Continuous hemoglobin monitoring in pediatric trauma patients with solid organ injury

Welker, Emily; Novák, J; Jelsma, Lindsey R.; Koehler, Tracy J.; Davis, Alan L.; DeCou, James M.; Durkin, Emily T.

doi:10.1016/j.jpedsurg.2017.12.015

Cited by 18 publications

(19 citation statements)

References 23 publications

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“…In pediatric intensive care unit patients, the Masimo Pronto SpHb Monitor provided adequate agreement between the nHgb and iHgb values for Hgb, but the authors cautioned that other clinical indicators need to be utilized to determine whether an iHgb draw is needed and that nHgb should not be used as the primary indicator for transfusion decisions 8. In contrast to our results and the pediatric intensive care unit study, a study conducted in pediatric trauma patients with solid organ injury noted only slight differences between iHgb and nHgb (Masimo Radical-7 continuous Hgb monitor results, but no differences were great enough to result in the change of clinical management 12. Researchers caution that nHgb may be used as an initial screening tool to determine whether iHgb needs to be conducted but should not replace iHgb monitoring should other clinical factors indicate the need for transfusion 8,12.…”

Section: Discussioncontrasting

confidence: 83%

“…11,12 In addition, these prior studies have shown that nHgb monitoring was more efficient, less expensive, and preferred by patients compared with invasive hemoglobin (iHgb) monitoring. 11,12 However, although an nHgb monitor has been developed for children, to our knowledge, it has not yet been validated for use in children for routine postoperative Hgb assessment. 8 If validated, nHgb monitoring could decrease anxiety, fear, and discomfort in hospitalized children who may have already been in distress due to postoperative pain.…”

mentioning

confidence: 99%

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Noninvasive Hemoglobin Monitoring for Postoperative Pediatric Orthopaedic Patients: A Preliminary Study

Mathew

Pulido²,

Larson³

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Hemoglobin (Hgb) levels are frequently checked through venipuncture [invasive hemoglobin (iHgb)] in pediatric orthopaedic patients after high blood loss procedures. This needlestick may causes further anxiety and fear in hospitalized children. Noninvasive hemoglobin (nHgb) monitoring has been effectively utilized in the adult intensive care and postoperative total joint arthroplasty setting. nHgb monitoring has not yet been validated in children for routine postoperative Hgb assessment in pediatric orthopaedics. Methods: In this prospective study, 46 pediatric orthopaedic patients were enrolled who were undergoing surgery and postoperative standard of care iHgb testing. On postoperative day 1, Hgb levels were obtained through venipuncture and nHgb monitor (Pronto-7; Masimo) within a 2-hour period. Patient preferences, iHgb and nHgb values, time to result, and provider preferences were recorded. Cost data were estimated based on the standard Medicare payment rates for lab services versus the cost of nHgb probe. Results: nHgb results were obtained after 1 attempt in 38 patients (83%), after multiple attempts in 7 patients (15%), and could not be obtained in 1 patient. The mean time to obtain nHgb value was significantly shorter than that to obtain iHgb results (1.3 ± 1.5 vs. 40 ± 18.1 min; P < 0.0001). The mean nHgb value was significantly higher than the mean iHgb value (11.7 ± 1.5 vs. 10.6 ± 1.1 g/dL, P < 0.0001). nHgb exceeded iHgb by 2 g/dL or more in 12 (26%) patients (2.64 ± 0.9 vs. 0.54 ± 0.84 g/dL; P < 0.0001). The concordance correlation coefficient between the 2 Hgb methods was 0.59, indicating moderate agreement. Fortythree (93%) of our patients and 34 (74%) of the care providers preferred nHgb over iHgb if results were equivalent. At our institution, the cost per iHgb monitoring is approximately $28 per blood draw as compared with $5 for nHgb monitoring. Interestingly, no patients required postoperative transfusion during the study period, as asymptomatic patients with no cardiac disease are typically observed unless the Hgb is < 6. Conclusions: nHgb monitoring in postoperative pediatric patients overestimated Hgb levels compared with the standard of care methods; however, nHgb had high patient and provider satisfaction and had moderate agreement with iHgb. As no patients required transfusion, postoperative Hgb checks could likely be discontinued in some portion of our population.

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Section: Discussioncontrasting

confidence: 83%

mentioning

confidence: 99%

Noninvasive Hemoglobin Monitoring for Postoperative Pediatric Orthopaedic Patients: A Preliminary Study

Mathew

Pulido²,

Larson³

et al. 2022

Journal of Pediatric Orthopaedics

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“…INVOS ® (Somanetics Corp., Troy, MI, USA) was developed for measuring regional brain oxygen saturation through the use of 2 light-emitting diodes [13], and IN-VOS ® has also been widely used to obtain tissue oxygen saturation in areas other than the brain and peripheral microcircular reactivity measurements using VOT [1,2,14]. O3 TM (Massimo Corp., Irvine, CA, USA) is a recently developed NIRS method that uses 4 wavelengths, and only a few studies have used this device to measure cerebral oxygen saturation [15] or StO 2 [16].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Different Near-Infrared Spectroscopy Devices for Assessing Tissue Oxygenation with a Vascular Occlusion Test in Healthy Volunteers

Chung

Jang

et al. 2020

J Vasc Res

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Near-infrared spectroscopy devices can measure peripheral tissue oxygen saturation (StO 2). This study aims to compare StO 2 using INVOS ® and different O3™ settings (O3 25:75 and O3 30:70). Twenty adults were recruited. INVOS ® and O3™ probes were placed simultaneously on 1 side of forearm. After baseline measurement, the vascular occlusion test was initiated. The baseline value, rate of deoxygenation and reoxygenation, minimum and peak StO 2 , and time from cuff release to peak value were measured. The parameters were compared using ANOVA and Kruskal-Wallis tests. Bonferroni's correction and Mann-Whitney pairwise comparison were used for post hoc analysis. The agreement between StO 2 of devices was evaluated using Bland-Altman plots. IN-VOS ® baseline value was higher (79.7 ± 6.4%) than that of O3 25:75 and O3 30:70 (62.4 ± 6.0% and 63.7 ± 5.5%, respectively, p < 0.001). The deoxygenation rate was higher with IN-VOS ® (10.6 ± 2.1%/min) than with O3 25:75 and O3 30:70 (8.4 ± 2.2%/min, p = 0.006 and 7.5 ± 2.1%/min, p < 0.001). The minimum and peak StO 2 were higher with INVOS ®. No significant difference in the reoxygenation rate was found between the devices and settings. The time to reach peak after cuff deflation was faster with INVOS ® (both p < 0.001). Other parameters were similar. There were no differences between the different O3™ settings. There were differences in StO 2 measurements between the devices, and these devices should not be interchanged. Differences were not observed between O3™ device settings.

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“…The continuous non-invasive measurement of Hb concentration can be performed with a pulse co-oximeter. This method was tested in different clinical scenarios: emergency room [ 9 ], complex spine surgery [ 10 ], major abdominal and pelvic surgery [ 11 ], liver transplantation [ 12 ], trauma [ 13 ], neurosurgery [ 14 ], cardiopulmonary bypass [ 15 ], and pediatrics [ 16 ]. To our knowledge, there was only one study performed on ICU patients, comparing continuous pulse co-oximetry to three different invasive methods [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Hemoglobin Determination Using Pulse Co-Oximetry and Reduced-Volume Blood Gas Analysis in the Critically Ill: A Prospective Cohort Study

2022

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Hospital-acquired anemia is common in patients hospitalized in the intensive care unit (ICU). A major source of iatrogenic blood loss in the ICU is the withdrawal of blood for laboratory testing. The aim of our study was to analyze the feasibility and accuracy of non-invasive spot-check pulse co-oximetry (SpHb), and a reduced-volume blood gas analysis (ABG Hb) for the determination of Hb concentration in critically ill patients. Comparisons between Hb determined with test devices and the gold standard—complete blood count (CBC)—were performed using Bland–Altman analysis and concordance correlation coefficient (CCC). The limits of agreement between SpHb and CBC Hb were –2.0 [95%CI −2.3–(−1.7)] to 3.6 (95%CI 3.3–3.9) g/dL. The limits of agreement between ABG Hb and CBC Hb were −0.6 [95%CI −0.7–(−0.4)] to 2.0 (95%CI 1.9–2.2) g/dL. Spearman’s coefficient and CCC between ABG Hb and CBC Hb were 0.96 (95%CI 0.95–0.97, p <0.001) and 0.91 (95% CI 0.88–0.92), respectively. Non-invasive spot-check Hb co-oximetry is not sufficiently accurate for the monitoring of hemoglobin concentration in critically ill patients. Reduced volume arterial blood gas analysis has acceptable accuracy and could replace complete blood count for the monitoring of Hb concentration in critically ill patients, leading to a significant reduction in blood volume lost for anemia diagnostics.

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Continuous hemoglobin monitoring in pediatric trauma patients with solid organ injury

Cited by 18 publications

References 23 publications

Noninvasive Hemoglobin Monitoring for Postoperative Pediatric Orthopaedic Patients: A Preliminary Study

Noninvasive Hemoglobin Monitoring for Postoperative Pediatric Orthopaedic Patients: A Preliminary Study

Evaluation of Different Near-Infrared Spectroscopy Devices for Assessing Tissue Oxygenation with a Vascular Occlusion Test in Healthy Volunteers

Hemoglobin Determination Using Pulse Co-Oximetry and Reduced-Volume Blood Gas Analysis in the Critically Ill: A Prospective Cohort Study

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