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Park SK, Hur C, Kim YW, Yoo S, Lim YJ, Kim JT. Noninvasive hemoglobin monitoring for maintaining hemoglobin concentration within the target range during major noncardiac surgery: A randomized controlled trial. J Clin Anesth 2024; 93:111326. [PMID: 37988814 DOI: 10.1016/j.jclinane.2023.111326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/09/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
STUDY OBJECTIVE The effect of noninvasive CO-oximetry hemoglobin (SpHb) monitoring on the clinical outcomes of patients undergoing surgery remains unclear. This trial aimed to evaluate whether SpHb monitoring helps maintain hemoglobin levels within a predefined target range during major noncardiac surgeries with a potential risk of intraoperative hemorrhage. DESIGN A single-center, prospective, randomized controlled trial. SETTING University hospital. PATIENTS One hundred and thirty patients undergoing elective noncardiac surgery with a potential risk of hemorrhage. INTERVENTIONS Patients were randomly allocated to undergo either SpHb-guided management (SpHb group) or usual care (control group). MEASUREMENTS The primary outcome was the rate of deviation of the total hemoglobin concentration (determined from laboratory testing) from a pre-specified target range (8-14 g/dL). This was defined as the number of laboratory tests revealing such deviations divided by the total number of laboratory tests performed during the surgery. MAIN RESULTS The primary outcome occurred significantly less frequently in the SpHb group as compared to that in the control group (15/555 [2.7%]) vs. 68/598 [11.4%]; relative risk, 0.24; 95% confidence interval, 0.13-0.41; P < 0.001). Fewer point-of-care blood tests were performed in the SpHb group than in the control group (median [interquartile range], 2 [1-4] vs. 4 [2-5]; P < 0.001). There were no significant intergroup differences in the number of patients who received red blood cell transfusions during surgery (SpHb vs. control, 33.8% vs. 46.2%; P = 0.201). The incidence of unnecessary red blood cell preparation (>2 units) was lower in the SpHb group than in the control group (3.1% vs. 16.9%; P = 0.024). CONCLUSIONS Compared with routine care, SpHb-guided management resulted in significantly lower rates of hemoglobin deviation outside the target range intraoperatively in patients undergoing major noncardiac surgeries with a potential risk of hemorrhage. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT03816514).
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Affiliation(s)
- Sun-Kyung Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chahnmee Hur
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Won Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Jin Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Yassen K, Omer N, Alsahaf F, Al Amer F, Alhamad F, Alherz I, Bushehab A, Alniniya F, Alwabari M. Comparing Non-Invasive Spectrophotometry to Hematology Analysis for Hemoglobin Measurements in Sickle Cell Disease Patients. J Clin Med 2023; 12:7517. [PMID: 38137588 PMCID: PMC10744205 DOI: 10.3390/jcm12247517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Patients with sickle cell disease (SCD) require repeated blood sampling for hemoglobin (Hb) concentration measurements. The primary aim of this study was to compare non-invasive spectrophotometric hemoglobin (SpHb, g/dL) measurements to those taken via an automated hematology analyzer (Hb, g/dL) in patients with SCD visiting outpatient clinics and to investigate the correlations and agreements between both measurement techniques. Secondarily, we aimed to identify the SpHb cut-off concentration for the diagnosis of anemia and to monitor the effects of the pleth variability index (PVI, %) and perfusion index (PI) on SpHb measurements. The results gained from the examination of one hundred and fifty-eight patients indicated that the SpHb measurements overestimated the lab Hb concentrations, with a mean (SpHb-Hb) bias of 0.82 g/dL (SD 1.29). The SpHb measurements were positively correlated with the Hb measurements (Kendall's tau correlation (τ), n = 158, τ = 0.68, p < 0.001), with an intra-class correlation (ICC) of 0.67 and a 95% CI from 0.57 to 0.74 (p = 0.000). The SpHb cut-off concentration to diagnose anemia was 11.4 and 11.7 g/dL for males and females, respectively. SpHb sensitivity was low for males and females at 64.4% and 57.1%; however, the specificity was higher at 90.9% and 75%, with positive predictive values (PPVs) of 95.6 and 85.7, respectively. No correlation existed between SpHb measurements and the PVI (%) in contrast with a moderate correlation with the PI (r = 0.049, p = 0.54, and r = 0.36, p < 0.001, respectively). The mean PI was low at 2.52 ± 1.7. In conclusion, the SpHb measurements were consistently higher than the lab Hb concentrations, with a positive correlation. The sensitivity and precision of the SpHb measurements were lower than expected. However, the SpHb specificity and its positive predictive values (PPVs) indicated that it is less likely for a patient with a positive SpHb test result for anemia to be non-anemic. These results will allow SpHb measurement to play a role in excluding the presence of anemia. In light of the low PI values determined, the SpHb measurements were challenging to take and, thus, require further technological improvements.
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Affiliation(s)
- Khaled Yassen
- Anesthesia Unit, Surgery Department, College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia
| | - Nawal Omer
- Hereditary Blood Disease Center, Hofuf 36422, Al Ahsa, Saudi Arabia;
| | - Fatimah Alsahaf
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.A.); (F.A.); (M.A.)
| | - Fatima Al Amer
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.A.); (F.A.); (M.A.)
| | - Fatimah Alhamad
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.A.); (F.A.); (M.A.)
| | - Imran Alherz
- Anesthesia Department, King Fahad Hospital, Ministry of Health, Hofuf 36441, Al Ahsa, Saudi Arabia; (I.A.); (F.A.)
| | - Abdulaziz Bushehab
- Nursing Services, Hereditary Blood Disease Center, Hofuf 36422, Al Ahsa, Saudi Arabia;
| | - Fatma Alniniya
- Anesthesia Department, King Fahad Hospital, Ministry of Health, Hofuf 36441, Al Ahsa, Saudi Arabia; (I.A.); (F.A.)
| | - Maryam Alwabari
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.A.); (F.A.); (M.A.)
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Alwabari M, Alhamad F, Alsahaf F, Al Amer F, Alniniya F, Alherz I, Omer N, Bushehab A, Yassen K. Can Non-Invasive Spectrophotometric Hemoglobin Replace Laboratory Hemoglobin Concentrations for Preoperative Anemia Screening? A Diagnostic Test Accuracy Study. J Clin Med 2023; 12:5733. [PMID: 37685800 PMCID: PMC10488634 DOI: 10.3390/jcm12175733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Preoperative assessment of hemoglobin concentration in blood is important to diagnose anemia. The primary aim of this prospective diagnostic test accuracy study was to monitor non-invasive spectrophotometric hemoglobin (SpHb, g/dL) concentrations among adults prior to elective surgery and to investigate the correlation and agreement of SpHb with laboratory hemoglobin (Hb, g/dl). A secondary aim was to identify the anemia cut-off values for SpHb based on the World Health Organization (WHO) definitions for anemia. This study included 151 consecutive patients (age ≥ 18 year) presenting for preoperative evaluation prior to scheduled elective general or orthopedic surgery. Results identified the mean ± SD of SpHb at 11.43 ± 2.01 g/dL, which underestimated the mean laboratory Hb (12.64 ± 2.29 g/dL, p < 0.001). A bias mean difference (SpHb-Hb) of -1.21 g/dL, with a SD of 1.76, was reported. This bias (SpHb-Hb) was inversely correlated with the mean Hb concentrations. A positive correlation existed between SpHb and Hb, with a good degree of reliability and a significant Intra Class Correlation (ICC). SpHb diagnosed anemia in 32.3% and 60.3% of males and females, respectively. The SpHb cut-off values to identify anemia were 11.3 and 10.2 g/dL for males and females, respectively, with a sensitivity of 83.3% for males and only 62.9% for females. The specificity for males and females were 81% and 91.3%, respectively. SpHb sensitivity allows for anemia diagnosis among males, but not females. However, the specificity allows SpHb to rule out anemia for both.
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Affiliation(s)
- Maryam Alwabari
- Anesthesia Department, King Fahad Hospital, Ministry of Health, Hofuf 36441, Al Ahsa, Saudi Arabia; (M.A.); (F.A.); (I.A.)
| | - Fatimah Alhamad
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.); (F.A.A.)
| | - Fatimah Alsahaf
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.); (F.A.A.)
| | - Fatima Al Amer
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.); (F.A.A.)
| | - Fatma Alniniya
- Anesthesia Department, King Fahad Hospital, Ministry of Health, Hofuf 36441, Al Ahsa, Saudi Arabia; (M.A.); (F.A.); (I.A.)
| | - Imran Alherz
- Anesthesia Department, King Fahad Hospital, Ministry of Health, Hofuf 36441, Al Ahsa, Saudi Arabia; (M.A.); (F.A.); (I.A.)
| | - Nawal Omer
- Hereditary Blood Disease Center, Hofuf 36422, Al Ahsa, Saudi Arabia;
| | - Abdulaziz Bushehab
- Nursing Services, Hereditary Blood Disease Center, Hofuf 36422, Al Ahsa, Saudi Arabia;
| | - Khaled Yassen
- Anesthesia Unit, Surgery Department, College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia
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Saracoglu A, Abdullayev R, Sakar M, Sacak B, Girgin Incekoy F, Aykac Z. Continuous hemoglobin measurement during frontal advancement operations can improve patient outcomes. J Clin Monit Comput 2022; 36:1689-1695. [PMID: 35257263 DOI: 10.1007/s10877-022-00813-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
Massive hemorrhage in pediatric cranioplasty operations may necessitate blood transfusion, which may cause many complications. Radical-7 Pulse CO-Oximeter (Massimo Corporation, Irvine, CA) can provide continuous hemoglobin concentration (SpHb) measurements noninvasively. In this study, we aimed to evaluate the effects of SpHb measurement on perioperative transfusion management and postoperative patient outcomes. For this retrospective case-control study, we collected the data of pediatric patients undergoing fronto-orbital advancement surgery for plagiocephaly and trigonocephaly between 2018 and 2021. Perioperative SpHb monitoring was performed for patients in the SpHb Group. Other patients that were managed conventionally were considered as the control group (C Group). The data on patients' demographic and clinical characteristics, intraoperative hemodynamic and laboratory variables such as blood gases, intraoperative blood losses, the amount of the transfused blood products, the length of postoperative intensive care unit (ICU) stay, and the duration of hospital stay were collected. The data of 42 patients were collected, and 29 of these patients were males (69%). In 16 of the patients, SpHb monitoring was performed. The demographic, clinical, and perioperative hemodynamic characteristics of the patients were comparable between the groups. Compared to the C Group, the SpHb Group had significantly lower perioperative packed red blood cell (PRBC) transfusion (136.3 ± 40.1 vs. 181.5 ± 74.8 mL, P = 0.015), less postoperative drainage (125.3 ± 47.7 vs. 185.8 ± 97.6 mL, P = 0.013), and shorter ICU stay (37.1 ± 12.0 vs. 64.8 ± 24.9 h, P < 0.001). There was a positive correlation between the amount of PRBC transfusion and the length of ICU stay (r = 0.459, P = 0.003). Patients with perioperative continuous SpHb measurement have lower intraoperative PRBC transfusion, less postoperative bleeding, and shorter ICU stay. When necessary, SpHb, together with clinical judgment and laboratory confirmation, can be used in decision-making for perioperative PRBC transfusion.
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Affiliation(s)
- Ayten Saracoglu
- Marmara University Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Ruslan Abdullayev
- Marmara University Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Mustafa Sakar
- Marmara University Department of Neurosurgery, Istanbul, Turkey
| | - Bulent Sacak
- Marmara University Department of Plastic and Reconstructive Surgery, Istanbul, Turkey
| | | | - Zuhal Aykac
- Marmara University Department of Anesthesiology and Reanimation, Istanbul, Turkey
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Tayari H, Flaherty D, Schauvliege S, La Rosa L, Auckburally A. Accuracy and trending capability of haemoglobin measurement by noninvasive pulse co-oximetry in anaesthetized horses. Vet Anaesth Analg 2021; 49:76-84. [PMID: 34801406 DOI: 10.1016/j.vaa.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/21/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the accuracy and trending capability of continuous measurement of haemoglobin concentration [Hb], haemoglobin oxygen saturation (SaO2) and oxygen content (CaO2) measured by the Masimo Radical-7 pulse co-oximeter in horses undergoing inhalational anaesthesia. STUDY DESIGN Prospective observational clinical study. ANIMALS A group of 23 anaesthetized adult horses. METHODS In 23 healthy adult horses undergoing elective surgical procedures, paired measurements of pulse co-oximetry-based haemoglobin concentration (SpHb), SaO2 (SpO2), and CaO2 (SpOC) and simultaneous arterial blood samples were collected at multiple time points throughout anaesthesia. The arterial samples were analysed by a laboratory co-oximeter for total haemoglobin (tHb), SaO2 and manually calculated CaO2. Bland-Altman plots, linear regression analysis, error grid analysis, four-quadrant plot and Critchley polar plot were used to assess the accuracy and trending capability of the pulse co-oximeter. Data are presented as mean differences and 95% limits of agreement (LoA). RESULTS In 101 data pairs analysed, the pulse co-oximeter slightly underestimated tHb (bias 0.06 g dL-1; LoA -1.0 to 1.2 g dL-1), SaO2 (bias 1.4%; LoA -2.0% to 4.8%), and CaO2 (bias 0.3 mL dL-1; LoA -2.1 to 2.7 mL dL-1). Zone A of the error grid encompassed 99% of data pairs for SpHb. Perfusion index (PI) ≥ 1% was recorded in 58/101 and PI < 1% in 43/101. The concordance rate for consecutive changes in SpHb and tHb with PI ≥ 1% and < 1% was 80% and 91% with four-quadrant plot, and 45.8% and 66.6% with Critchley polar plot. CONCLUSIONS Pulse co-oximetry has acceptable accuracy for the values measured, even with low PI, whereas its trending ability requires further investigation in those horses with a higher [Hb] variation during anaesthesia.
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Affiliation(s)
- Hamaseh Tayari
- Southern Counties Veterinary Specialists, Anaesthesia Department, Ringwood, UK.
| | - Derek Flaherty
- Southern Counties Veterinary Specialists, Anaesthesia Department, Ringwood, UK
| | - Stijn Schauvliege
- Department of Surgery and Anaesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Lavinia La Rosa
- Department of Surgery and Anaesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Adam Auckburally
- Southern Counties Veterinary Specialists, Anaesthesia Department, Ringwood, UK
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An R, Huang Y, Man Y, Valentine RW, Kucukal E, Goreke U, Sekyonda Z, Piccone C, Owusu-Ansah A, Ahuja S, Little JA, Gurkan UA. Emerging point-of-care technologies for anemia detection. LAB ON A CHIP 2021; 21:1843-1865. [PMID: 33881041 PMCID: PMC8875318 DOI: 10.1039/d0lc01235a] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Anemia, characterized by low blood hemoglobin level, affects about 25% of the world's population with the heaviest burden borne by women and children. Anemia leads to impaired cognitive development in children, as well as high morbidity and early mortality among sufferers. Anemia can be caused by nutritional deficiencies, oncologic treatments and diseases, and infections such as malaria, as well as inherited hemoglobin or red cell disorders. Effective treatments are available for anemia upon early detection and the treatment method is highly dependent on the cause of anemia. There is a need for point-of-care (POC) screening, early diagnosis, and monitoring of anemia, which is currently not widely accessible due to technical challenges and cost, especially in low- and middle-income countries where anemia is most prevalent. This review first introduces the evolution of anemia detection methods followed by their implementation in current commercially available POC anemia diagnostic devices. Then, emerging POC anemia detection technologies leveraging new methods are reviewed. Finally, we highlight the future trends of integrating anemia detection with the diagnosis of relevant underlying disorders to accurately identify specific root causes and to facilitate personalized treatment and care.
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Affiliation(s)
- Ran An
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Yuning Huang
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Yuncheng Man
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Russell W Valentine
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Erdem Kucukal
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Utku Goreke
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Zoe Sekyonda
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Connie Piccone
- Department of Pediatric Hematology, Carle Foundation Hospital, Urbana, IL, USA
| | - Amma Owusu-Ansah
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Sanjay Ahuja
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Jane A Little
- Division of Hematology & UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Umut A Gurkan
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA. and Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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Tayari H, Flaherty D, Yamaoka TT, Auckburally A. Assessment of pulse co-oximetry technology after in vivo adjustment in anaesthetized dogs. Vet Anaesth Analg 2021; 48:297-304. [PMID: 33610477 DOI: 10.1016/j.vaa.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/16/2020] [Accepted: 08/21/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare values of haemoglobin concentration (SpHb), arterial haemoglobin saturation (SpO2) and calculated arterial oxygen content (SpOC), measured noninvasively with a pulse co-oximeter before and after in vivo adjustment (via calibration of the device using a measured haemoglobin concentration) with those measured invasively using a spectrophotometric-based blood gas analyser in anaesthetized dogs. STUDY DESIGN Prospective observational clinical study. ANIMALS A group of 39 adult dogs. METHODS In all dogs after standard instrumentation, the dorsal metatarsal artery was catheterised for blood sampling, and a pulse co-oximeter probe was applied to the tongue for noninvasive measurements. Paired data for SpHb, SpO2 and SpOC from the pulse co-oximeter and haemoglobin arterial oxygen saturation (SaO2) and arterial oxygen content (CaO2) from the blood gas analyser were obtained before and after in vivo adjustment. Bland-Altman analysis for repeated measurements was used to evaluate the bias, precision and agreement between the pulse co-oximeter and the blood gas analyser. Data are presented as mean differences and 95% limits of agreement (LoA). RESULTS A total of 39 data pairs were obtained before in vivo adjustment. The mean invasively measured haemoglobin-SpHb difference was -2.7 g dL-1 with LoA of -4.9 to -0.5 g dL-1. After in vivo adjustment, 104 data pairs were obtained. The mean invasively measured haemoglobin-SpHb difference was -0.2 g dL-1 with LoA of -1.1 to 0.6 g dL-1. The mean SaO2-SpO2 difference was 0.86% with LoA of -0.8% to 2.5% and that between CaO2-SpOC was 0.66 mL dL-1 with LoA of -2.59 to 3.91 mL dL-1. CONCLUSIONS Before in vivo adjustment, pulse co-oximeter derived values overestimated the spectrophotometric-based blood gas analyser haemoglobin and CaO2 values. After in vivo adjustment, the accuracy, precision and LoA markedly improved. Therefore, in vivo adjustment is recommended when using this device to monitor SpHb in anaesthetised dogs.
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Affiliation(s)
- Hamaseh Tayari
- ChesterGates Veterinary Specialists CVS (UK) Ltd, Chester, UK.
| | - Derek Flaherty
- Southern Counties Veterinary Specialist (SCVS) (UK) Independent Vetcare Ltd, Ringwood, UK
| | | | - Adam Auckburally
- Southern Counties Veterinary Specialist (SCVS) (UK) Independent Vetcare Ltd, Ringwood, UK
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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: 8] [Impact Index Per Article: 1.6] [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.
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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
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Odeh JM, Hill SE. Noninvasive Continuous Hemoglobin Monitoring: Role in Cardiovascular Surgery. J Cardiothorac Vasc Anesth 2019; 33 Suppl 1:S73-S75. [PMID: 31279356 DOI: 10.1053/j.jvca.2019.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Blood transfusions in the operating room are associated with increased morbidity and mortality as well as increased cost. The technology exists for continuous noninvasive hemoglobin monitoring (SpHb), which could allow for the rapid diagnosis and treatment of acute blood loss anemia secondary to surgical bleeding. However, the accuracy of this technology has been called into question. SpHb in the operating room could reduce cost by decreasing lab draws, unnecessary transfusions, and the morbidity associated with blood transfusions. This review examines the accuracy of noninvasive hemoglobin monitoring as well as the role it may play in the operating room.
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Affiliation(s)
- Jaffer M Odeh
- University of Texas Southwestern Medical Center, Dallas, TX.
| | - Steven E Hill
- University of Texas Southwestern Medical Center, Dallas, TX
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Abstract
PURPOSE OF REVIEW Determination of hemoglobin (Hb) concentration is essential for the detection of anemia and hemorrhage and is widely used to evaluate a patient for a possible blood transfusion. Although commonly accepted as intrinsic to the process, traditional laboratory measurements of Hb are invasive, intermittent, and time-consuming. Noninvasive Hb (NIHb)-monitoring devices have recently become available and promise the potential for detecting sudden changes in a patient's Hb level. In addition to reduced delays in clinical intervention, these devices also allow for a reduction in patient discomfort, infection risk, required personnel, and long-term costs. Unfortunately, it has been shown that many clinical factors can influence their accuracy. RECENT FINDINGS Many studies have been published on the accuracy and precision of NIHb-monitoring devices in various clinical settings. A recent meta-analysis has shown a small mean difference but wide limits of agreement between NIHb and laboratory measurements, indicating that caution should be used by physicians when making clinical decisions based on this device. SUMMARY NIHb measurements may currently be considered to be a supplemental tool for monitoring trends in Hb concentration, but are not currently developed enough to replace an invasive approach. Moreover, further studies are still required before implementing NIHb in the clinical decision-making process. Specifically, no studies have demonstrated that this technology improves clinical outcomes or patient safety.
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