Clinical implications of using non-invasive haemoglobin monitoring for red blood cell transfusion decision in hip arthroplasty

Impact of Continuous Non-Invasive Hemoglobin Monitoring on Red Blood Cell Transfusion During Decompressive Craniotomy for Acute Brain Injury: A Randomized Control Study

BACKGROUND

Evidence suggests that liberal transfusion and anemia correction have negative effects on patients with acute brain injuries (ABI). Such patients with indications for decompressive surgeries require precise and real-time monitoring technology for estimation of intraoperative hemoglobin in order to assess the need for transfusion.

AIMS

The primary objective was to evaluate non-invasive hemoglobin (SpHb) monitoring as a guide for red blood cell transfusion (RBCT) during emergency decompressive craniotomy in ABI patients. The secondary objectives were to evaluate the incidence of postoperative infections, length of ICU stay, duration of mechanical ventilation, 30-day mortality, and extended Glasgow outcome scale (E-GOS) score at 90 days.

METHODS AND MATERIAL

Eighty patients (aged 18-65) with ABI requiring decompressive surgery were randomized into two groups of 40 patients each: group A (SpHb monitoring group) and group B (standard care group). They were compared for RBCT management, and postoperative infections, ventilator days, length of stay in ICU, E-GOS, and mortality. RESULTS: The number of patients requiring a single RBCT was significantly higher in group A as compared to Group B (P < 0.0001). However, patients requiring two transfusions and the total volume of RBCT were higher in group B (P < 0.01). Three or more RBCT were required only in Group B (P 0.07). The duration of mechanical ventilation was higher in group B as opposed to group A (P 0.07). However, there was no significant difference in the hemodynamic variables between the two groups.

CONCLUSIONS

The inclusion of continuous SpHb monitoring during decompressive procedures in ABI patients may assist in the optimal management of blood transfusion, thereby reducing transfusion-related complications.

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

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.