Non-invasive monitoring is coming the full circle, making our patients safer!
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EDITORIAL
Non‑invasive monitoring is coming the full circle, making our patients safer! Michael A. Ramsay1 Received: 8 January 2020 / Accepted: 14 January 2020 © Springer Nature B.V. 2020
Abstract Non-invasive monitoring is becoming more accurate, more available and mobile. The clinical advantage that this developing technology provides is that the data may be monitored continuously; relatively unobtrusively, and transmitted directly to the caregiver. The downside of being non-invasive has been the potential loss of accuracy in the data displayed. This has been overcome in the measurement of oxygen saturation of hemoglobin by pulse oximetry, in that treatment will be instigated by a decline in oxygen saturation without necessarily an arterial blood gas analysis being performed. The development of pulse oximetry to measure hemoglobin levels (SpHb) has relied on “trend accuracy” to indicate the need for a confirmatory laboratory analysis of hemoglobin level. The study by Applegate et al. [1] confirms the trend accuracy of SpHb as an indication to perform a laboratory confirmation of hemoglobin level. This will lead to earlier laboratory screening, so that developing adverse conditions, such as postoperative bleeding, may be identified at a time that major events, such as failure to rescue can be avoided. This increased availability of non-invasive technology will make patients safer both in our hospitals and at home. Keywords Noninvasive monitoring · Improved surveillance technology · Patient safety · Reducing “Failure to Rescue” events In this edition of JCMC, Applegate et al. demonstrate that the improvement in technology in pulse oximetry is advancing the trend accuracy of non-invasive hemoglobin (SpHb) measurement [1]. This will hopefully lead to the end of the “stat” bring back to the operating room at 7 am in the morning of patients, when the routine morning laboratory results are reviewed. The non-invasive monitoring of SpHb may have demonstrated the declining SpHb at midnight causing a laboratory hemoglobin check and either the treatment of a coagulopathy negating the need for a return to the operating room or an early re-exploration. The continuous display of SpHb may lead to the more appropriate blood management of major surgical patients by indicating when a laboratory check is necessary. When I started practicing anesthesia 40 years ago. Noninvasive monitoring was the norm for most patients undergoing anesthesia. This consisted of a finger on the pulse, that * Michael A. Ramsay [email protected] 1
Department of Anesthesiology, Baylor University Medical Center, Baylor Scott and White Health Care System, Dallas, TX, USA
measured the strength, volume and character of the pulse continually. If you can feel the superficial temporal pulse the blood pressure is at least 70 mm hg was the assumption. Assessment of temperature and diaphoresis was made by observation and touch of the forehead. A monoaural stethoscope, with custom made earpiece, allowed assessment of breath sounds, respiratory rat
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