Continuous Noninvasive Haemoglobin Monitoring in Vascular Surgery within the Goal-Directed Therapy Protocol (original) (raw)
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Multicenter comparison of three intraoperative hemoglobin trend monitoring methods
Journal of Clinical Monitoring and Computing, 2019
Transfusion decisions are guided by clinical factors and measured hemoglobin (Hb). Time required for blood sampling and analysis may cause Hb measurement to lag clinical conditions, thus continuous intraoperative Hb trend monitoring may provide useful information. This multicenter study was designed to compare three methods of determining intraoperative Hb changes (trend accuracy) to laboratory determined Hb changes. Adult surgical patients with planned arterial catheterization were studied. With each blood gas analysis performed, pulse cooximetry hemoglobin (SpHb) was recorded, and arterial blood Hb was measured by hematology (tHb), arterial blood gas cooximetry (ABGHb), and point of care (aHQHb) analyzers. Hb change was calculated and trend accuracy assessed by modified Bland-Altman analysis. Secondary measures included Hb measurement change direction agreement. Trend accuracy mean bias (95% limits of agreement; g/dl) for SpHb was 0.10 (− 1.14 to 1.35); for ABGHb was − 0.02 (− 1.06 to 1.02); and for aHQHb was 0.003 (− 0.95 to 0.95). Changes more than ± 0.5 g/dl agreed with tHb changes more than ± 0.25 g/dl in 94.2% (88.9-97.0%) SpHb changes, 98.9% (96.1-99.7%) ABGHb changes and 99.0% (96.4-99.7%) aHQHb changes. Sequential changes in SpHb, ABGHb and aHQHb exceeding ± 0.5 g/dl have similar agreement to the direction but not necessarily the magnitude of sequential tHb change. While Hb blood tests should continue to be used to inform transfusion decisions, intraoperative continuous noninvasive SpHb decreases more than − 0.5 g/dl could be a good indicator of the need to measure tHb.
Comparison of haemoglobin measurement methods in the operating theatre
British Journal of Anaesthesia, 2013
† This study compared the accuracy of four bedside methods for haemoglobin (Hb) assessment [non-invasive and continuous haemoglobin measurement with Pulse CO-Oximetry (SpHb), arterial blood measurement by satellite CO-Oximetry (HbSat), and HemoCue arterial (HcueArt) and capillary (HcueCap) blood] with a laboratory haematology analyser (LHA). † HcueArt is closest to LHA even when Hb concentrations change rapidly. † HbSat provided values in close agreement LHA but requires sample preparation and handling. † SpHb is less invasive, less accurate, but measures continuously. † When absolute accuracy is essential then invasive measurements are needed to confirm SpHb or HcueCap values before transfusion. Background. Various methods of haemoglobin (Hb) measurement are available to guide transfusion including several methods that allow for measurement at the bedside. This study directly compared their absolute and trend accuracy compared with values from the central lab (reference method). Methods. Adult patients undergoing surgery with expected blood loss wore a rainbow ReSposable sensor connected to a Radical-7 Pulse CO-Oximeter (SpHb). Arterial samples were analysed with a haematology analyser (HbLab), a satellite CO-Oximeter (HbSat), and a point-of-care haemoglobinometer (HemoCue; HcueArt). Concomitantly, ear capillary blood was tested using the same haemoglobinometer (HcueCap). Absolute accuracy and the clinical significance of error were assessed with Bland-Altman plots and three-zone error grids. Trend analysis was performed using a modified polar plot, testing both directionality and magnitude of Hb changes compared with the reference. Results. Two hundred and nineteen measurements from 53 patients with HbLab ranging between 6.8 and 16.3 g dl 21 (4.2 and 10.1 mmol litre 21) were recorded. Compared with the reference method, bias (precision) was 0.2 (0.2) g dl 21 [0.1 (0.1) mmol litre 21 ] for HcueArt, 0.8 (0.3) g dl 21 [0.5 (0.2) mmol litre 21 ] for HbSat, 0.5 (0.5) g dl 21 [0.3 (0.3) mmol litre 21 ] for HcueCap and 1.0 (1.2) g dl 21 [0.6 (0.7) mmol litre 21 ] for SpHb. None of the devices tested would have led to unnecessary or delayed transfusion according to 2006 ASA transfusion criteria. Trend accuracy was better for HcueArt and HbSat than for HcueCap and SpHb. Conclusion. Bedside Hb measurement methods differ in their agreement to a laboratory haematology analyser but none would have led to transfusion errors.
Accuracy of Continuous Monitoring of Haemoglobin Concentration after In-Vivo Adjustment
During open aortic aneurysm repair, continuous, non-invasive measurementof Haemoglobin concentration (SpHb), provided by Radical 7 device (Masimo Corp, Irvine, CA, USA) may be advantageous for assessing acute anaemia and improve the ability of the anesthesiologist to decide when to initiate blood transfusion. A strategy to improve the device's accuracy is the in-vivo adjustment (AdHb) using a haemoglobin value provided by Blood Gas Analyser (BGA).
Perioperative on-site haemoglobin determination: as accurate as laboratory values?
Canadian Journal of Anaesthesia, 1996
Perioperative on-site haemoglobin determination: as accurate as laboratory values? Purpose: This study assessed the accuracy of photometer based haemoglobin (lib) determination technology (HemoCue | when used by different anaesthetists in situations of rapidly changing Hb values during anaesthesia. Methods: (Part I) In the laboratory, repeated measurements were done on 16 split samples of blood using both the Hematology Analyzer (CELL-DYN 3500 System TM, Abbot Laboratories, San Jose, California) and the photometer. (Part 2) Twelve patients had blood samples drawn from an arterial line J?)r simultaneous Hb determination in the hospital laboratory and by the photometer. At the same time, capillary samples were taken ~?om the patient's earlobe for Hb determination by the photometer. All sample collection and photometer measurements were done by the same operator. (Part 3) The Part 2 protocol was then repeated with different anaesthetists performing both the sampling and the photometer measurements. Statistical comparison was by ANOVA and a two-tailed paired t-test. Results: (Part I) Samples determined by the photometer and the laboratory were highly correlated (r 2 = 1.0, P < 0.001). The average error of each method was similar (<4%). (Part 2) Using a 2-tailed paired t-test, the photometer arterial measurements were not different from the laboratory measurements, however the photometer capillary measurements were consistently -8% higher (P = 0.003). (Part 3) When multiple operators performed the sampling there were no differences on arterial or capillary samples (re = 0.942, re = 0.851 respectively), although the variance was greater. Conclusions: The HemoCue | haemoglobinometer has sufficient accuracy to support treatment decisions regarding blood tran.~]'usions.
Journal of Cardiothoracic and Vascular Anesthesia, 2018
Objective: The primary objective was to compare I-Stat, HemoCue, and RapidLab in measurements of the hemoglobin concentration during cardiac surgeries using cardiopulmonary bypass. Design: Prospective analysis. Setting: Single-center, academic, tertiary care cardiovascular center. Participants: Thirty-four consecutive patients undergoing cardiac surgery requiring cardiopulmonary bypass. Interventions: Blood samples have been collected intraoperatively, and the hemoglobin concentration in each sample was measured, or calculated, simultaneously by the 3 point-of-care devices, HemoCue, RapidLab, and I-Stat. Measurements and Main Results: Correlation coefficients from the regression analysis for HemoCue versus I-Stat, RapidLab versus HemoCue, and RapidLab versus I-Stat were 0.89, 0.96, and 0.88, respectively. Results of the Bland-Altman analysis of the hemoglobin concentration measurements for each device against one another (Fig 1) were as follows: RapidLab versus I-Stat (bias 0.42; 95% confidence interval [CI],-1.05 to 1.89), I-Stat versus HemoCue (bias 0.23; 95% CI,-1.14 to 1.59), and RapidLab versus HemoCue (bias 0.65; 95% CI,-0.17 to 1.47). It appears that I-Stat slightly underestimated the concentration of hemoglobin when compared with both RapidLab and HemoCue. The results of Bland-Altman analysis of each device to a mean Z value (Fig 2) were as follows: RapidLab versus Z (bias 0.36; 95% CI,-0.29 to 1.01), I-Stat versus Z (bias-0.07; CI-0.97 to 0.84), and HemoCue versus Z (bias-0.29; 95% CI,-0.86 to 0.28). Based on the 174 paired samples used for the Pearson moment analysis, the R 2 values for I-Stat versus HemoCue, I-Stat versus RapidLab, and RapidLab versus HemoCue were 0.79, 0.80, and 0.87, respectively Conclusions: These data support the interchangeability of these 3 devices for the intermittent intraoperative point-of-care assessment of hemoglobin concentrations in cardiac surgery patients. It is important, however, to consider the possible pitfalls associated with each device when making a clinical decision to transfuse
The Association between Hemoglobin Value and Estimation of Amount of Intraoperative Blood Loss
Open Journal of Internal Medicine, 2017
Introduction: The estimation of blood loss rate during surgery for prediction of transfusion of blood or blood products requirement is important for surgeon and anesthesiologist. In regard to various results and lack of definite index for start of transfusion in operating rooms, the assessment of blood loss reduction is necessary. The aim of study was evaluation of hemoglobin (Hb) value and hemorrhage estimation rate. Methods and materials: 48 cases underwent major orthopedic surgery with high probability of intraoperative blood loss rate was included in study. Hb, hematocrit (Hct) and basic vital signs were measured preoperatively and blood loss rate was estimated by using of blood volume in suction, bloody gases and blood loss in operation field and recorded. The blood sample per 100 mL blood loss was sent to laboratory. For transfusion deciding based on Hb, we did not any intervention. Results: 26 males and 22 females were included in study. Our results showed that Hb value of males was higher significantly of females in preoperative period. After beginning of blood loss, Hb and Hct values declined with fixed slope and there was high negative correlation between them. First, intraoperative systolic and diastolic pressures declined with high slope and then reduced with mild slope. Hb value reduced significantly per 100 mL blood loss. During survey, no alteration in urine output did not be observed. Conclusion: Present study showed that much more intraoperative blood loss could reduce Hb with high correlation coefficient and measurement of it is efficient on transfusion.
A Comparison of Four Bedside Methods of Hemoglobin Assessment During Cardiac Surgery
Anesthesia and Analgesia, 1995
The purpose of this study was to compare the accuracy of conductivity, adjusted conductivity, photometric, and centrifugation methods of measuring or estimating hemoglobin (I%) with Coulter measured HB as the reference. These bedside methods were studied in 25 cardiac surgery patients during euvolemia and hemodilution and after salvaged autologous red blood cell transfusion.
British journal of anaesthesia, 2014
Delay in diagnosis of anaemia during preoperative assessment poses logistic problems, leading to multiple clinic visits, inadequate preoperative management, and unnecessary delay of surgery. Therefore, we tested an instant spectrophotometric haemoglobin (SpHb) measurement technique to facilitate this assessment. We evaluated portable instant SpHb vs standard laboratory screening of anaemia between March 2012 and December 2013. Paired Hb measurements were performed on 726 patients using SpHb (Pronto-7, Masimo Corporation, Irvine, CA, USA) and Hb measured on the same day using an automated analyser. The results were obtained from a group of 638 patients from the pre-anaesthetic clinic with expected normal Hb values, and 88 patients from the oncology clinic with known low Hb. Median (range) SpHb was 129.5 (67-171) compared with 136 g litre(-1) (63-178) Hb measured using the automated system. Identifying Hb below a threshold of 130 g litre(-1) for males had a high sensitivity (93%), whi...