, Department of Anesthesiology, Perioperative Medicine and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, The Royal Women's Hospital Parkville, and the University of Melbourne, Department of Critical Care and Obstetrics, Gynaecology and Newborn Health, Melbourne, Australia
| |
Collapse
|
4
|
Bonetta-Misteli F, Collins T, Pavek T, Carlgren M, Bashe D, Frolova A, Shmuylovich L, O’Brien CM. Development and evaluation of a wearable peripheral vascular compensation sensor in a swine model of hemorrhage. BIOMEDICAL OPTICS EXPRESS 2023; 14:5338-5357. [PMID: 37854551 PMCID: PMC10581812 DOI: 10.1364/boe.494720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 10/20/2023]
Abstract
Postpartum hemorrhage (PPH) is the leading and most preventable cause of maternal mortality, particularly in low-resource settings. PPH is currently diagnosed through visual estimation of blood loss or monitoring of vital signs. Visual assessment routinely underestimates blood loss beyond the point of pharmaceutical intervention. Quantitative monitoring of hemorrhage-induced compensatory processes, such as the constriction of peripheral vessels, may provide an early alert for PPH. To this end, we developed a low-cost, wearable optical device that continuously monitors peripheral perfusion via laser speckle flow index (LSFI) to detect hemorrhage-induced peripheral vasoconstriction. The measured LSFI signal produced a linear response in phantom models and a strong correlation coefficient with blood loss averaged across subjects (>0.9) in a large animal model, with superior performance to vital sign metrics.
Collapse
Affiliation(s)
| | - Toi Collins
- Division of Comparative Medicine, Washington University in St. Louis; St. Louis, USA
| | - Todd Pavek
- Division of Comparative Medicine, Washington University in St. Louis; St. Louis, USA
| | - Madison Carlgren
- Department of Biomedical Engineering, Washington University in St. Louis; St. Louis, USA
- Department of Obstetrics & Gynecology, Washington University in St. Louis; St. Louis, USA
| | - Derek Bashe
- Department of Biomedical Engineering, Washington University in St. Louis; St. Louis, USA
- Department of Radiology, Washington University in St. Louis; St. Louis, USA
| | - Antonina Frolova
- Department of Obstetrics & Gynecology, Washington University in St. Louis; St. Louis, USA
| | - Leonid Shmuylovich
- Department of Radiology, Washington University in St. Louis; St. Louis, USA
- Department of Dermatology, Washington University in St. Louis; St. Louis, USA
| | - Christine M. O’Brien
- Department of Biomedical Engineering, Washington University in St. Louis; St. Louis, USA
- Department of Obstetrics & Gynecology, Washington University in St. Louis; St. Louis, USA
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Bonetta-Misteli F, Collins T, Pavek T, Carlgren M, Frolova A, Shmuylovich L, O'Brien CM. Development and evaluation of a wearable peripheral vascular compensation sensor in a swine model of hemorrhage. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.20.529156. [PMID: 36865173 PMCID: PMC9979989 DOI: 10.1101/2023.02.20.529156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Postpartum hemorrhage (PPH) is both the leading and most preventable cause of maternal mortality. PPH is currently diagnosed through visual estimation of blood loss or vital sign analysis of shock index (ratio of heart rate to systolic blood pressure). Visual assessment underestimates blood loss, particularly in the setting of internal bleeding, and compensatory mechanisms stabilize hemodynamics until hemorrhage is massive, beyond the point of pharmaceutical intervention. Quantitative monitoring of hemorrhage-induced compensatory processes, such as the constriction of peripheral vessels to shunt blood to the central organs, may provide an early alert for PPH. To this end, we developed a low-cost, wearable optical device that continuously monitors peripheral perfusion via laser speckle flow index (LSFI) to detect hemorrhage-induced peripheral vasoconstriction. The device was first tested using flow phantoms across a range of physiologically relevant flow rates and demonstrated a linear response. Subsequent testing occurred in swine hemorrhage studies (n=6) by placing the device on the posterior side of the swine's front hock and withdrawing blood from the femoral vein at a constant rate. Resuscitation with intravenous crystalloids followed the induced hemorrhage. The mean LSFI vs. percent estimated blood volume loss had an average correlation coefficient of -0.95 during the hemorrhage phase and 0.79 during resuscitation, both of which were superior to the performance of the shock index. With continued development, this noninvasive, low-cost, and reusable device has global potential to provide an early alert of PPH when low-cost and accessible management strategies are most effective, helping to reduce maternal morbidity and mortality from this largely preventable problem.
Collapse
|
7
|
Beleta MI, Abdallah SR, Hammad YM, Yahia HEM, Ali AAE, Mohamed AA, AbdElhameed BM. Noninvasive continuous hemoglobin monitoring of blood transfusion in obstetric procedures. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2153976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mohamed Ibrahim Beleta
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shady Rady Abdallah
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yehia Mohamed Hammad
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam Eldin Mostafa Yahia
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ashraf Abd ElMawgood Ali
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Abdallah Mohamed
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Bassant Mohamed AbdElhameed
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
8
|
Mohta M, Siddiqui S, Chilkoti GT, Agarwal R. Oxytocin infusion rates for maintaining uterine tone during non-elective cesarean section in laboring patients: a randomized, controlled trial. J Anesth 2022; 36:456-463. [PMID: 35484429 DOI: 10.1007/s00540-022-03067-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Oxytocin infusions for uterine tone maintenance are recommended following initial low oxytocin doses during cesarean section. Very limited literature is available on the optimal infusion rates in laboring patients who have been earlier exposed to oxytocin. METHODS 105 patients, having received oxytocin for induction/augmentation of labor, received oxytocin infusions at rates of 2.5 IU/h (Group 2.5), 5 IU/h (Group 5) or 10 IU/h (Group 10) following 3 IU slow bolus. The primary outcome measure was estimated intraoperative blood loss; secondary outcome measures included uterine tone adequacy, requirements for additional uterotonics, and any side effects. Minor postpartum hemorrhage (PPH) was defined as blood loss > 500 ml and major/severe hemorrhage as blood loss > 1000 ml. RESULTS Group 10 had minimum blood loss (311.1 ± 44.9 ml) and uterotonic requirements compared to other groups (p < 0.001). Group 2.5 had maximum blood loss (549.4 ± 74.3 ml) and uterotonic requirements; Group 5 had intermediate values (402.0 ± 49.5 ml). Twenty-six patients in group 2.5 had minor PPH against only one in group 5 and none in group 10 (p < 0.001). No patient in either group had major PPH. The incidence of hypotension was higher in group 10 than in group 2.5 (p = 0.004). Nausea and vomiting were also more frequent in group 10 than in the other two groups. CONCLUSION Oxytocin infusions at 5 IU/h and 10 IU/h are more effective in reducing blood loss and preventing PPH than 2.5 IU/h. The dose of 10 IU/h, although the most efficacious, is associated with a high incidence of side effects. Hence, further studies are needed to find out the optimal maintenance infusion rate of oxytocin during cesarean section in laboring patients who have received oxytocin earlier.
Collapse
Affiliation(s)
- Medha Mohta
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
| | - Sheeba Siddiqui
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Geetanjali T Chilkoti
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rachna Agarwal
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| |
Collapse
|
9
|
Abstract
Obstetric hemorrhage is a leading cause of morbidity and mortality. Prevention includes identifying patients with risk factors and actively managing the third stage of labor. The anesthesiologist should be ready to manage hemorrhage with general strategies as well as strategies tailored to the specific cause of hemorrhage. Both neuraxial anesthesia and general anesthesia are appropriate in different situations. Treatments proven to be effective include increasing the oxytocin infusion, administering tranexamic acid early, guiding transfusion with point-of-care tests, and using cell salvage. Utilization of protocols and checklists within systems that encourage effective communication between teams should be implemented.
Collapse
Affiliation(s)
- Sarah Kroh
- Obstetric Anesthesiology, UPMC Magee Women's Hospital, University of Pittsburgh Medical School, 300 Halket Street, Pittsburgh, PA 15213, USA.
| | - Jonathan H Waters
- Anesthesiology & Perioperative Medicine, UPMC Magee-Womens Hospital, Patient Blood Management Program, 300 Halket Street, Pittsburgh, PA 15213, USA
| |
Collapse
|
10
|
Selvaraj N, Jain G, Tripathy DK, Mittal A, Indulekha H. Accuracy of non-invasive haemoglobin measurements in patients undergoing transurethral resection of prostate surgery. Indian J Anaesth 2021; 65:S62-S68. [PMID: 34188257 PMCID: PMC8191187 DOI: 10.4103/ija.ija_1067_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/04/2020] [Accepted: 01/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: The aim of this study was to evaluate the accuracy of non-invasive haemoglobin (SpHb) compared to laboratory venous haemoglobin (tHb) measurements among patients undergoing elective transurethral resection of prostate (TURP) surgery under spinal anaesthesia. Methods: In a prospective, observational, outcome-assessor blinded, cohort trial, we enroled 50 American Society of Anesthesiologists physical status (ASA-PS) I-II patients with benign prostatic hyperplasia. The primary outcome included SpHb and tHb measurements performed at four perioperative time-points: just before initiating the fluid preload (T1), and at 30 min (T2), 1 h (T3), and 2 h (T4) after starting the prostate resection, respectively. Statistical tool included intra-class correlation (ICC), Bland-Altman plots, and linear regression analysis. Results: We collected 200 SpHb/tHb data sets from 50 patients. The SpHb had a non-significant negative bias of –0.83 g/dL, –0.43 g/dL, –0.81 g/dL, and –0.46 g/dL, with limits of agreement of 2.6 g/dL to –4.2 g/dL, 2.4 g/dL to –3.3 g/dL, 1.3 g/dL to –2.8 g/dL, and 1.4 g/dL to –2.3 g/dL, for T1 to T4, respectively. The SpHb/tHb pairs correlated significantly (time-dependent increase in ICC from T1 to T4). The SpHb-tHb difference correlated significantly with corresponding serum sodium (T1 to T3), but not with perfusion index. No correlation existed between % change in SpHb-tHb difference (T1 to T4), and intraoperative blood loss or perioperative weight gain. Conclusion: The SpHb exhibited a clinically acceptable negative bias compared to tHb during TURP surgery. Although a wide limit of agreement between the SpHb/tHb pairs is a limitation, the real-time SpHb trends can still serve in clinical judgement.
Collapse
Affiliation(s)
- Naveen Selvaraj
- Departments of Anaesthesiology, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, Uttarakhand, India
| | - Gaurav Jain
- Departments of Anaesthesiology, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, Uttarakhand, India
| | - Debendra Kumar Tripathy
- Departments of Anaesthesiology, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, Uttarakhand, India
| | - Ankur Mittal
- Department of Urology, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, Uttarakhand, India
| | - Haritha Indulekha
- Departments of Anaesthesiology, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, Uttarakhand, India
| |
Collapse
|
11
|
Mohta M, Chowdhury RB, Tyagi A, Agarwal R. Efficacy of different infusion rates of oxytocin for maintaining uterine tone during elective caesarean section: A randomised double blind trial. Anaesth Intensive Care 2021; 49:183-189. [PMID: 33934618 DOI: 10.1177/0310057x20984480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most research in this field has focused on finding oxytocin doses for initiating uterine contractions. Only limited data are available regarding the optimal rate of oxytocin infusion to maintain adequate uterine tone. This randomised, double blind study included 120 healthy term pregnant patients with uncomplicated, singleton pregnancy undergoing elective caesarean section under spinal anaesthesia. Following an initial 1 IU bolus, the patients received oxytocin infusion at 1.25 IU/hour (group 1.25), 2.5 IU/hour (group 2.5) or 5.0 IU/hour (group 5) for four hours. Uterine tone was assessed as adequate or inadequate at various intervals. If found inadequate, additional uterotonics were administered. Estimated blood loss was mean (standard deviation) 499 (172) ml, 454 (117) ml and 402 (151) ml in groups 1.25, 2.5 and 5, respectively (P value groups 1.25 versus 5 = 0.012). Oxytocin infusion at 5 IU/hour resulted in a significantly lower incidence of minor postpartum haemorrhage, defined as blood loss greater than 500 ml, than 1.25 IU/hour (P = 0.009). No patient had major/severe haemorrhage (>1000 ml blood loss). No significant difference was seen in haemoglobin levels (P = 0.677) and uterine tone. Fifteen, six and nine patients, respectively, required additional oxytocin (P = 0.151). The incidence of tachycardia (P = 0.726), hypotension (P = 0.321) and nausea/vomiting (P = 0.161) was comparable. To conclude, 5 IU/hour was more effective than 1.25 IU/hour in reducing total blood loss and the incidence of minor postpartum haemorrhage. Thus 5 IU/hour appears to be an optimal oxytocin infusion rate following 1 IU slow intravenous oxytocin injection for the maintenance of adequate uterine contraction in patients undergoing elective caesarean section under spinal anaesthesia.
Collapse
Affiliation(s)
- Medha Mohta
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rohit B Chowdhury
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Asha Tyagi
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rachna Agarwal
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| |
Collapse
|
12
|
Waters JH, Bonnet MP. When and how should I transfuse during obstetric hemorrhage? Int J Obstet Anesth 2021; 46:102973. [PMID: 33903001 DOI: 10.1016/j.ijoa.2021.102973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 10/21/2022]
Abstract
The incidence of maternal hemorrhage and blood transfusion has increased over time. Causes of massive hemorrhage, defined as a transfusion > 10 units of erythrocytes, include abnormal placental insertion, preeclampsia, and placental abruption. Although ratio-based transfusion has been described for managing massive hemorrhage, a goal-directed approach using laboratory or point-of-care data may lead to better outcomes. Autotransfusion, which involves the collection, washing, and filtration of maternal shed blood, avoids many of the complications associated with allogeneic blood transfusion. In this review, we provide an overview of transfusion practices related to the management of obstetric hemorrhage.
Collapse
Affiliation(s)
- J H Waters
- Department of Anesthesiology & Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Mcgowan Institute for Regenerative Medicine, Pittsburgh, PA, USA.
| | - M P Bonnet
- Sorbonne University, Department of Anesthesia and Intensive Care, Armand Trousseau Hospital, DMU DREAM, GRC 29, AP-HP, Paris, France; Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| |
Collapse
|
13
|
Drew T, Carvalho JCA, Subramanian C, Yoon EW, Downey K, Thorneloe B, Balki M. The association of shock index and haemoglobin variation with postpartum haemorrhage after vaginal delivery: a prospective cohort pilot study. Int J Obstet Anesth 2020; 45:67-73. [PMID: 33298343 DOI: 10.1016/j.ijoa.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/03/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Shock index and continuous non-invasive haemoglobin monitoring (SpHb) have both been proposed for the timely recognition of postpartum haemorrhage (PPH). We sought to determine, in parallel, the association of each of shock index and SpHb with blood loss after vaginal delivery. METHODS Sixty-six women were recruited to this prospective observational study. Shock index and SpHb were recorded postpartum for 120 min. The association between each of shock index and SpHb with quantitative blood loss (QBL) at 30, 60 and 120 min postpartum was determined using linear mixed models. Area-under-the-receiver-operator-characteristic (AUROC) curves were constructed to evaluate the diagnostic ability of shock index and SpHb to detect PPH (defined as QBL ≥1000 mL). RESULTS Shock index trend was associated with QBL over the first 30 min (r=0.37, P=0.002), but not over 60 or 120 min. There was an association of SpHb trend with QBL over the first 30 min (P=0.06), but not over 60 min (r=-0.32, P=0.009) or 120 min (r=-0.26, P=0.03). Maximum shock index within 60 min correlated with QBL (r=0.54, P <0.001) and was a predictor of PPH (P=0.0012, AUROC 0.796). Maximum change in SpHb within 60 min negatively correlated with QBL (r=-0.4, P <0.001) and was a predictor of PPH (P=0.048, AUROC 0.761). CONCLUSIONS The trend of shock index and its peak values are associated with blood loss after vaginal delivery and are early indicators of PPH. Negative trend of SpHb is a late sign of PPH and has a weaker association with blood loss than shock index.
Collapse
Affiliation(s)
- T Drew
- Department of Anaesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
| | - J C A Carvalho
- Department of Anaesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - C Subramanian
- Department of Anaesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - E W Yoon
- Maternal and Infant Care Research Center, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - K Downey
- Department of Anaesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - B Thorneloe
- Department of Anaesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - M Balki
- Department of Anaesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| |
Collapse
|
14
|
Zortéa T, Wizbicki DPDS, Madeira K, Ambrosio PG, Souza ROBD, Durães ESM. Monitorização não invasiva da hemoglobina em ensaios clínicos: uma revisão sistemática e metanálise. Braz J Anesthesiol 2020; 70:388-397. [DOI: 10.1016/j.bjan.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/25/2019] [Accepted: 05/15/2019] [Indexed: 12/12/2022] Open
|
15
|
Zortéa T, Wizbicki DPDS, Madeira K, Ambrosio PG, Souza ROBD, Durães ESM. Noninvasive hemoglobin monitoring in clinical trials: a systematic review and meta-analysis. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32682505 PMCID: PMC9373349 DOI: 10.1016/j.bjane.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and objectives The measurement of hemoglobin concentration (Hb) by co-oximetry is an innovative technique that offers efficiency and agility in the processing of information regarding the measurement of Hb obtained through continuous, non-invasive and rapid monitoring. Because of this attribute, it avoids unnecessary exposures of the patient to invasive procedures by allowing a reduction in the number of blood samples for evaluation and other unnecessary therapies. It also helps to make decisions about the need for transfusion and how to handle it. The objective of this study is to compare the performance offered to obtain Hb values between the Masimo Corporation (Irvine, CA, USA) instrument and the standard gold tool (laboratory examination). Contents The study corresponds to a systematic review followed by meta-analysis, which included fully registered full-text clinical trials published from 1990 to 2018. PubMed, Cochrane, Medline, Embase and Web of Science databases were investigated. The mean overall difference found between the non-invasive and invasive methods of hemoglobin monitoring was 0.23 (95% CI −0.16, 0.62), that is, it did not present statistical significance (p = 0.250). The results of the analysis of heterogeneity within and between the studies indicated high levels of inconsistency (Q = 461.63, p < 0.0001, I2 = 98%), method for Hb values. Conclusions Although the mean difference between noninvasive measurements of Hb and the gold standard method is small, the co-oximeter can be used as a non-invasive “trend” monitor in detecting unexpected responses at Hb levels.
Collapse
Affiliation(s)
- Tailyne Zortéa
- Universidade do Extremo Sul Catarinense, Criciúma, SC, Brasil.
| | | | - Kristian Madeira
- Universidade do Extremo Sul Catarinense, Ciências da Saúde com ênfase em Bioestatística e Epidemiologia, Criciúma, SC, Brasil; Universidade do Extremo Sul Catarinense, Laboratório de Biomedicina Translacional, Grupo de Pesquisas em Métodos Quantitativos Aplicados, Criciúma, SC, Brasil
| | | | | | - Edson Souza Machado Durães
- Hospital São José, Jaraguá do Sul, SC, Brasil; Hospital Unimed, Criciúma, SC, Brasil; Sociedade Brasileira de Anestesiologia (SBA), Criciúma, SC, Brasil
| |
Collapse
|
16
|
Transcutaneous Hemoglobin Screening in an Adult Orthopaedic Trauma Population. J Orthop Trauma 2020; 34:e165-e169. [PMID: 31663876 DOI: 10.1097/bot.0000000000001677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate a noninvasive hemoglobin measurement device in an orthopaedic trauma population. DESIGN Prospective. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS One hundred five patients consecutively admitted to the orthopaedic trauma service after surgical treatment of fracture. INTERVENTION Transcutaneous hemoglobin (TcHgb) monitoring using the Masimo Pronto Pulse CO-Oximeter model with Rainbow SET Technology for spot TcHgb measurement. MAIN OUTCOME MEASUREMENTS TcHgb measurements and standard venipuncture hemoglobin (vHgb) were obtained. Patient preferences for each were recorded. RESULTS TcHgb measurements were obtained in 100 patients and compared with their corresponding vHgb measurements. The mean vHgb and TcHgb were 10.2 ± 1.9 g/dL and 11.2 ± 2.1 g/dL, respectively, and the mean difference was 1.1 ± 1.6 g/dL, which was statistically different from 0 (P < 0.001). In 76% of cases, the TcHgb device overestimated vHgb. In a subgroup of patients undergoing procedures with minimal expected blood loss (external fixators of knee or ankle, irrigation and debridement, or open reduction and internal fixation of ankle or calcaneal fractures), the mean difference between vHgb and TcHgb was 0.68 ± 1.6 g/dL (P = 0.06). CONCLUSIONS A preliminary study of TcHgb monitoring with the tested device as a potential screening mechanism to limit unnecessary blood draws showed statistical difference from vHgb; however, the mean bias 1.1 g/dL of hemoglobin was notably small. In a subgroup of patients undergoing procedures with minimal expected blood loss, the device may have merit. Larger studies are required to determine the clinical relevance of differences in measurements between the 2 methods. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
17
|
Eliason MJ. Estimated versus actual; The accuracy of accounting for blood loss during endoscopic sinus surgery. Am J Otolaryngol 2020; 41:102342. [PMID: 31735445 DOI: 10.1016/j.amjoto.2019.102342] [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: 11/05/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Endoscopic sinus surgery (ESS) is the mainstay for chronic inflammatory and neoplastic sinonasal process and as a result many modalities have been studied to minimize blood loss and patient morbidity and to maximize intraoperative visualization. However, often conclusions of actual blood loss are based on surgeons' estimations without ever actually assessing the accuracy of these estimations. The objective of this study was to determine the accuracy of intraoperative blood loss estimates by attending otolaryngology surgeons among patients undergoing ESS. MATERIALS AND METHODS After obtaining institutional review board approval, data were collected on six surgeons performing ESS at a military academic medical center for 21 surgical cases. Specifically, both hourly and end-of-case total "estimated" (EBL) and "calculated actual" (ABL) blood loss values were recorded and compared statistically. Surgeons were blinded to the results until after all data were collected. RESULTS The difference between mean EBL and ABL was 62.5 ml and was statistically significant (p = .007, Power 86.2%). EBL lagged ABL for both hourly intervals during a surgical case and the total end-of-surgery values. CONCLUSION The surgeons studied had EBL that were statistically significantly less than ABL both at hourly intervals during the surgery and at the conclusion of the case. As a result there exists potential for adverse consequences in clinical care and in efforts in medical research/advancement.
Collapse
|
18
|
Kim H, Do SH, Hwang JW, Na HS. Intraoperative continuous noninvasive hemoglobin monitoring in patients with placenta previa undergoing cesarean section: a prospective observational study. Anesth Pain Med (Seoul) 2019; 14:423-428. [PMID: 33329772 PMCID: PMC7713795 DOI: 10.17085/apm.2019.14.4.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/09/2019] [Accepted: 04/25/2019] [Indexed: 11/17/2022] Open
Abstract
Background Obstetric patients with placenta previa are at risk for sever peripartum hemorrhage. Early detection of anemia and proper transfusion strategy are important for the management of obstetric hemorrhage. In this study, we assessed the utility and accuracy of noninvasive hemoglobin (SpHb) monitoring in patients with placenta previa during cesarean section. Methods Parturients diagnosed with placenta previa and scheduled for cesarean section under spinal anesthesia were enrolled. SpHb and laboratory Hb (Lab-Hb) were measured during surgery as primary outcomes. Results Seventy-four pairs of SpHb and Lab-Hb were collected from 39 patients. The correlation coefficient was 0.877 between SpHb and Lab-Hb (P < 0.001). The Bland–Altman plot showed a mean difference ± SD of 0.3 ± 0.8 g/dl between noninvasive Hb and Lab-Hb, and the limits of agreement were −1.2 to 1.8 g/dl. The magnitude of the difference between SpHb and Lab-Hb was < 0.5 g/dl in 64.9%; however, it was > 1.5 g/dl in 10.8%. Conclusions SpHb monitoring had a good correlation with Lab-Hb. A small mean difference between SpHb and lab-Hb might not be clinically significant; however, the limits of agreements were not narrow. In particular, SpHb could be overestimated in the anemic population. Based on our results, further studies investigating the accuracy and precision of SpHb monitoring should be performed in parturients presenting Hb below 10 g/dl.
Collapse
Affiliation(s)
- Hyunsung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
19
|
Mooney C, Byrne M, Kapuya P, Pentony L, De la Salle B, Cambridge T, Foley D. Point of care testing in general haematology. Br J Haematol 2019; 187:296-306. [PMID: 31578729 DOI: 10.1111/bjh.16208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
20
|
Chang FC, Lin JR, Liu FC. Validity of accuracy and trending ability of non-invasive continuous total hemoglobin measurement in complex spine surgery: a prospective cohort study. BMC Anesthesiol 2019; 19:117. [PMID: 31272378 PMCID: PMC6611019 DOI: 10.1186/s12871-019-0790-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/23/2019] [Indexed: 01/24/2023] Open
Abstract
Background Patients undergoing complex spine surgery present with multilevel spinal involvement, advanced age, and multiple comorbidities. Surgery is associated with significant blood loss and remarkable hemodynamic changes. The present study aimed to investigate the accuracy and trending ability of a non-invasive continuous method to monitor hemoglobin (SpHb) concentrations using a Radical-7™ Pulse CO-Oximeter in complex spine surgery. Methods Forty-nine patients who underwent complex spine surgery were enrolled in this prospective observational study. Multiple time points were established for data collection throughout the operation. Simultaneous SpHb–total hemoglobin (tHb) paired data were recorded for analyses. Linear regression analysis, Bland–Altman plot, four-quadrant plot, and Critchley polar plot were used to assess the accuracy and trending ability of the monitor. Results A total of 272 pairs of SpHb-tHb data were available and were divided into two groups based on the perfusion index (PI): PI values ≥1.0 (n = 200) and PI values < 1.0 (n = 72). The correction coefficients (r) between SpHb and tHb were 0.6946 and 0.6861 in the groups with PI values ≥1.0 and < 1.0, respectively (P < 0000.1). In the ≥1.0 group, the mean bias was − 0.21 g/dL and the percentage error (PE) was 15.85%, whereas in the < 1.0 group, the mean bias was − 0.04 g/dL and the PE was 17.42%. Four-quadrant plot revealed a concordance rate of 85.11%, whereas the Critchley polar plot showed a concordance rate of 67.21%. Conclusions The present study demonstrates the acceptable accuracy of the Radical-7™ Pulse CO-Oximeter even with a low PI. However, the trending ability was limited and unsatisfactory.
Collapse
Affiliation(s)
- Feng-Cheng Chang
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, No. 5, Fusing St, Guishan District, Taoyuan City, 33305, Taiwan
| | - Jr-Rung Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, No. 5, Fusing St, Guishan District, Taoyuan City, 33305, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fu-Chao Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, No. 5, Fusing St, Guishan District, Taoyuan City, 33305, Taiwan. .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
21
|
Accuracy and trending ability of hemoglobin measurement by the Pulse CO-Oximeter during vascular surgery. J Clin Monit Comput 2019; 34:501-508. [DOI: 10.1007/s10877-019-00337-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/06/2019] [Indexed: 12/19/2022]
|
22
|
Fedoruk K, Seligman KM, Carvalho B, Butwick AJ. Assessing the Association Between Blood Loss and Postoperative Hemoglobin After Cesarean Delivery. Anesth Analg 2019; 128:926-932. [DOI: 10.1213/ane.0000000000003449] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
23
|
Comparison of invasive and noninvasive blood hemoglobin measurement in the operating room: a systematic review and meta-analysis. J Anesth 2019; 33:441-453. [PMID: 30895376 DOI: 10.1007/s00540-019-02629-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/06/2019] [Indexed: 12/30/2022]
Abstract
Noninvasive hemoglobin (Hb)-monitoring devices are new inventions in pulse oximeter systems that show hemoglobin levels continuously. The aim of this systematic review and meta-analysis was to evaluate the accuracy and precision of noninvasive versus standard central laboratory Hb measurements in the operating room. We systematically searched multiple databases. Then, for the quality assessment of studies, we modified QUADAS-2 in the Revman 5.3 software. The GRADE approach was used to measure the quality of evidence (Grading of Recommendations Assessment, Development, and Evaluation). Data were analyzed using the meta-analysis method (random effect model) using STATA 11 software. A total of 28 studies on 2000 participants were included in the meta-analysis. Meta-analysis results of mean differences between noninvasive and the central laboratory Hb measurements in overall pooled random effects were - 0.27 (95% LoA (0.44, - 0.10); P value < 0.05). According to this meta-analysis, noninvasive hemoglobin measurement has acceptable accuracy in comparison with the standard invasive method.
Collapse
|
24
|
Duffield A, McKenzie C, Carvalho B, Ramachandran B, Yin V, El-Sayed YY, Riley ET, Butwick AJ. Effect of a High-Rate Versus a Low-Rate Oxytocin Infusion for Maintaining Uterine Contractility During Elective Cesarean Delivery: A Prospective Randomized Clinical Trial. Anesth Analg 2017; 124:857-862. [PMID: 28212181 DOI: 10.1213/ane.0000000000001658] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Oxytocin is routinely used as prophylaxis against uterine atony. During elective cesarean delivery (CD), an oxytocin bolus is used to initiate adequate uterine tone, followed by an oxytocin infusion to maintain uterine contractility. However, it is unclear whether oxytocin maintenance infusion rate influences total estimated blood loss (EBL). METHODS We performed a prospective, randomized, double-blind trial in 51 women undergoing elective CD. Women were randomly assigned to receive an oxytocin maintenance infusion of 2.5 or 15 U/h. All women received an oxytocin 1 U bolus to initiate adequate uterine tone. The primary outcome was EBL. EBL values between groups were compared using a Mann-Whitney U test; P < .05 as statistically significant. The median EBL difference with 95% confidence intervals was also calculated. Secondary outcomes included adequacy of uterine tone, use of additional uterotonics, and oxytocin-related side effects, including hypotension. RESULTS Of 51 women, 24 received a low-rate infusion and 27 received a high-rate infusion. Median (interquartile range) EBL values in the low-rate and high-rate groups were 634 (340-886) mL versus 512 (405-740) mL, respectively (P = .7). The median difference in EBL between groups was 22 mL; 95% confidence interval = -158 to 236 mL. The rate of postpartum hemorrhage did not differ between groups (low-rate group: 4/24 [16.7%] versus high-rate group: 4/26 [15.4%]). There were no between-group differences over time (first 20 minutes after commencing infusion) in the incidence of adequate uterine tone (P = .72) or hypotension (P = .32). CONCLUSIONS Among women undergoing elective CD receiving an oxytocin maintenance infusion, EBL and uterine tone did not differ between women receiving 2.5 U/h oxytocin and those receiving 15 U/h oxytocin. Our findings suggest that efficacy can be obtained with a low oxytocin maintenance infusion rate; however, dose-finding studies are needed to determine the infusion rate that optimizes drug efficacy while minimizing side effects.
Collapse
Affiliation(s)
- Adrienne Duffield
- From the *Department of Anesthesiology, Perioperative, and Pain Medicine and †Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Trending, Accuracy, and Precision of Noninvasive Hemoglobin Monitoring During Human Hemorrhage and Fixed Crystalloid Bolus. Shock 2016; 44 Suppl 1:45-9. [PMID: 25521537 DOI: 10.1097/shk.0000000000000310] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Automated critical care systems for en route care will rely heavily on noninvasive continuous monitoring. It has been reported that noninvasive assessment of blood hemoglobin via CO-oximetry (SpHb) assessed by spot measurements lacks sufficient accuracy for clinical decision making in trauma patients. However, the precision and utility of trending of continuous hemoglobin have not been evaluated in hemorrhaging humans. This study measured the trending and concordance of SpHb changes during dynamic variations resulting from controlled hemorrhage with concomitant fluid infusion. With institutional review board approval and informed consent, 12 healthy volunteers under general anesthesia were subjected to hemorrhage (10 mL/kg for 15 min) accompanied by Ringer's lactate solution infusion (30 mL/kg for 20 min). The SpHb was measured continuously by the Masimo Radical-7, whereas total blood hemoglobin was measured by arterial blood sampling. Trend analysis, assessed by plots of SpHb against time of 12 subjects, shows consistent falls in SpHb during hemodilution without exception. Four-quadrant concordance analysis was 95.4% with an exclusion zone of 1 g/dL. Spot comparisons of 106 data pairs (SpHb and total blood hemoglobin) showed that 50% exhibited an error of more than 1 g/dL with bias of 1.08 ± 0.82 g/dL and 95% limits of agreement of -0.5 to 2.6. Both trend analysis and concordance analysis suggest high precision of pulse CO-oximetry during hemodilution by hemorrhage and fluid bolus in human volunteers. However, accuracy was similar to other studies and therefore the use of pulse CO-oximetry alone is likely insufficient to make transfusion decisions.
Collapse
|
26
|
Riess ML, Pagel PS. Noninvasively Measured Hemoglobin Concentration Reflects Arterial Hemoglobin Concentration Before but Not After Cardiopulmonary Bypass in Patients Undergoing Coronary Artery or Valve Surgery. J Cardiothorac Vasc Anesth 2016; 30:1167-71. [PMID: 27475734 DOI: 10.1053/j.jvca.2016.03.148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study compared noninvasively measured hemoglobin and arterial hemoglobin before and after cardiopulmonary bypass in patients undergoing coronary artery or valve surgery. DESIGN Observational study with retrospective data analysis. SETTING Veterans Affairs hospital. PARTICIPANTS Thirty-five men. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Hemoglobin values were measured noninvasively by co-oximetry to corresponding arterial hemoglobin concentrations taken at clinically relevant time points chosen at the discretion of the cardiac anesthesiologist. Thirty-five and 27 pooled pairs of data were obtained before and after cardiopulmonary bypass, respectively. Arterial hemoglobin concentration was analyzed using i-STAT CG8+test cartridges routinely used in the authors' operating rooms and those of other institutions. Linear regression and Bland-Altman analysis revealed a significant positive bias, wide limits of agreement, and low correlation coefficients between the noninvasive and arterial hemoglobin measurements. These findings were especially notable after compared with before cardiopulmonary bypass. CONCLUSIONS The results suggested that noninvasive measurement of hemoglobin overestimates arterial hemoglobin by almost 1 g/dL when compared to iSTAT. A lack of precision also was observed with noninvasive measurement of hemoglobin, especially after cardiopulmonary bypass. These findings supported the contention that sole reliance on noninvasive measurement of hemoglobin for transfusion decisions in cardiac surgery patients may be inappropriate.
Collapse
Affiliation(s)
- Matthias L Riess
- Departments of Anesthesiology and Pharmacology, Vanderbilt University Medical Center, Nashville, TN; TVHS VA Medical Center, Nashville, TN.
| | - Paul S Pagel
- Clement J. Zablocki VA Medical Center, Milwaukee, WI
| |
Collapse
|
27
|
Bhat A, Upadhyay A, Jaiswal V, Chawla D, Singh D, Kumar M, Yadav CP. Validity of non-invasive point-of-care hemoglobin estimation in healthy and sick children-a method comparison study. Eur J Pediatr 2016; 175:171-9. [PMID: 26286814 DOI: 10.1007/s00431-015-2602-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/15/2015] [Accepted: 07/20/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study was conducted at a tertiary care center in northern India to evaluate the validity of non-invasive transcutaneous hemoglobin estimation in healthy and sick children in comparison to hemoglobin estimation by traditional lab method. A method comparison study was conducted including 150 subjects. Enrolled patients included 80 neonates with average age of 3.9 ± 2.1 days, and 70 children with average age of 5.8 ± 2 years. Each population (newborn and children) comprised of almost equal numbers of healthy and critically ill patients with shock. Hemoglobin (Hb) was estimated on enrolment by transcutaneous spectrophotometry (SpHb) and traditional automated lab analyzer (Hb-Lab). Difference between Hb levels by the two methods (called bias) was measured and analyzed using Bland-Altman method. Out of 148 data pairs analyzed, bias between SpHb and Hb-Lab was -1.52 ± 1.91 g/dl (mean ± SD). SpHb showed excellent positive correlation with Hb-Lab (r = 0.94 (p < 0.001)) and good visual agreement on Bland-Altman plots. Bias was higher in sick subjects with shock as compared to healthy ones in both neonatal and pediatric population (-2.31 ± 2.21 g/dl versus -0.77 ± 1.2 g/dl, respectively). CONCLUSIONS SpHb showed good accuracy and correlated well with lab estimated Hb levels in healthy children. However, in children with impaired peripheral perfusion, its diagnostic accuracy was inadequate to justify routine use for quantification of severity of anemia and making transfusion decisions solely on non-invasive estimation of hemoglobin. WHAT IS KNOWN Non-invasive hemoglobin estimation is a relatively new and novel method which has given mixed results regarding its potential efficacy in adults. There is limited data regarding usefulness and accuracy of non-invasive Hb estimation by SpHb in sick neonates and children. WHAT IS NEW Non-invasive Hb estimation by SpHb monitor is reasonably accurate in healthy neonates and children. It can be used in critically ill children and neonates, but in conjunction with lab confirmation of Hb values.
Collapse
Affiliation(s)
- Aditya Bhat
- Department of Paediatrics, LLRM Medical College, Meerut, Uttar, Pradesh, 250002, India.
| | - Amit Upadhyay
- Department of Paediatrics, LLRM Medical College, Meerut, Uttar, Pradesh, 250002, India.
| | - Vijay Jaiswal
- Department of Paediatrics, LLRM Medical College, Meerut, Uttar, Pradesh, 250002, India.
| | - Deepak Chawla
- Department of Paediatrics, Government Medical College, Chandigarh, India.
| | - Dharamveer Singh
- Department of Paediatrics, LLRM Medical College, Meerut, Uttar, Pradesh, 250002, India.
| | - Mithilesh Kumar
- Department of Paediatrics, LLRM Medical College, Meerut, Uttar, Pradesh, 250002, India.
| | - C P Yadav
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
| |
Collapse
|
28
|
Charpentier E, Looten V, Fahlgren B, Barna A, Guillevin L. Meta-analytic estimation of measurement variability and assessment of its impact on decision-making: the case of perioperative haemoglobin concentration monitoring. BMC Med Res Methodol 2016; 16:7. [PMID: 26787309 PMCID: PMC4717612 DOI: 10.1186/s12874-016-0107-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022] Open
Abstract
Background As a part of a larger Health Technology Assessment (HTA), the measurement error of a device used to monitor the hemoglobin concentration of a patient undergoing surgery, as well as its decision consequences, were to be estimated from published data. Methods A Bayesian hierarchical model of measurement error, allowing the meta-analytic estimation of both central and dispersion parameters (under the assumption of normality of measurement errors) is proposed and applied to published data; the resulting potential decision errors are deduced from this estimation. The same method is used to assess the impact of an initial calibration. Results The posterior distributions are summarized as mean ± sd (credible interval). The fitted model exhibits a modest mean expected error (0.24 ± 0.73 (−1.23 1.59) g/dL) and a large variability (mean absolute expected error 1.18 ± 0.92 (0.05 3.36) g/dL). The initial calibration modifies the bias (−0.20 ± 0.87 (−1.99 1.49) g/dL), but the variability remains almost as large (mean absolute expected error 1.05 ± 0.87 (0.04 3.21) g/dL). This entails a potential decision error (“false positive” or “false negative”) for about one patient out of seven. Conclusions The proposed hierarchical model allows the estimation of the variability from published aggregates, and allows the modeling of the consequences of this variability in terms of decision errors. For the device under assessment, these potential decision errors are clinically problematic. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0107-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Emmanuel Charpentier
- Secrétariat Scientifique du CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France.
| | - Vincent Looten
- Secrétariat Scientifique du CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France
| | - Björn Fahlgren
- Secrétariat Scientifique du CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France
| | - Alexandre Barna
- Secrétariat Scientifique du CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France
| | - Loïc Guillevin
- CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France
| |
Collapse
|
29
|
Validation of noninvasive hemoglobin measurement by pulse co-oximeter in newborn infants. J Perinatol 2015; 35:617-20. [PMID: 25742288 DOI: 10.1038/jp.2015.12] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the accuracy of noninvasive hemoglobin (Hb) obtained with pulse co-oximeter (SpHb) compared with total Hb (tHb) from laboratory co-oximeter in neonates. STUDY DESIGN Neonates with birth weight (BW) <3000 g admitted to LAC+USC Medical Center neonatal intensive care unit were included. SpHb was recorded using Masimo Radical-7 and compared with tHb. A total of three data sets were obtained for each patient. Regression analysis and Bland-Altman analysis were performed. RESULT Sixty-one patients (mean±s.d., BW 1177±610 g and gestational age 28.7±3.9 weeks) were enrolled. The mean tHb value was 13.9±2.0 g dl(-1) and the mean SpHb was 14.0±2.0 g dl(-1). There was a moderately positive correlation between SpHb and tHb (r=0.66, P<0.001) with a bias and precision of -0.09±1.67 g dl(-1). Data from a subgroup of infants with gestational age ⩽32 weeks (52/61 patients) were analyzed, and the correlation coefficient was moderately positive (r=0.69, P<0.001) with a bias and precision of -0.23±1.60 g dl(-1). CONCLUSION Our results suggest that noninvasive SpHb may be considered as an adjunct to invasive tHb measurements in newborn infants <3000 g especially in preterm infants ⩽32 weeks of gestation.
Collapse
|
30
|
Hiscock R, Kumar D, Simmons SW. Systematic Review and Meta-Analysis of Method Comparison Studies of Masimo Pulse Co-Oximeters (Radical-7™ or Pronto-7™) and HemoCue® Absorption Spectrometers (B-Hemoglobin or 201+) with Laboratory Haemoglobin Estimation. Anaesth Intensive Care 2015; 43:341-50. [DOI: 10.1177/0310057x1504300310] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We assessed agreement in haemoglobin measurement between Masimo pulse co-oximeters (Rad-7™ and Pronto-7™) and HemoCue® photometers (201+ or B-Hemoglobin) with laboratory-based determination and identified 39 relevant studies (2915 patients in Masimo group and 3084 patients in HemoCue group). In the Masimo group, the overall mean difference was -0.03 g/dl (95% prediction interval -0.30 to 0.23) and 95% limits of agreement -3.0 to 2.9 g/dl compared to 0.08 g/dl (95% prediction interval -0.04 to 0.20) and 95% limits of agreement -1.3 to 1.4 g/dl in the HemoCue group. Only B-Hemoglobin exhibited bias (0.53, 95% prediction interval 0.27 to 0.78). The overall standard deviation of difference was larger (1.42 g/dl versus 0.64 g/dl) for Masimo pulse co-oximeters compared to HemoCue photometers. Masimo devices and HemoCue 201+ both provide an unbiased, pooled estimate of laboratory haemoglobin. However, Masimo devices have lower precision and wider 95% limits of agreement than HemoCue devices. Clinicians should carefully consider these limits of agreement before basing transfusion or other clinical decisions on these point-of-care measurements alone.
Collapse
Affiliation(s)
- R. Hiscock
- Department of Anaesthesia, Mercy Hospital for Women, Heidelberg, Victoria
| | - D. Kumar
- Department of Anaesthesia, Mercy Hospital for Women, Heidelberg, Victoria
| | - S. W. Simmons
- Department of Anaesthesia, Mercy Hospital for Women, Heidelberg, Department of Pharmacology, University of Melbourne, Victoria
| |
Collapse
|
31
|
|
32
|
Awada WN, Mohmoued MF, Radwan TM, Hussien GZ, Elkady HW. Continuous and noninvasive hemoglobin monitoring reduces red blood cell transfusion during neurosurgery: a prospective cohort study. J Clin Monit Comput 2015; 29:733-40. [PMID: 25649717 PMCID: PMC4621711 DOI: 10.1007/s10877-015-9660-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 01/27/2015] [Indexed: 10/26/2022]
Abstract
Continuous, noninvasive hemoglobin (SpHb) monitoring provides clinicians with the trending of changes in hemoglobin, which has the potential to alter red blood cell transfusion decision making. The objective of this study was to evaluate the impact of SpHb monitoring on blood transfusions in high blood loss surgery. In this prospective cohort study, eligible patients scheduled for neurosurgery were enrolled into either a Control Group or an intervention group (SpHb Group). The Control Group received intraoperative hemoglobin monitoring by intermittent blood sampling when there was an estimated 15% blood loss. If the laboratory value indicated a hemoglobin level of ≤10 g/dL, a red blood cell transfusion was started and continued until the estimated blood loss was replaced and a laboratory hemoglobin value was >l0 g/dL. In the SpHb Group patients were monitored with a Radical-7 Pulse CO-Oximeter for continuous noninvasive hemoglobin values. Transfusion was started when the SpHb value fell to ≤l0 g/dL and was continued until the SpHb was ≥l0 g/dL. Blood samples were taken pre and post transfusion. Percent of patients transfused, average amount of blood transfused in those who received transfusions and the delay time from the hemoglobin reading of <10 g/dL to the start of transfusion (transfusion delay) were compared between groups. The trending ability of SpHb, and the bias and precision of SpHb compared to the laboratory hemoglobin were calculated. Compared to the Control Group, the SpHb Group had fewer units of blood transfused (1.0 vs 1.9 units for all patients; p ≤ 0.001, and 2.3 vs 3.9 units in patients receiving transfusions; p ≤ 0.0 l), fewer patients receiving >3 units (32 vs 73%; p ≤ 0.01) and a shorter time to transfusion after the need was established (9.2 ± 1.7 vs 50.2 ± 7.9 min; p ≤ 0.00 l). The absolute accuracy of SpHb was 0.0 ± 0.8 g/dL and trend accuracy yielded a coefficient of determination of 0.93. Adding SpHb monitoring to standard of care blood management resulted in decreased blood utilization in high blood loss neurosurgery, while facilitating earlier transfusions.
Collapse
Affiliation(s)
- Wael N Awada
- Department of Anesthesia, ICU and Pain Management, Cairo University, Manyal, Cairo, Egypt.
| | - Maher F Mohmoued
- Department of Anesthesia, ICU and Pain Management, Cairo University, Manyal, Cairo, Egypt.
| | - Tarek M Radwan
- Department of Anesthesia, ICU and Pain Management, Cairo University, Manyal, Cairo, Egypt.
| | - Gomaa Z Hussien
- Department of Anesthesia, ICU and Pain Management, Cairo University, Manyal, Cairo, Egypt.
| | - Hany W Elkady
- Department of Anesthesia, ICU and Pain Management, Cairo University, Manyal, Cairo, Egypt.
| |
Collapse
|
33
|
von Schweinitz BA, De Lorenzo RA, Cuenca PJ, Anschutz RL, Allen PB. Does a non-invasive hemoglobin monitor correlate with a venous blood sample in the acutely ill? Intern Emerg Med 2015; 10:55-61. [PMID: 25322853 DOI: 10.1007/s11739-014-1129-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 09/04/2014] [Indexed: 01/31/2023]
Abstract
Non-invasive hemoglobin measuring technology has potential for rapid, portable, and accurate way of providing identification of blood loss or anemia. Our objective is to determine if this technology is reliable in critically ill patients presenting to the Emergency Department. Prospective cross-sectional observational study was done at an urban level-one trauma center, 135 subjects were conveniently sampled, suspected of having active bleeding, sepsis, or other critically ill condition. Non-invasive measurements with Masimo (Irvine, CA, USA) Radical-7 and Rad-57 hemoglobin monitors were compared with the Beckman-Coulter LH-550 (Brea, CA, USA) clinical laboratory blood cell analyzer. The primary outcome was the relationship of the non-invasive device to the clinical laboratory results. Secondary evaluations included the effect of pulse rate, systolic BP, respiratory rate, temperature, capillary refill, skin color, nail condition, extremity movement. The Radical-7 was able to capture reading in 78% (88/113) of subjects, and the Rad-57 in 65% (71/110) of subjects. The correlation (R(2)) of the device Hb was 0.69 and 0.67 (p < 00.01) for the Radical-7 and Rad-57, respectively. The coefficient of variation for the Radical-7 was 18%, and for the Rad57 it was 13%. Univariate analysis shows none of the observed factors is associated with the difference values between the device Hb and laboratory Hb. Our results show that Radical-7 and Rad-57 devices do not report readings in 29% of patients and accuracy is significantly lower than reported by the manufacturer with over 50% of readings falling outside of ± 1 g/dL. We determined that none of the several potential factors examined are associated with the degree of device accuracy.
Collapse
Affiliation(s)
- Benjamin A von Schweinitz
- Department of Emergency Medicine, San Antonio Military Medical Center, JBSA-Fort Sam Houston, TX, 78234, USA,
| | | | | | | | | |
Collapse
|
34
|
Butwick A, Gutierrez MC, Hilton G. The impact of advanced maternal age on peripartum thromboelastographic coagulation profiles: a prospective observational exploratory study. Can J Anaesth 2014; 62:504-12. [DOI: 10.1007/s12630-014-0300-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/09/2014] [Indexed: 11/24/2022] Open
|
35
|
Accuracy of noninvasive hemoglobin monitoring in patients at risk for hemorrhage. J Trauma Acute Care Surg 2014; 77:S134-9. [PMID: 25159346 DOI: 10.1097/ta.0000000000000326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Monitoring for acute blood loss is critical in surgical patients, and delays in identifying hemorrhage can result in poor outcomes. The current standard of care for monitoring patients at risk for bleeding is serial measurement of hemoglobin (Hgb) by standard laboratory complete blood count (CBC). Point-of-care testing (i.e., iSTAT) can be a rapid method of evaluating Hgb, and spectrophotometry-based devices (i.e., Radical-7) offer the advantages of being continuous and noninvasive. We sought to evaluate the accuracy of Radical-7 and iSTAT in measuring Hgb and assessing for blood loss when compared with the criterion standard CBC. METHODS Adult patients at risk for hemorrhage admitted to the surgical intensive care unit of a tertiary referral, Level I trauma center were eligible for this study. Serial CBC Hgb measurements were drawn as clinically indicated. The Radical-7 device was placed on the patient for noninvasive Hgb measurements (SpHb), and at each CBC measurement, concurrent iSTAT Hgb measurements were obtained. Bland-Altman analysis was used to compare the three methods of measuring Hgb with accuracy defined as measurements within 1.0-g/dL CBC Hgb. Concordance measurements were also performed to compare trends between values. RESULTS Eighty-eight patients were enrolled and underwent 572 CBC measurements. Bland-Altman analysis of SpHb versus CBC resulted in an estimated bias of 1.49 g/dL, with 95% limits of agreement of -2.2 g/dL to 5.0 g/dL. iSTAT versus CBC resulted in an estimated bias of -0.63 g/dL, with 95% limits of agreement of -3.4 g/dL to 2.2 g/dL. Changes in SpHb had concordance with CBC Hgb 60% of the time, compared with 76% for iSTAT versus CBC CONCLUSION: Radical-7 SpHb was inaccurate when compared with CBC Hgb levels, and serial SpHb achieved concordance with CBC Hgb 60% of the time. As such, the clinical utility of Radical-7 as a rapid, noninvasive predictor of acute hemorrhage may be limited. LEVEL OF EVIDENCE Diagnostic study, level II; care management, level III.
Collapse
|
36
|
Aya AG, Ducloy-Bouthors AS, Rugeri L, Gris JC. [Anesthetic management of severe or worsening postpartum hemorrhage]. ACTA ACUST UNITED AC 2014; 43:1030-62. [PMID: 25447392 DOI: 10.1016/j.jgyn.2014.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Risk factors of maternal morbidity and mortality during postpartum hemorrhage (PPH) include non-optimal anesthetic management. As the anesthetic management of the initial phase is addressed elsewhere, the current chapter is dedicated to the management of severe PPH. METHODS A literature search was performed using PubMed and Medline databases, and the Cochrane Library, for articles published from 2003 up to and including 2013. Several keywords related to anesthetic and critical care practice, and obstetrical management were used, in various combinations. Guidelines from several societies and organisations were also read. RESULTS When PPH worsens, one should ask for additional team personnel (professional consensus). Patients should be monitored for heart rate, blood pressure, skin and mucosal pallor, bleeding at skin puncture sites, diuresis and the volume of genital bleeding (grade B). Because of the possible rapid worsening of coagulapathy, patients should undergo regular evaluation of coagulation status (professional consensus). Prevention and management of hypothermia should be considered (professional consensus), by warming intravenous fluids and blood products, and by active body warming (grade C). Antibiotics should be given, if not already administered at the initial phase (professional consensus). Vascular fluids must be given (grade B), the choice being left at the physician discretion. Blood products transfusion should be decided based on the clinical severity of PPH (professional consensus). Priority is given to red blood cells (RBC) transfusion, with the aim to maintain Hb concentration>8g/dL. The first round of products could include 3 units of RBC (professional consensus), and the following round 3 units of RBC, and 3 units of fresh frozen plasma (FFP). The FFP:RBC ratio should be kept between 1:2 and 1:1 (professional consensus). Depending on the etiology of PPH, the early administration of FFP is left at the discretion of the physician (professional consensus). Platelet count should be maintained at>50 G/L (professional consensus). During massive PPH, fibrinogen concentration should be maintained at>2g/L (professional consensus). Fibrinogen can be given without prior fibrinogen measurement in case of massive bleeding (professional consensus). General anesthesia should be considered in case of hemodynamic instability, even when an epidural catheter is in place (professional consensus). CONCLUSION The anesthetic management aims to restore and maintain optimal respiratory state and circulation, to treat coagulation disorders, and to allow invasive obstetrical and radiologic procedures. Clinical and instrumental monitoring are needed to evaluate the severity of PPH, to guide the choice of therapeutic options, and to assess treatments efficacy.
Collapse
Affiliation(s)
- A G Aya
- Département anesthésie-douleur, groupe hospitalo-universitaire Caremeau, place du Pr.-Debré, 30029 Nîmes cedex 09, France; EA2992, faculté de médecine Montpellier-Nîmes, 186, chemin du Carreau-de-Lanes, 30029 Nîmes cedex 2, France.
| | - A-S Ducloy-Bouthors
- Pôle d'anesthésie-réanimation, CHU Lille, 2, avenue Oscar-Lambret, 59037 Lille, France
| | - L Rugeri
- Unité d'hémostase clinique, hôpital Édouard-Herriot, pavillon E 5, place d'Arsonval, 69003 Lyon, France
| | - J-C Gris
- Laboratoire et consultations d'hématologie, groupe hospitalo-universitaire Caremeau, place du Pr.-Debré, 30029 Nîmes cedex 09, France; EA2992, faculté de médecine Montpellier-Nîmes, 186, chemin du Carreau-de-Lanes, 30029 Nîmes cedex 2, France
| |
Collapse
|
37
|
DeLeon A, De Oliveira GS, Kalayil M, Narang S, McCarthy RJ, Wong CA. The incidence of coagulopathy in pregnant patients with intrahepatic cholestasis: should we delay or avoid neuraxial analgesia? J Clin Anesth 2014; 26:623-7. [PMID: 25439411 DOI: 10.1016/j.jclinane.2014.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/21/2014] [Accepted: 04/26/2014] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To estimate the incidence of coagulopathy in patients with intrahepatic cholestasis inhepatic cholestasis of pregnancy (ICP). DESIGN Retrospective cohort investigation. SETTING University medical center. MEASUREMENTS The records of 319 parturients who met study inclusion criteria were reviewed for various laboratory values. The primary outcome was the incidence of abnormal hemostasis, defined as prothrombin time (PT) greater than 14.5 seconds (INR>1.2). The incidence of postpartum hemorrhage was evaluated as a secondary outcome. MAIN RESULTS The incidence (95% CI) of abnormal PT was 0% (0 to 1.8). Other coagulation tests [partial thromboplastin time (PTT) and platelet count] were also normal, even in study subjects with significant (>5 times) elevation of liver enzymes. The incidence of postpartum hemorrhage after vaginal delivery was 2.4% (4 of 208 pts) and 6.3% (7 of 111 pts) after Cesarean delivery. CONCLUSIONS Coagulation abnormalities are rare in pregnant patients with ICP, even when a strict criterion is utilized (INR<1.2). The use of neuraxial anesthesia and/or analgesia may not necessarily be delayed in parturients with isolated ICP.
Collapse
Affiliation(s)
- Alexander DeLeon
- Department of Anesthesiology, Northwestern University, Chicago, IL 60611, USA.
| | | | - Manoj Kalayil
- Department of Anesthesiology, Northwestern University, Chicago, IL 60611, USA
| | - Shweta Narang
- Department of Anesthesiology, John H. Stroger, Jr., Hospital of Cook County, Chicago, IL 60612, USA
| | - Robert J McCarthy
- Department of Anesthesiology, Northwestern University, Chicago, IL 60611, USA
| | - Cynthia A Wong
- Department of Anesthesiology, Northwestern University, Chicago, IL 60611, USA
| |
Collapse
|
38
|
Hammer AR, Göbel G, Anliker M, Stauder R. Feasibility and accuracy of noninvasive anemia screening. J Am Geriatr Soc 2014; 62:199-201. [PMID: 25180389 DOI: 10.1111/jgs.12623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Kim SH, Choi JM, Kim HJ, Choi SS, Choi IC. Continuous Noninvasive Hemoglobin Measurement Is Useful in Patients Undergoing Double-Jaw Surgery. J Oral Maxillofac Surg 2014; 72:1813-9. [DOI: 10.1016/j.joms.2014.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/05/2014] [Accepted: 03/08/2014] [Indexed: 10/25/2022]
|
40
|
Hiscock R, Simmons SW, Carstensen B, Gurrin LC. Comparison of Massimo Pronto-7 and Hemocue Hb 201+ with Laboratory Haemoglobin Estimation: A Clinical Study. Anaesth Intensive Care 2014; 42:608-13. [DOI: 10.1177/0310057x1404200510] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We prospectively studied agreement in haemoglobin estimation between two point-of-care devices (Pronto-7® Pulse CO-Oximetry™, Masimo Corporation, Irvine, California, USA and HemoCue® Hb 201+, HemoCue, Angelholm, Sweden) and an automated laboratory analyser (Sysmex XE5000, Sysmex Corporation, Kobe, Japan). Venous blood sampling and finger co-oximeter readings were performed on 141 pregnant women undergoing routine mid-trimester haemoglobin assessment. Three replicate measures were performed and analysis used Bayesian-based variance component modelling to provide estimates of repeatability, between person within method bias and precision. Repeatability, assessed by coefficient of variation, was higher for Pronto-7® (2.3%) compared to HemoCue® (5.2%). Fixed bias (mean difference, device - laboratory) was +1.18 (standard deviation 1.19) g/dl and - 0.01 (standard deviation 1.34) g/dl for Pronto-7® and HemoCue® respectively, with no statistical evidence of proportional bias. Based upon a single device reading, the 95% prediction limits for Pronto-7® were −1.2 to 3.6 g.dl-1 and HemoCue® were −2.7 to 2.7 g/dl. For both devices precision was not meaningfully improved by averaging replicate readings. However, repeated readings may allow detection of aberrant results. Overall both devices are imprecise and 95% prediction limits wide. We present further prediction limits, derived from the posterior distribution and adjusted for any fixed bias for set levels of probability (certainty). These may be used to support clinical decisions when using these point-of-care devices.
Collapse
Affiliation(s)
- R. Hiscock
- Department of Anaesthesia, Mercy Hospital for Women, Heidelberg, Victoria
| | - S. W. Simmons
- Department of Anaesthesia, Mercy Hospital for Women, Heidelberg, Victoria
- Department of Anaesthesia, Mercy Hospital for Women, Heidelberg, Victoria, Australia, Department of Pharmacology, University of Melbourne, Victoria
| | - B. Carstensen
- Department of Anaesthesia, Mercy Hospital for Women, Heidelberg, Victoria
- Steno Diabetes Center, Gentofte, Denmark
| | - L. C. Gurrin
- Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health, University of Melbourne, Victoria
| |
Collapse
|
41
|
Moreno I, Artieda O, Vicente R, Zarragoikoetxea I, Vicente JL, Barberá M. [Evaluation of non-invasive hemoglobin measurements using the Masimo Rainbow Radical-7® device in a patient with extracorporeal membrane oxygenation]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2014; 61:388-391. [PMID: 24370278 DOI: 10.1016/j.redar.2013.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 06/18/2013] [Accepted: 06/23/2013] [Indexed: 06/03/2023]
Abstract
Circulatory assist devices such as extracorporeal membrane oxygenation are indicated in cases of cardiogenic shock refractory to optimal conventional treatment. Bleeding is a serious complication of such systems, mainly due to coagulation disorders caused by continuous administration of heparin, as well as platelet dysfunction. Serial coagulation and hemoglobin (Hb) measurements are essential. Hb measurements can be performed through repeated arterial blood gasometry, and more recently with a new spectrophotometric sensor, Masimo Rainbow Radical-7® device, which gives Hb values continuously and non-invasively. We report a case of a patient undergoing cardiac surgery who required extracorporeal membrane oxygenation for severe cardiogenic shock immediately after surgery. We compare the correlation and the level of agreement with Hb levels measured by 2 existing systems in clinical practice. Our results indicate that the Masimo® spectrophotometric monitor showed statistically comparable Hb values, in the correlation (r=.85; P<.01) and in agreement with those obtained by serial blood gas analyzer, ABL800 FLEX® (wavelength). In view of these results we consider the Masimo® device as a valid alternative for the continuous follow-up of the Hb and control of bleeding in these patients.
Collapse
Affiliation(s)
- I Moreno
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - O Artieda
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - R Vicente
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - I Zarragoikoetxea
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J L Vicente
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M Barberá
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario y Politécnico La Fe, Valencia, España
| |
Collapse
|
42
|
Kim SH, Lilot M, Murphy LSL, Sidhu KS, Yu Z, Rinehart J, Cannesson M. Accuracy of Continuous Noninvasive Hemoglobin Monitoring. Anesth Analg 2014; 119:332-346. [DOI: 10.1213/ane.0000000000000272] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
43
|
|
44
|
Saito J, Kitayama M, Oishi M, Kudo T, Sawada M, Hashimoto H, Hirota K. The accuracy of non-invasively continuous total hemoglobin measurement by pulse CO-Oximetry undergoing acute normovolemic hemodilution and reinfusion of autologous blood. J Anesth 2014; 29:29-34. [PMID: 24972855 DOI: 10.1007/s00540-014-1863-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 05/31/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Non-invasively continuous total hemoglobin (SpHb) measurement has not been assessed adequately in acute bleeding and rapid blood transfusion during surgery. Thus, we have assessed the efficacy of SpHb during both acute normovolemic hemodilution (ANH) and autologous blood transfusion (ABT). METHODS Twenty-four patients undergoing urological and gynecological surgery were enrolled. ANH was induced by withdrawing blood of 800 g with simultaneous fluid administration. When surgical hemostasis was completed, collected blood was reinfused. Measurement of SpHb, perfusion index (PI) and real total Hb (tHb) were done before and after each 400 ml blood removal (-0, -400, -800 ml) and reinfusion (+0, +400, +800 ml). RESULTS A Bland-Altman analysis for repeated measurements showed a bias (precision) g/dl of 1.12 (1.25), 1.43 (1.24) and 1.10 (1.23) for all data, during ANH and during ABT, respectively. Additionally, a bias (precision) increased with a reduction in tHb (g/dl): ≥10.0; 0.74 (1.30), 8.0-10.0; 1.15 (1.12) and <8.0; 1.60 (1.28). Although the difference between SpHb and tHb was almost zero before anesthesia induction, it became significant just before ANH and did not change further by ANH and ABT. Significant correlations between SpHb and tHb for all data (r = 0.75, n = 228, p < 0.001) were observed. PI slightly correlated with the difference between SpHb and tHb (r = 0.38, n = 216, p < 0.001). Furthermore, before and after induction of anesthesia, PI also correlated with the difference between SpHb and tHb (r = 0.42, n = 23, p = 0.048 and r = 0.51, n = 22, p = 0.016, respectively). CONCLUSIONS The present data suggest that SpHb may overestimate tHb during ANH and ABT. In addition, PI and tHb levels had an impact on the accuracy of SpHb measurements.
Collapse
Affiliation(s)
- Junichi Saito
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan,
| | | | | | | | | | | | | |
Collapse
|
45
|
The effect on perioperative bleeding of placental extraction from an exteriorized uterus during caesarean section. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:384-390. [PMID: 24927289 DOI: 10.1016/s1701-2163(15)30583-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effect on perioperative bleeding of an alternative technique for Caesarean section, in which placental extraction is performed while the uterus is exteriorized. METHODS We performed a retrospective matched cohort study using data obtained through chart review. Group 1 included women who had CS performed using the technique of placental removal while the uterus was exteriorized, and group 2 included women who had CS performed using the conventional method of placental removal from a non-exteriorized uterus. Women in each group were matched for number of previous Caesarean sections, indications for CS, and gestational age. The primary outcome was the difference between preoperative and postoperative hemoglobin concentrations. Secondary outcomes included the incidence of blood transfusion, estimated blood loss (EBL), operative time, the incidence of postoperative endometritis, and length of hospital stay. RESULTS A total of 90 charts were reviewed (45 per group). Baseline clinical characteristics were similar in both groups. The mean decrease in hemoglobin concentration was 22% less in women who had placental extraction from an exteriorized uterus than in those who had the conventional placental extraction (13.2g/L vs. 16.9 g/L, P=0.016). Among secondary outcomes, women in group 1 had a lower mean EBL (531.1 mL vs. 691.1 mL, P<0.05) and a shorter mean duration of surgery (28.0 minutes vs. 40.5 minutes, P<0.05). CONCLUSION Exteriorizing the uterus prior to removal of the placenta during CS may decrease intraoperative and immediate postoperative bleeding compared with the conventional technique. Further studies on this technique are indicated.
Collapse
|
46
|
Dyer RA, Vorster AD, Arcache MJ, Vasco M. New trends in the management of postpartum haemorrhage. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2014.10844564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- RA Dyer
- Department of Anaesthesia, University of Cape Town and Groote Schuur Hospital, Cape Town
| | - AD Vorster
- Department of Anaesthesia, University of Cape Town and Groote Schuur Hospital, Cape Town
| | - MJ Arcache
- Department of Anaesthesia, University of Cape Town and Groote Schuur Hospital, Cape Town
| | - M Vasco
- Unisanitas and Clinica Reina Sofia, Bogota, Colombia
| |
Collapse
|
47
|
Miller RD, Ward TA, McCulloch CE, Cohen NH. A comparison of lidocaine and bupivacaine digital nerve blocks on noninvasive continuous hemoglobin monitoring in a randomized trial in volunteers. Anesth Analg 2014; 118:766-71. [PMID: 24651230 DOI: 10.1213/ane.0000000000000144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Blood hemoglobin can be monitored continuously and noninvasively with a noninvasive spectrophotometric sensor (Masimo SpHb). The perfusion index (PI) of the finger is directly related to the clinical accuracy of SpHb. We evaluated those variables that influence PI without the influences of surgery and anesthesia. METHODS Based on our past studies, 12 awake adult volunteers were studied. A SpHb sensor was attached to the same finger of each hand. The temperature of each finger was measured via a skin surface probe. A digital nerve block (DNB) was performed with 1% lidocaine on one finger and 0.25% bupivacaine on the other finger of the opposite hand. SpHb, PI, and finger temperature were monitored continuously 30 minutes before and 3 to 4 hours after placement of the DNB. A random effects spline regression was used to flexibly model the outcomes before and after the DNB and to compare the effects of lidocaine and bupivacaine. RESULTS The DNBs increased the PI for both lidocaine and bupivacaine (P < 0.0001) and finger temperature from both lidocaine (P < 0.0001) and bupivacaine (P = 0.02). The duration of action of bupivacaine was markedly longer than that of lidocaine (P < 0.0001). Between 45 and 75 minutes after insertion of the DNB, the PI with bupivacaine was substantially higher than that of lidocaine. The PI was directly related to changes in finger temperature and SpHb. During this time interval, 11 of the 12 volunteers receiving bupivacaine descriptively had increases in finger temperature ranging from no change to 6.1°C. In contrast, only 6 of the 12 lidocaine volunteers had increases in finger temperature ranging from no change to 4°C. Changes in PI were directly correlated with SpHb values (correlation coefficient = 0.7). CONCLUSIONS A DNB increases PI and finger temperature. These increases lasted 2 to 3 hours longer with bupivacaine than lidocaine. The increases in PI were associated with slightly higher SpHb values. We conclude that the DNB induces increases in PI and temperature of the finger. Because of the close relationship between finger temperature, PI, and SpHb, consistently increasing finger temperature and PI could increase the accuracy of SpHb.
Collapse
Affiliation(s)
- Ronald D Miller
- From the Departments of *Anesthesia and Perioperative Care, and †Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | | | | | | |
Collapse
|
48
|
Miyashita R, Hirata N, Sugino S, Mimura M, Yamakage M. Improved non-invasive total haemoglobin measurements after in-vivo adjustment. Anaesthesia 2014; 69:752-6. [PMID: 24800903 DOI: 10.1111/anae.12681] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 11/30/2022]
Abstract
We hypothesised that an in-vivo adjustment method and/or a newer sensor would increase the accuracy of non-invasive and continuous haemoglobin monitoring (SpHb) measurements. Two sensors, the R1-25 and R2-25a (the newer version), were used with laboratory total haemoglobin concentration (tHb) values simultaneously recorded. In-vivo adjusted SpHb (AdHb) was calculated by a simple formula: AdHb = SpHb - (1(st) SpHb - 1(st) tHb). The correlation coefficients between SpHb (or AdHb) and tHb were compared: SpHb in both sensors correlated strongly with tHb (p < 0.0001). In-vivo adjustment improved the correlation coefficient between SpHb and tHb from 0.86 to 0.95 for the R1-25 and from 0.83 to 0.93 for the R2-25a. There was no difference between the R1-25 and R2-25a sensors. The in vivo adjustment method improved the accuracy of SpHb measurements in both sensors.
Collapse
Affiliation(s)
- R Miyashita
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | | | | | | | | |
Collapse
|
49
|
Yoshida A, Saito K, Ishii K, Azuma I, Sasa H, Furuya K. Assessment of noninvasive, percutaneous hemoglobin measurement in pregnant and early postpartum women. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:11-6. [PMID: 24470779 PMCID: PMC3896274 DOI: 10.2147/mder.s54696] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Using the Pronto-7® analyzer, we measured percutaneous hemoglobin (SpHb) noninvasively in pregnant and early postpartum women, and assessed the accuracy of the measurements by comparing them with laboratory measurements of hemoglobin. METHODS We obtained SpHb measurements from 193 pregnant women, 269 early postpartum women, and 76 nonpregnant women. A laboratory total hemoglobin (tHb) measurement, from venous blood sampling, was obtained immediately prior to the SpHb measurement. The total number of measurements obtained from the nonpregnant, pregnant, and postpartum women was 76, 438, and 347, respectively. RESULTS The mean biases (SpHb - tHb) among the nonpregnant, first trimester, second trimester, third trimester, and early postpartum women were -0.20, 0.19, 1.01, 1.32, and 1.10 g/dL, respectively. The Bland-Altman comparison showed neither the tendency of a fixed bias nor proportional biases among the measurements in the category of nonpregnant and first trimester women. But in the second and third trimester and postpartum category, a significant fixed bias was noted, without any tendencies of proportional bias. CONCLUSION In this study, we found higher hemoglobin values with the Pronto-7 analyzer than were measured in the laboratory. We consider that the device has certain limitations in obstetrical utility and requires further modifications for use in the perinatal period.
Collapse
Affiliation(s)
- Atsushi Yoshida
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan
| | - Keiko Saito
- Department of Obstetrics and Gynecology, Nishisaitama-Chuo National Hospital, Tokorozawa, Japan
| | - Kenji Ishii
- Department of Obstetrics and Gynecology, Nishisaitama-Chuo National Hospital, Tokorozawa, Japan
| | - Isao Azuma
- Department of Obstetrics and Gynecology, Nishisaitama-Chuo National Hospital, Tokorozawa, Japan
| | - Hidenori Sasa
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan
| | - Kenichi Furuya
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan
| |
Collapse
|
50
|
Giraud B, Frasca D, Debaene B, Mimoz O. Comparison of haemoglobin measurement methods in the operating theatre. Br J Anaesth 2013; 111:946-54. [DOI: 10.1093/bja/aet252] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|