Accuracy and Trending of Continuous Noninvasive Hemoglobin Monitoring in Patients Undergoing Liver Transplantation

Huang, Pei-Wei; Shih, Bin-Fu; Tsai, Yueh-Ju; Chung, Pei‐Hua; Liu, F.C.; Yu, Huang-Ping; Lee, W.C.; Chang, Chee Jen; Lin, Chun‐Cheng

doi:10.1016/j.transproceed.2015.12.121

Cited by 16 publications

(15 citation statements)

References 12 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%

“…The percentage error in this study was calculated with the LoA divided by the mean hemoglobin data {100 × [LOA/ (mean SpHb + mean tHb)/2]}. Although several studies have excluded data with low perfusion values [11, 23, 24], we sought to determine the accuracy in this group of paired data. Therefore, the present study, we compared the paired data with PI values < 1.0 with those having a PI value ≥1.0 to assess the accuracy of SpHb.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, prolonged operation time and significant blood loss are important factors that contribute to instability in these patients during the surgical procedure. Although several studies have examined different surgical methods and in different populations [11–24], only few of these studies have determined the validity of SpHb in spine surgery [19, 20]. Ehrenfeld et al have reported that the SpHb-guided blood management in various orthopedic surgeries was associated with a 4% absolute reduction in the risk of blood transfusion compared with the standard care without the monitoring of SpHb values.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…However, Huang et al [20], in a study conducted in the same surgical population (blood loss 1982.50 ± 1470.54 mL), demonstrated that the correlation between SpHb and tHb was 0.59 (p < 0.001). The Bland−Altman analysis revealed that bias between SpHb and tHb was 2.28 g/dL, and limits of agreement were from −0.78 to 5.34 g/dL.…”

Section: Discussionmentioning

confidence: 93%

Continuous Noninvasive Haemoglobin Monitoring in Vascular Surgery within the Goal-Directed Therapy Protocol

Rosa¹,

Romanelli²,

Calabria³

et al. 2019

CEACR

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The optimisation of DO2, within the Goal-Direct Therapy Protocol (GDTP) in high-risk surgical patients, improves their outcome. Haemodynamic and haemoglobin monitoring become crucial to achieve optimal DO2. Our study compared Hb as measured by three methods: Coulter Counter (standard laboratory method) and CO-Oximetry (Masimo rainbow SET Radical 7 Pulse CO-Oximetry (SpHb) and Blood Gas Analysis) to establish the utility of the Hb continuous intraoperative monitoring, within the GDTP, in high-risk bleeding surgery. We studied 72 patients undergoing open abdominal aortic aneurysm repair. We compared the accuracy and the trending ability in measuring the haemoglobin concentration between the three methods (Coulter Counter, BGA and Masimo). We collected three simultaneous haemoglobin measurements: after induction of anaesthesia, pre- and post-aortic cross-clamping and at the end of the surgery. SpHb showed an excellent r-value for all samples (0.952, CI-95% (0.939, 0.961), p-value < 0.0001) compared to laboratory measurements. The results of the linear regression between SpHb and laboratory, for each time considered, demonstrated that SpHb showed excellent r and R2 value. All data were statistically significant, with a p-value <0.0001. A Bland-Altmann analysis for SpHb vs. laboratory showed a bias of −1.45 g/dL (CI-95% −1.51 and −1.39 g/dL, LOA from −2.42 to −0.48 g/dL) with a precision of 0.49 g/dL. Four-quadrant plot trend analyses showed a high concordance rate ≥90%. During elective high-risk surgery, Masimo Pulse CO-Oximetry is not enough sufficiently accurate to assess the current value of haemoglobin but may be useful for the trend value ensuring DO2 within intraoperative GDTP.

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“…Huang et al conducted a study to evaluate the accuracy of SpHb measured by Radical-7 in patients with liver transplantation. In addition to an insufficient trending ability, they found that the correlation was moderate (r � 0.59) but bias and limits of agreement were high (2.28 g/ dL, -0.78 to 5.34 g/dL) between SpHb and tHb [39]. A recent study by Erdogan Kayhan et al revealed that the absolute bias and limits of agreement between tHb and SpHb detected by Radical-7 in preanhepatic phase were 1.11 g/dL and − 2.08 to 4.31 g/dL, respectively [40].…”

Section: Discussionmentioning

confidence: 98%

Development and Validation of a Photoplethysmography System for Noninvasive Monitoring of Hemoglobin Concentration

Liu

Peng

et al. 2020

Journal of Electrical and Computer Engineering

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Background. Traditional invasive hemoglobin (Hb) detection led to delayed diagnosis, operational inefficiency, incorrect critical decision making, and uncomfortable patient experience. To facilitate real-time total hemoglobin (tHb) monitoring, a portable prototype of a noninvasive Hb detection system was developed, and the accuracy of Hb predicted based on partial least squares (PLS) as well as backpropagation artificial neural network (BP-ANN) models was validated. Results. The prototype was combined with a signal processing circuit and a spectrophotometric probe containing 8 wavelength LEDs light source and photodiode array. Laboratory invasive Hb (Lab_tHb) and spot check Hb measurements with PLS (SpHb_PLS) and BP (SpHb_BP) methods were obtained simultaneously by hematology analyzer and the designed system. The invasive and noninvasive estimates of the Hb levels were analyzed using Spearman correlation as well as Bland–Altman plot and receiver operating characteristic (ROC) curve analysis. A total of 238 volunteers had attempted laboratory invasive and noninvasive spot check Hb measurements. Mean Lab_tHb, SpHb_PLS, and SpHb_BP were 13.6 ± 1.80 g/dL, 13.5 ± 1.07 g/dL, and 13.6 ± 1.06 g/dL, respectively. Noninvasive SpHb_PLS (r = 0.61, p<0.001) and SpHb_BP (r = 0.62, p<0.001) had a strong correlation with invasive tHb values. The Bland–Altman plot showed excellent consistency between the proposed noninvasive methods and laboratory invasive reference. In ROC analysis, PLS and BP models were good at predicting Hb ≥ 12 g/dL with area under the curve of 0.828 and 0.824, respectively. Observed differences between invasive and noninvasive Hb measurements displayed no significant correlation with perfusion index values. Conclusions. The result confirmed that noninvasive Hb monitoring had an excellent correlation with traditional invasive Hb measurement. Furthermore, it is suggested that the developed prototype has the potential for the noninvasive detection of Hb concentration with the methods of PLS and BP-ANN.

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Accuracy and Trending of Continuous Noninvasive Hemoglobin Monitoring in Patients Undergoing Liver Transplantation

Cited by 16 publications

References 12 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

Continuous Noninvasive Haemoglobin Monitoring in Vascular Surgery within the Goal-Directed Therapy Protocol

Development and Validation of a Photoplethysmography System for Noninvasive Monitoring of Hemoglobin Concentration

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