Hemoximetry as the “Gold Standard”? Error Assessment Based on Differences Among Identical Blood Gas Analyzer Devices of Five Manufacturers

Gehring, Hartmut; Duembgen, Lutz; Peterlein, Mareike; Hagelberg, Söhnke; Dibbelt, L.

doi:10.1213/01.ane.0000268713.58174.cc

Cited by 39 publications

(24 citation statements)

References 10 publications

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“…When SpHb values were compared to a reference laboratory device in our study, we found a higher standard deviation than what has been reported for Hb measurements from consecutive blood samples run on the same model lab device [33]. However, the standard deviation of SpHb to Hb in our study was similar to that found for Hb measurements from consecutive blood samples analyzed on two separate laboratory devices [34].…”

Section: Discussionsupporting

confidence: 74%

Continuous And Noninvasive Hemoglobin Monitoring Reduces Red Blood Cell Transfusion During Neurosurgery: A Prospective Cohort Study

Awada

2013

Qatar Foundation Annual Research Forum Volume 2013 Issue 1

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Continuous, noninvasive hemoglobin (SpHb) monitoring provides clinicians with the trending of changes in hemoglobin, which has the potential to alter red blood cell transfusion decision making. The objective of this study was to evaluate the impact of SpHb monitoring on blood transfusions in high blood loss surgery. In this prospective cohort study, eligible patients scheduled for neurosurgery were enrolled into either a Control Group or an intervention group (SpHb Group). The Control Group received intraoperative hemoglobin monitoring by intermittent blood sampling when there was an estimated 15 % blood loss. If the laboratory value indicated a hemoglobin level of B10 g/dL, a red blood cell transfusion was started and continued until the estimated blood loss was replaced and a laboratory hemoglobin value was [l0 g/dL. In the SpHb Group patients were monitored with a Radical-7Pulse CO-Oximeter for continuous noninvasive hemoglobin values. Transfusion was started when the SpHb value fell to Bl0 g/dL and was continued until the SpHb was Cl0 g/dL. Blood samples were taken pre and post transfusion. Percent of patients transfused, average amount of blood transfused in those who received transfusions and the delay time from the hemoglobin reading of \10 g/dL to the start of transfusion (transfusion delay) were compared between groups. The trending ability of SpHb, and the bias and precision of SpHb compared to the laboratory hemoglobin were calculated. Compared to the Control Group, the SpHb Group had fewer units of blood transfused (1.0 vs 1.9 units for all patients; p B 0.001, and 2.3 vs 3.9 units in patients receiving transfusions; p B 0.0 l), fewer patients receiving [3 units (32 vs 73 %; p B 0.01) and a shorter time to transfusion after the need was established (9.2 ± 1.7 vs 50.2 ± 7.9 min; p B 0.00 l). The absolute accuracy of SpHb was 0.0 ± 0.8 g/dL and trend accuracy yielded a coefficient of determination of 0.93. Adding SpHb monitoring to standard of care blood management resulted in decreased blood utilization in high blood loss neurosurgery, while facilitating earlier transfusions.

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Section: Discussionsupporting

confidence: 74%

Continuous And Noninvasive Hemoglobin Monitoring Reduces Red Blood Cell Transfusion During Neurosurgery: A Prospective Cohort Study

Awada

2013

Qatar Foundation Annual Research Forum Volume 2013 Issue 1

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“…Several physiologic variables such as body position, blood source (e.g., arterial vs. peripheral venous), and time may influence the accuracy of tHb. [13][14][15] To eliminate some of these variables, we used the same sampling site (radial artery), time, and body position (prone) in all patients. The overall variability for the measurement of tHb in our Medical Center's central laboratory is consistently small (coefficient of variation: 0.8%-1.0%).…”

Section: Discussionmentioning

confidence: 99%

“…The overall variability for the measurement of tHb in our Medical Center's central laboratory is consistently small (coefficient of variation: 0.8%-1.0%). 13 Hospitals are required to intermittently confirm the variability of their measurement techniques.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Three Methods of Hemoglobin Monitoring in Patients Undergoing Spine Surgery

Miller¹,

Ward²,

Shiboski

et al. 2011

Anesthesia &Amp; Analgesia

135

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“…First, tHb was measured using an automated gas analyser in the haematology laboratory to provide the reference haemoglobin values. Gehring et al [9] have reported significant intra-device and inter-device variation; therefore, it is important to remember that the reference device also has inherent errors. Second, although an important feature of SpHb is that it is non-invasive, our in-vivo adjustment method requires an invasive blood sample.…”

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confidence: 99%

Improved non-invasive total haemoglobin measurements after in-vivo adjustment

et al. 2014

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SummaryWe hypothesised that an in-vivo adjustment method and/or a newer sensor would increase the accuracy of non-invasive and continuous haemoglobin monitoring (SpHb) measurements. Two sensors, the R1-25 and R2-25a (the newer version), were used with laboratory total haemoglobin concentration (tHb) values simultaneously recorded. In-vivo adjusted SpHb (AdHb) was calculated by a simple formula: AdHb = SpHb À (1 st SpHb À 1 st tHb). The correlation coefficients between SpHb (or AdHb) and tHb were compared: SpHb in both sensors correlated strongly with tHb (p < 0.0001). In-vivo adjustment improved the correlation coefficient between SpHb and tHb from 0.86 to 0.95 for the R1-25 and from 0.83 to 0.93 for the R2-25a. There was no difference between the R1-25 and R2-25a sensors. The in vivo adjustment method improved the accuracy of SpHb measurements in both sensors.

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Hemoximetry as the “Gold Standard”? Error Assessment Based on Differences Among Identical Blood Gas Analyzer Devices of Five Manufacturers

Abstract: The variance of sO2 measurements between identical devices increased significantly when saturation decreased from the normal level of 97% to the hypoxemic levels of 85% and 75%.

Cited by 39 publications

References 10 publications

Continuous And Noninvasive Hemoglobin Monitoring Reduces Red Blood Cell Transfusion During Neurosurgery: A Prospective Cohort Study

Continuous And Noninvasive Hemoglobin Monitoring Reduces Red Blood Cell Transfusion During Neurosurgery: A Prospective Cohort Study

A Comparison of Three Methods of Hemoglobin Monitoring in Patients Undergoing Spine Surgery

Improved non-invasive total haemoglobin measurements after in-vivo adjustment

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