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Kietaibl S, Ahmed A, Afshari A, Albaladejo P, Aldecoa C, Barauskas G, De Robertis E, Faraoni D, Filipescu DC, Fries D, Godier A, Haas T, Jacob M, Lancé MD, Llau JV, Meier J, Molnar Z, Mora L, Rahe-Meyer N, Samama CM, Scarlatescu E, Schlimp C, Wikkelsø AJ, Zacharowski K. Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care: Second update 2022. Eur J Anaesthesiol 2023; 40:226-304. [PMID: 36855941 DOI: 10.1097/eja.0000000000001803] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.
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Affiliation(s)
- Sibylle Kietaibl
- From the Department of Anaesthesiology & Intensive Care, Evangelical Hospital Vienna and Sigmund Freud Private University Vienna, Austria (SK), Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust (AAh), Department of Cardiovascular Sciences, University of Leicester, UK (AAh), Department of Paediatric and Obstetric Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (AAf), Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (AAf), Department of Anaesthesiology & Critical Care, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble-Alpes University Hospital, Grenoble, France (PA), Department of Anaesthesiology & Intensive Care, Hospital Universitario Rio Hortega, Valladolid, Spain (CA), Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania (GB), Division of Anaesthesia, Analgesia, and Intensive Care - Department of Medicine and Surgery, University of Perugia, Italy (EDR), Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA (DFa), University of Medicine and Pharmacy Carol Davila, Department of Anaesthesiology & Intensive Care, Emergency Institute for Cardiovascular Disease, Bucharest, Romania (DCF), Department of Anaesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria (DFr), Department of Anaesthesiology & Critical Care, APHP, Université Paris Cité, Paris, France (AG), Department of Anesthesiology, University of Florida, College of Medicine, Gainesville, Florida, USA (TH), Department of Anaesthesiology, Intensive Care and Pain Medicine, St.-Elisabeth-Hospital Straubing, Straubing, Germany (MJ), Department of Anaesthesiology, Medical College East Africa, The Aga Khan University, Nairobi, Kenya (MDL), Department of Anaesthesiology & Post-Surgical Intensive Care, University Hospital Doctor Peset, Valencia, Spain (JVL), Department of Anaesthesiology & Intensive Care, Johannes Kepler University, Linz, Austria (JM), Department of Anesthesiology & Intensive Care, Semmelweis University, Budapest, Hungary (ZM), Department of Anaesthesiology & Post-Surgical Intensive Care, University Trauma Hospital Vall d'Hebron, Barcelona, Spain (LM), Department of Anaesthesiology & Intensive Care, Franziskus Hospital, Bielefeld, Germany (NRM), Department of Anaesthesia, Intensive Care and Perioperative Medicine, GHU AP-HP. Centre - Université Paris Cité - Cochin Hospital, Paris, France (CMS), Department of Anaesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest and University of Medicine and Pharmacy Carol Davila, Bucharest, Romania (ES), Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Linz and Ludwig Boltzmann-Institute for Traumatology, The Research Centre in Co-operation with AUVA, Vienna, Austria (CS), Department of Anaesthesia and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark (AW) and Department of Anaesthesiology, Intensive Care Medicine & Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany (KZ)
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Kumar Y, Dogra A, Kaushik A, Kumar S. Progressive evaluation in spectroscopic sensors for non-invasive blood haemoglobin analysis - a review. Physiol Meas 2021; 43. [PMID: 34883473 DOI: 10.1088/1361-6579/ac41b7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/09/2021] [Indexed: 11/11/2022]
Abstract
Frequent monitoring of haemoglobin concentration is highly recommended by physicians to diagnose anaemia and polycythemia Vera. Moreover, Some other conditions also demand assessment of haemoglobin, and these conditions are blood loss, before blood donation, during pregnancy, preoperative, perioperative and postoperative conditions. Cyanmethaemoglobin/haemiglobincyanide method, portable haemoglobinometers and haematology analyzers are few standard methods to diagnose mentioned ailments. However, discomfort, delay and risk of infection are typical limitations of traditional measuring solutions. These limitations create the necessity to develop a non-invasive haemoglobin monitoring technique for a better lifestyle. Various methods and products are already developed and popular due to their non-invasiveness; however, invasive solutions are still considered as the reference standard method. Therefore, this review summarizes the attributes of existing non-invasive solutions. These attributes are finalized as brief details, accuracy, optimal benefits, and research challenges for exploring potential gaps, advancements and possibilities to consider as futuristic alternative methodologies. Non-invasive total haemoglobin assessing techniques are mainly based on optical spectroscopy (reflectance/transmittance) or digital photography or spectroscopic imaging in spot check/continuous monitoring mode. In all these techniques, we have noticed that there is a need to consider different light conditions, motion artefacts, melanocytes, other blood constituents, smoking and precise fixing of the sensor from the sensing spot for exact formulation. Moreover, based on careful and critical analysis of outcomes, none of these techniques or products is used independently or intended to replace invasive laboratory testing. Therefore there is a requirement for a more accurate technique that can eliminate the requirement of blood samples and likely end up as a reference standard method.
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Affiliation(s)
- Yogesh Kumar
- Biomedical Instrumentation, CSIR Central Scientific Instruments Organisation, ., Chandigarh, 160030, INDIA
| | | | - Ajeet Kaushik
- Department of Natural Sciences, Florida Polytechnic University, 4700 Research Way, IST#2018, Lakeland, Florida, 33805, UNITED STATES
| | - Sanjeev Kumar
- Biomedical Instrumentation, CSIR Central Scientific Instruments Organisation, ., Chandigarh, 160020, INDIA
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Nakamori E, Shigematsu K, Higashi M, Yamaura K. Postoperative Noninvasive Hemoglobin Monitoring Is Useful to Prevent Unnoticed Postoperative Anemia and Inappropriate Blood Transfusion in Patients Undergoing Total Hip or Knee Arthroplasty: A Randomized Controlled Trial. Geriatr Orthop Surg Rehabil 2021; 12:21514593211060575. [PMID: 34820147 PMCID: PMC8606913 DOI: 10.1177/21514593211060575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 01/28/2023] Open
Abstract
Introduction Postoperative nadir hemoglobin (Hb) is related to a longer length of stay for geriatric patients undergoing orthopedic surgery. We investigated whether postoperative pulse Hb (SpHb) measurement is useful for avoiding anemia and inappropriate blood transfusion after total hip arthroplasty and total knee arthroplasty. Material and Methods This prospective randomized controlled study included 150 patients randomly assigned to receive blood transfusion, either guided by SpHb monitoring (SpHb group) or based on the surgeons’ experience (control group). The target laboratory Hb value was set to >8 g/dL at postoperative day 1 (POD1). The primary endpoints were the product of total time and degree of SpHb <8 g/dL (area under SpHb 8 g/dL) during the period up to POD1 and the incidence of laboratory Hb <8 g/dL at POD1. The secondary endpoints were the amount of blood transfusion and inappropriate blood transfusion, which was defined as allogeneic blood transfusion unnecessary in a case of SpHb >12 g/dL or delayed transfusion in a case of SpHb <8 g/dL. Results The area under SpHb 8 g/dL was 37.6 ± 44.1 g/dL-min (5 patients) in the control group and none in the SpHb group (P = .0281). There was 1 patient with Hb <8 g/dL at POD1 in the control group. There was no difference in laboratory Hb levels and the amount of blood transfusion. Forty-one patients (19 in the control group and 22 in the SpHb group) received an allogeneic blood transfusion. Among these patients, 7 in the control group and none in the SpHb group received inappropriate blood transfusion (P = .0022). Discussion The SpHb monitoring could reduce unnoticed anemia, which may prevent complications and be useful in avoiding unnecessary and excessive blood transfusion. Conclusion Postoperative SpHb monitoring decreased the incidence of transient, unnoticed anemia during the period up to POD1 and inappropriate blood transfusion.
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Affiliation(s)
- Erisa Nakamori
- Department of Anesthesiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Kenji Shigematsu
- Department of Anesthesiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Midoriko Higashi
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Kumar Y, Dogra A, Shaw V, Kaushik A, Kumar S. NIR-based sensing system for non-Invasive detection of Hemoglobin for point-of-care applications. Curr Med Imaging 2021; 18:532-545. [PMID: 34425744 DOI: 10.2174/1573405617666210823100316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hemoglobin is essential biomolecule for the transportation of oxygen therefore; its assessment is also obligatory very frequently in innumerable clinical practices. Traditional invasive techniques have concomitant shortcomings e.g. time delay, onset of infections and discomfort, which necessitates a non-invasive hemoglobin estimating solution to get rid of these constraints in health informatics. Currently various techniques are underway in allied domain and scanty products are also feasible in the market but due to low satisfaction rate, invasive solutions are still assumed as gold standard. Recently introduced technologies are effectively evolved as optical spectroscopy and digital photographic concepts on different sensing spots e.g. fingertip, palpebral conjunctiva, bulbar conjunctiva and fingernail. Productive sensors utilize more than eight wavelengths to compute hemoglobin concentration and four wavelengths to display only Hb-index (trending of hemoglobin) either in disposable adhesive or reusable clip type sensor's configuration. OBJECTIVE This study aims an optimistic optical spectroscopic technique to measure hemoglobin concentration and conditional usability of non-invasive blood parameters' diagnostics at point-of-care. METHODS Two distinguishable light emitting sources (810nm & 1300nm) are utilized at isosbestic points with single photodetector (800-1700nm). With this purpose, reusable finger probe assembly is facilitated in transmittance mode based on newly offered sliding mechanism to block ambient light. RESULTS Investigation with proposed design presents correlation coefficients between reference hemoglobin and every individual feature, multivariate linear regression model for highly correlated independent features. Moreover, principal component analytical model with multivariate linear regression offers mean bias of 0.036 & -0.316 g/dL, precision of 0.878 & 0.838 and limits of agreement from -1.685 to 1.758 g/dL & -1.790 to 1.474 g/dL for 18 & 21 principle components respectively. CONCLUSION The encouraging readouts emphasize favorable precision therefore proposed sensing system is amenable to assess hemoglobin in settings with limited resources and strengthening future routes for point of care applications.
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Affiliation(s)
- Yogesh Kumar
- CSIR-Central Scientific Instruments Organisation, Chandigarh-160030. India
| | - Ayush Dogra
- CSIR-Central Scientific Instruments Organisation, Chandigarh-160030. India
| | - Vikash Shaw
- CSIR-Central Scientific Instruments Organisation, Chandigarh-160030. India
| | - Ajeet Kaushik
- NanoBioTech Laboratory, Health Systems Engineering Department of Natural Sciences, Division of Sciences, Arts & Mathematics, Florida Polytechnic University, Lakeland, FL, 33805-8531. United States
| | - Sanjeev Kumar
- CSIR-Central Scientific Instruments Organisation, Chandigarh-160030. India
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Suner S, Rayner J, Ozturan IU, Hogan G, Meehan CP, Chambers AB, Baird J, Jay GD. Prediction of anemia and estimation of hemoglobin concentration using a smartphone camera. PLoS One 2021; 16:e0253495. [PMID: 34260592 PMCID: PMC8279386 DOI: 10.1371/journal.pone.0253495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/06/2021] [Indexed: 01/11/2023] Open
Abstract
Anemia, defined as a low hemoglobin concentration, has a large impact on the health of the world’s population. We describe the use of a ubiquitous device, the smartphone, to predict hemoglobin concentration and screen for anemia. This was a prospective convenience sample study conducted in Emergency Department (ED) patients of an academic teaching hospital. In an algorithm derivation phase, images of both conjunctiva were obtained from 142 patients in Phase 1 using a smartphone. A region of interest targeting the palpebral conjunctiva was selected from each image. Image-based parameters were extracted and used in stepwise regression analyses to develop a prediction model of estimated hemoglobin (HBc). In Phase 2, a validation model was constructed using data from 202 new ED patients. The final model based on all 344 patients was tested for accuracy in anemia and transfusion thresholds. Hemoglobin concentration ranged from 4.7 to 19.6 g/dL (mean 12.5). In Phase 1, there was a significant association between HBc and laboratory-predicted hemoglobin (HBl) slope = 1.07 (CI = 0.98–1.15), p<0.001. Accuracy, sensitivity, and specificity of HBc for predicting anemia was 82.9 [79.3, 86.4], 90.7 [87.0, 94.4], and 73.3 [67.1, 79.5], respectively. In Phase 2, accuracy, sensitivity and specificity decreased to 72.6 [71.4, 73.8], 72.8 [71, 74.6], and 72.5 [70.8, 74.1]. Accuracy for low (<7 g/dL) and high (<9 g/dL) transfusion thresholds was 94.4 [93.7, 95] and 86 [85, 86.9] respectively. Error trended with increasing HBl values (slope 0.27 [0.19, 0.36] and intercept -3.14 [-4.21, -2.07] (p<0.001) such that HBc tended to underestimate hemoglobin in higher ranges and overestimate in lower ranges. Higher quality images had a smaller bias trend than lower quality images. When separated by skin tone results were unaffected. A smartphone can be used in screening for anemia and transfusion thresholds. Improvements in image quality and computational corrections can further enhance estimates of hemoglobin.
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Affiliation(s)
- Selim Suner
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
- School of Engineering, Brown University, Providence, Rhode Island, United States of America
| | - James Rayner
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Ibrahim U. Ozturan
- Alpert School of Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Geoffrey Hogan
- Alpert School of Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Caroline P. Meehan
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Alison B. Chambers
- Department of Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Janette Baird
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Gregory D. Jay
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
- School of Engineering, Brown University, Providence, Rhode Island, United States of America
- Department of Medicine, Brown University, Providence, Rhode Island, United States of America
- * E-mail:
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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.
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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
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Capturing hemoglobin on graphene sheet from sub-microliter whole blood for quantitative characterization by internal extractive electrospray ionization mass spectrometry. Talanta 2019; 202:436-442. [PMID: 31171205 DOI: 10.1016/j.talanta.2019.04.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/25/2019] [Accepted: 04/27/2019] [Indexed: 11/21/2022]
Abstract
A disposable blood sampler, which is consisted of a sub-microliter whole blood collector and a graphene filter, loading graphene sheet to selectively capture hemoglobin from sub-microliter whole blood, was developed for both qualitative and quantitative characterization hemoglobin by internal extractive electrospray ionization mass spectrometry (iEESI-MS). The blood collector was elegantly fabricated in syringe-like fashion for precisely sampling tiny amounts (1.0 μL - 2%) of whole blood, which was immediately diluted by water inside the syringe and was then pressed through the graphene filter placed between the waste outlet and the syringe reservoir to capture the hemoglobin in the blood sample. Then the graphene with hemoglobin was directly eluted by a charged (+2.5 kV) solution (mathanol/water/formic acid, 48/48/4, v/v/v) to produce the hemoglobin ions for mass spectrometric analysis. Low detection-of-limit (19.3 mg L-1 (89.5 picomol)), acceptable linear response range (300-1500 mg L-1, R2 = 0.998), relative standard deviation (0.5-6.5%, n = 3), low sample consumption (≤1.0 μL) and a relatively high speed (≤4 min per sample, including the sample loading) were achieved, demonstrating that the graphene based iEESI-MS was an alternative choice for direct detection of hemoglobin in whole blood with minimal sample consumption.
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Tang B, Yu X, Xu L, Zhu A, Zhang Y, Huang Y. Continuous noninvasive hemoglobin monitoring estimates timing for detecting anemia better than clinicians: a randomized controlled trial. BMC Anesthesiol 2019; 19:80. [PMID: 31101083 PMCID: PMC6525351 DOI: 10.1186/s12871-019-0755-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemoglobin measurement is important for transfusion decision-making. Pulse CO-Oximetry provides real-time continuous hemoglobin (SpHb) monitoring. The triage role of SpHb trends based on hemoglobin measurements was investigated. METHODS In this diagnostic randomized controlled trial, 69 patients undergoing spine or cytoreductive surgery were randomly enrolled into SpHb-monitoring and standard-care groups. Diagnostic blood samples were drawn for CO-oximetry Hb (CoOxHb) when the SpHb decreased by 1 g/dl or at the clinician's discretion in the standard-care group. The positive predictive value (PPV) was defined as the ability to detect a decrease in CoOxHb > 1 g/dl or a CoOxHb < 10 g/dl; the PPVs were compared using Fisher's exact test. The SpHb and trend accuracies were calculated. The transfusion units and postoperative hemoglobin levels were compared. RESULTS The PPV of a decrease in CoOxHb > 1 g/dl was 93.3% in the SpHb group vs 54.5% without SpHb monitoring (p = 0.002). The PPV of CoOxHb < 10 g/dl was 86.7% vs. 50.0% for these groups (p = 0.015). The CoOxHb was never < 7 g/dl with SpHb monitoring. Sixty SpHb-CoOxHb data pairs and 28 delta pairs (ΔSpHb-ΔCoOxHb) were collected. The bias, precision and limits of agreement were - 0.29, 1.03 and - 2.30 to 1.72 g/dl, respectively. When ΔSpHb and ΔCoOxHb were > 1 g/dl, the concordance rate for changes in hemoglobin reached 100%. The delta pairs revealed a positive correlation [ΔSpHb = 0.49 * ΔCoOxHb - 0.13; r = 0.69, 95% confidence interval (0.53, 0.82)]. No significant differences were found in the transfusion volume or postoperative anemia state. CONCLUSIONS The SpHb trend tracked changes in hemoglobin satisfactorily during surgery and more accurately estimated the appropriate timing for invasive hemoglobin measurements than the clinicians. TRIAL REGISTRATION ChiCTR1800016290 (Prospective registered). Initial registration date was 24/05/2018.
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Affiliation(s)
- Bo Tang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Xuerong Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Li Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Afang Zhu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Yuelun Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
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Abstract
OBJECTIVE Bleeding is a leading cause of death among trauma patients. Delayed assessment of blood hemoglobin level might result in either unnecessary blood transfusion in nonindicated patients or delayed blood transfusion in critically bleeding patients. In this study, we evaluate the precision of noninvasive hemoglobin monitoring in trauma patients with low hemoglobin levels. METHODS We included trauma patients with low hemoglobin levels (less than 8 g/dL) scheduled for surgical intervention. Blood samples were obtained on admission and after each blood unit with concomitant measurement of serum hemoglobin using radical-7 Masimo device. The change in blood hemoglobin after every transfused blood unit was also assessed by both methods (change in noninvasive Masimo hemoglobin [Delta-Sp-Hb] and change in laboratory hemoglobin [Delta-Lab-Hb]). The precision of Masimo hemoglobin level (Sp-Hb) compared with Laboratory hemoglobin level (Lab-Hb) was determined using both Bland-Altman and Pearson correlation analyses. RESULTS One hundred eighty-four time-matched samples were available for final analysis. Bland-Altman analysis showed excellent accuracy of Sp-Hb compared with Lab-Hb with mean bias of 0.12 g/dL and limits of agreement between -0.56 g/dL and 0.79 g/dL. Excellent correlation was reported between both measures with Pearson correlation coefficient of 0.872. Excellent agreement was also reported between both Delta-Sp-Hb and Delta-Lab-Hb with mean bias of -0.05 and limits of agreement from -0.62 to 0.51 CONCLUSIONS:: Sp-Hb showed accurate precision in both absolute values and trend values compared with Lab-Hb measurement in trauma patients with low hemoglobin levels.
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Murphy SM, Omar S. The Clinical Utility of Noninvasive Pulse Co-oximetry Hemoglobin Measurements in Dark-Skinned Critically Ill Patients. Anesth Analg 2018; 126:1519-1526. [DOI: 10.1213/ane.0000000000002721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Zhang X, Tan J, Xu X, Shi F, Li G, Yang Y. A coordination polymer based magnetic adsorbent material for hemoglobin isolation from human whole blood, highly selective and recoverable. J SOLID STATE CHEM 2017. [DOI: 10.1016/j.jssc.2017.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Shander A, Gilsanz F. Monitoring, safety and efficiency in the use of blood components. ACTA ACUST UNITED AC 2016; 64:1-5. [PMID: 27567346 DOI: 10.1016/j.redar.2016.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 12/24/2022]
Affiliation(s)
- A Shander
- Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, Estados Unidos de América; TeamHealth Research Institute, Englewood, New Jersey, Estados Unidos de América.
| | - F Gilsanz
- Servicio de Anestesia-Reanimación, Hospital Universitario La Paz, Madrid, España
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Technology is Great, Except When It Isn’t!*. Crit Care Med 2016; 44:1253-4. [DOI: 10.1097/ccm.0000000000001757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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