Multicenter comparison of three intraoperative hemoglobin trend monitoring methods
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ORIGINAL RESEARCH
Multicenter comparison of three intraoperative hemoglobin trend monitoring methods Richard L. Applegate II1,2 · Patricia M. Applegate3 · Maxime Cannesson4,5 · Prith Peiris6 · Beth L. Ladlie6 · Klaus Torp6 Received: 3 October 2019 / Accepted: 20 November 2019 © The Author(s) 2019
Abstract 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. Keywords Hemoglobin · Point of care tests · Noninvasive measurement · Intraoperative monitoring
1 Introduction
* Richard L. Applegate II [email protected] 1
Department of Anesthesiology, Loma Linda University, Loma Linda, CA, USA
2
Present Address: Department of Anesthesiology and Pain Medicine, University of California Davis, Sacramento, CA, USA
3
Department of Cardiology, University of California, Davis, Sacramento, CA, USA
4
Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA
5
Present Address: Department of Anesthesiology and Perioperative Care, University of California Los Angeles, Los Angeles, CA, USA
6
Department of Anesthesiology, Mayo Clinic in Florida, Jacksonville, FL, USA
Hemoglobin (Hb) measurement informs patient-specific perioperative transfusion decisions within the context of symptoms, comorbid conditions, surgical procedure, observed bleeding and hemodynamic performance [1, 2]. Hb measurement is a key component in many parts of patient blood management bundles [3], and is recommended between transfused red blood cell units if patient st
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