Noninvasively Measured Hemoglobin Concentration Reflects Arterial Hemoglobin Concentration Before but Not After Cardiopulmonary Bypass in Patients Undergoing Coronary Artery or Valve Surgery

Riess, Matthias L.; Pagel, Paul S.

doi:10.1053/j.jvca.2016.03.148

Cited by 11 publications

(10 citation statements)

References 43 publications

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“…The accurate and rapid measurement of hemoglobin concentration is crucial during the decision-making process for fluid and transfusion therapy in complicated surgical procedures. Several articles have discussed the accuracy of Radical-7™ Pulse CO-Oximeter [11–18]; however, the lack of statistical agreement renders the clinical applicability of this method debatable. In our consideration, the ability of one device to provide helpful measurement data may prove valuable for monitoring during complicated surgical procedures as well as critical populations.…”

Section: Discussionmentioning

confidence: 99%

Validity of accuracy and trending ability of non-invasive continuous total hemoglobin measurement in complex spine surgery: a prospective cohort study

2019

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Background Patients undergoing complex spine surgery present with multilevel spinal involvement, advanced age, and multiple comorbidities. Surgery is associated with significant blood loss and remarkable hemodynamic changes. The present study aimed to investigate the accuracy and trending ability of a non-invasive continuous method to monitor hemoglobin (SpHb) concentrations using a Radical-7™ Pulse CO-Oximeter in complex spine surgery. Methods Forty-nine patients who underwent complex spine surgery were enrolled in this prospective observational study. Multiple time points were established for data collection throughout the operation. Simultaneous SpHb–total hemoglobin (tHb) paired data were recorded for analyses. Linear regression analysis, Bland–Altman plot, four-quadrant plot, and Critchley polar plot were used to assess the accuracy and trending ability of the monitor. Results A total of 272 pairs of SpHb-tHb data were available and were divided into two groups based on the perfusion index (PI): PI values ≥1.0 ( n = 200) and PI values < 1.0 ( n = 72). The correction coefficients (r) between SpHb and tHb were 0.6946 and 0.6861 in the groups with PI values ≥1.0 and < 1.0, respectively ( P < 0000.1). In the ≥1.0 group, the mean bias was − 0.21 g/dL and the percentage error (PE) was 15.85%, whereas in the < 1.0 group, the mean bias was − 0.04 g/dL and the PE was 17.42%. Four-quadrant plot revealed a concordance rate of 85.11%, whereas the Critchley polar plot showed a concordance rate of 67.21%. Conclusions The present study demonstrates the acceptable accuracy of the Radical-7™ Pulse CO-Oximeter even with a low PI. However, the trending ability was limited and unsatisfactory.

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Section: Discussionmentioning

confidence: 99%

Validity of accuracy and trending ability of non-invasive continuous total hemoglobin measurement in complex spine surgery: a prospective cohort study

2019

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“…These findings indicated the unreliability of Masimo hemoglobin measurement and go in hand with Khalafallah et al [25] who reported that SpHb may enable prompt routine preoperative anemia management, but its precision was lower than expected and Galvagno et al [26] also found noninvasive SpHb monitoring did not enhance the ability to predict the need for blood transfusion. Recently, Riess & Pagel [27] observed a lack of precision with noninvasive Hb Data are presented as mean ± SD; Group NA: received normotensive anesthesia; Group HA: received hypotensive anesthesia; SBP: Systolic blood pressure, DBP: Diastolic blood pressure, MAP: Mean arterial pressure; HR: Heart rate; PO: Postoperative; NS: Non significant difference; p < 0.05: significant difference Table 2 Regional cerebral and peripheral arterial blood oxygen saturation in patients of both groups. Peripheral arterial blood oxygen saturation; rSO 2 : regional cerebral oxygen saturation; ΔSpO 2 : difference between peripheral and regional cerebral oxygen saturation; P value: P value of significance of difference between both groups; NS: Non-significant difference Data are presented as mean ± SD; Group NA: received normotensive anesthesia; Group HA: received hypotensive anesthesia; PO: Postoperative; ΔPVI: change of Pleth variability index; * : indicates significant difference versus preoperative measurement; P value: P value of significance of difference between both groups; NS: Non-significant difference; p < 0.05: significant difference measurement, especially after cardiopulmonary bypass.…”

Section: Resultsmentioning

confidence: 99%

Esmolol hypotension maintains tissue perfusion during myomectomy judged by Masimo monitoring of regional cerebral oxygen saturation and pleth variability index

Salman

Shehab

2018

Egyptian Journal of Anaesthesia

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To evaluate outcome of elective abdominal myomectomy under esmolol hypotensive anesthesia (HA) compared to normotensive anesthesia (NA). Methods: Patients were randomly divided into NA Group received NA and HA Group received esmolol (0.5 mg/ kg) bolus then infusion (0.05-0.3 mg/kg/min) to maintain mean arterial pressure at 60-70 mmHg till completion of myomectomy. Masimo Radical 7 was used to monitor regional cerebral oxygenation (rSO 2), total hemoglobin (Hb.) and pleth variability index (PVI). Fluid therapy (FT) included initial bolus of 5% human plasma protein followed by intraoperative (IO) Lactated Ringer's (LR) solution. Amount of IO blood loss, blood transfusion and urine output (UOP) were determined. Postoperative (PO) Hb. conc. was measured at laboratory (Lab). Results: IO blood pressure was significantly lower, while PVI was significantly higher with significantly lower ΔPVI with HA than NA. Operative time was significantly shorter with significantly less IO blood loss and blood transfusion with HA. Regional cerebral and peripheral tissue oxygen saturations showed non-significant difference between both groups. PO Masimo measured and Lab estimated Hb. was significantly higher with significantly lower ΔHb% in HA than NA group. Masimo measurement was significantly higher with significantly lower ΔHb% than lab estimation in both groups. Patients of NA group received significantly greater amount of LR, but UOP was non-significantly higher than in HA group. Conclusion: Esmolol HA allowed better control of IO bleeding, blood transfusion and FT. Masimo continuous monitoring of rSO2 assured preserved cerebral perfusion. Masimo measured PVI could non-invasively monitor tissue perfusion. 3. Setting Tertiary referral hospital, KSA.

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“…Our study has some limitations: (a) It was conducted at a single center; (b) we did not evaluate the accuracy of Masimo oximeter after cardiopulmonary bypass; however, a previous study in adult cardiac patients undergoing coronary artery or valve surgery showed that the accuracy Sp‐Hb worsened after the cardiopulmonary bypass 17 …”

Section: Discussionmentioning

confidence: 98%

Evaluation of noninvasive hemoglobin monitoring in children with congenital heart diseases

Kamel

Hasanin

Nawar

et al. 2020

Pediatric Anesthesia

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Background Noninvasive measurement of blood hemoglobin could save time and decrease the risk of anemia and infection. The accuracy of CO‐oximetry‐derived noninvasive hemoglobin (Sp‐Hb) had been evaluated in pediatric population; however, its accuracy in children with congenital heart disease has not been studied till date. We evaluated the accuracy of Sp‐Hb in relation to laboratory‐measured hemoglobin (Lab‐Hb) in children with congenital heart disease. Methods This prospective observational study included children with congenital heart disease undergoing procedural intervention. Sp‐Hb measurements were obtained using Radical‐7 Masimo pulse CO‐oximeter and were compared against simultaneous Lab‐Hb measurements obtained from the arterial line. Children were divided in cyanotic and acyanotic, and separate analysis was performed for each group. The values of both measurements were analyzed using Spearman's correlation coefficient and Bland‐Altman analysis. Correlation was performed between Sp‐Hb and Lab‐Hb bias and each of arterial oxygen saturation and perfusion index. Results One‐hundred and eleven pairs of readings were obtained from 65 children. The median (quartiles) age and weight of the children were 1 (1.2‐4) years and 11 (8‐17) kg, respectively. There was moderate correlation between Lab‐Hb and Sp‐Hb with a correlation coefficient (95% confidence interval [CI]) of 0.75 (0.63‐0.83) in acyanotic children and 0.62 (0.37‐0.79) in cyanotic children. The mean bias (95% limits of agreements) was −0.4 g/dL (−2.4 to 1.6 g/dL) and 1 g/dL (−2.7 to 4.6 g/dL) in acyanotic and cyanotic children, respectively. The mean bias between Sp‐Hb and Lab‐Hb showed a weak negative correlation with oxygen saturation (r [95% CI]): (−0.36 [−0.51‐−0.18]), and a weak positive correlation with the perfusion index (r [95% CI]): (0.19 [0.01‐0.37]). Conclusion The large bias and the wide limits of agreement between Sp‐Hb and Lab‐Hb denote that Masimo‐derived Sp‐Hb is not accurate in children with congenital heart disease especially in the cyanotic group; the error in Sp‐Hb increases when oxygen saturation decreases.

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Noninvasively Measured Hemoglobin Concentration Reflects Arterial Hemoglobin Concentration Before but Not After Cardiopulmonary Bypass in Patients Undergoing Coronary Artery or Valve Surgery

Cited by 11 publications

References 43 publications

Validity of accuracy and trending ability of non-invasive continuous total hemoglobin measurement in complex spine surgery: a prospective cohort study

Validity of accuracy and trending ability of non-invasive continuous total hemoglobin measurement in complex spine surgery: a prospective cohort study

Esmolol hypotension maintains tissue perfusion during myomectomy judged by Masimo monitoring of regional cerebral oxygen saturation and pleth variability index

Evaluation of noninvasive hemoglobin monitoring in children with congenital heart diseases

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