Abstract
BackgroundHemoglobin measurement is important for transfusion decision-making. Pulse CO-Oximetry provides real-time continuous hemoglobin (SpHb) monitoring. The triage role of SpHb trends based on hemoglobin measurements was investigated.MethodsIn this diagnostic randomized controlled trial, 69 patients undergoing spine or cytoreductive surgery were randomly enrolled into SpHb-monitoring and standard-care groups. Diagnostic blood samples were drawn for CO-oximetry Hb (CoOxHb) when the SpHb decreased by 1 g/dl or at the clinician’s discretion in the standard-care group. The positive predictive value (PPV) was defined as the ability to detect a decrease in CoOxHb > 1 g/dl or a CoOxHb < 10 g/dl; the PPVs were compared using Fisher’s exact test. The SpHb and trend accuracies were calculated. The transfusion units and postoperative hemoglobin levels were compared.ResultsThe PPV of a decrease in CoOxHb > 1 g/dl was 93.3% in the SpHb group vs 54.5% without SpHb monitoring (p = 0.002). The PPV of CoOxHb < 10 g/dl was 86.7% vs. 50.0% for these groups (p = 0.015). The CoOxHb was never < 7 g/dl with SpHb monitoring. Sixty SpHb–CoOxHb data pairs and 28 delta pairs (ΔSpHb-ΔCoOxHb) were collected. The bias, precision and limits of agreement were − 0.29, 1.03 and − 2.30 to 1.72 g/dl, respectively. When ΔSpHb and ΔCoOxHb were > 1 g/dl, the concordance rate for changes in hemoglobin reached 100%. The delta pairs revealed a positive correlation [ΔSpHb = 0.49 * ΔCoOxHb - 0.13; r = 0.69, 95% confidence interval (0.53, 0.82)]. No significant differences were found in the transfusion volume or postoperative anemia state.ConclusionsThe SpHb trend tracked changes in hemoglobin satisfactorily during surgery and more accurately estimated the appropriate timing for invasive hemoglobin measurements than the clinicians.Trial registrationChiCTR1800016290 (Prospective registered). Initial registration date was 24/05/2018.
Highlights
Hemoglobin measurement is important for transfusion decision-making
The incidence of unnecessary hemoglobin concentration (Hb) measurement was lower in the Continuous total hemoglobin (SpHb) monitoring group than in the standard care group
The positive predictive value (PPV) of a decrease in CO-oximetry Hb (CoOxHb) > 1 g/dl was 93.3% based on SpHb monitoring and 54.5% based on the clinicians’ perception (p = 0.002)
Summary
Hemoglobin measurement is important for transfusion decision-making. The triage role of SpHb trends based on hemoglobin measurements was investigated. A red blood cell transfusion decision should be made based on the patient’s hemoglobin concentration (Hb) to balance sufficient oxygen supply and transfusion-related reactions. A high number of transfusions are performed without objective indications. In the current clinical pathway for anemia detection during intraoperative blood loss, an invasive Hb measurement is performed at the clinicians’ discretion. Attention must be paid to the patient’s vital signs, blood volume in the surgical field, cotton pads, and cell savers and ongoing hemostasis procedures. The discretion of the clinician is totally subjective and is largely dependent on their clinical experience
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