. Temporary tracheal occlusion in fetal sheep with lung hypoplasia does not improve postnatal lung function.

Background Accurate measurement of intraoperative blood loss is an important clinical variable in managing fluid resuscitation and avoiding unnecessary transfusion of blood products. In this study, blood lost onto laparotomy sponges during surgical cases was measured using a tablet computer programmed with a unique algorithm modeled after facial recognition technology. In this study we assessed the accuracy and performance of the system in surgical cases. Methods In this prospective, multicenter study, 46 patients undergoing surgery with anticipated significant blood loss contributed laparotomy sponges for hemoglobin (Hb) loss measurement using the Triton System with Feature Extraction Technology (Gauss Surgical, Inc., Los Altos, USA). The Hb loss measured by the new system was compared to Hb loss measured by manual rinsing of the sponges. Accuracy was evaluated using linear regression and Bland-Altman analysis. In addition, the new system’s calculation of blood volume loss was compared with the gravimetric method of estimating blood loss from intraoperative sponge weights. Results A significant positive linear correlation was noted between the new system’s measurements and the rinsed Hb mass (r = 0.93, p < 0.0001). Bland-Altman analysis revealed a bias of 9.0 g and narrow limits of agreement (−7.5 g to 25.5 g) between the new system’s measures and the rinsed Hb mass. These limits were within the clinically relevant difference of +/−30 g, which is approximately half of the Hb content of a unit of allogeneic whole blood. Bland-Altman analysis of the estimated blood loss on sponges using the gravimetric method demonstrated a bias of 466 ml (overestimation) with limits of agreement of −171 ml and 1103 ml, due to the presence of contaminants other than blood on the laparotomy sponges. Conclusion The novel mobile monitoring system provides an accurate measurement of Hb mass on surgical sponges as compared with manual rinsing measurements and is significantly more accurate than the gravimetric method. Further study is warranted to assess the clinical utility of the technology.

Background Accurate measurement of intraoperative blood loss is an important clinical variable in managing fluid resuscitation and avoiding unnecessary transfusion of blood products. In this study, we measured surgical blood loss using a tablet computer programmed with a unique algorithm modeled after facial recognition technology. The aim of the study was to assess the accuracy and performance of the system on surgical laparotomy sponges in vitro. Study Design and Methods Whole blood samples of pre-measured hemoglobin (Hb) and volume were reconstituted from units of human packed red blood cells and plasma and distributed across surgical laparotomy sponges. Normal saline was added to simulate the presence of varying levels of hemodilution and/or irrigation use. Soaked sponges from four different manufacturers were scanned using the Triton System with Feature Extraction Technology (Gauss Surgical, Inc., Palo Alto, USA) under three different ambient light conditions in an operating room. Accuracy of Hb loss measurement was evaluated relative to the pre-measured values using linear regression and Bland-Altman analysis. Correlations between studied variables and measurement bias were analyzed using nonparametric tests. Results The overall mean percent error for measure of Hb loss for the Triton System was 12.3% [95% CI 8.2 to 16.4%]. A strong positive linear correlation between the pre-measured and actual Hb masses was noted across the full range of intraoperative lighting conditions, including (A) high (r = 0.95 [95% CI 0.93–0.96]), (B) medium (r = 0.94 [95% CI 0.93–0.96]), and (C) low (r = 0.90 [95% CI 0.87–0.93]) mean ambient light intensity. Bland-Altman analysis revealed a bias of 0.01 g [95% CI −0.03 to 0.06 g] of Hb per sponge between the two measures. The corresponding lower and upper limits of agreement were −1.16 g [95% CI −1.21 to −1.12 g] per sponge and 1.19 g [95% CI 1.15 to 1.24 g] per sponge, respectively. Measurement bias of estimated blood loss and Hb mass using the new system were not associated with the volume of saline used to reconstitute the samples (p = 0.506 and p = 0.469, respectively), suggesting that the system is robust under a wide range of sponge saturation conditions. Conclusion Mobile blood loss monitoring using the Triton system is accurate in assessing Hb mass on surgical sponges across a range of ambient light conditions, sponge saturation, saline contamination, and initial blood Hb. Utilization of this tool could significantly improve the accuracy of blood loss estimates.

Electronic mandatory IRS data entry and an initiative to understand and address reporting barriers and motivators were associated with sustained increases in the adverse event reporting rate. These strategies to minimize underreporting enhance IRS value for learning and may be generalizable.