Trending, Accuracy, and Precision of Noninvasive Hemoglobin Monitoring During Human Hemorrhage and Fixed Crystalloid Bolus

Nicole Ribeiro Marques, George Kramer, Richard Benjamin Voigt, Michael G. Salter, Michael Kinsky

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

BACKGROUND: Automated critical care systems for enroute care will rely heavily on noninvasive continuous monitoring. It has been reported that noninvasive assessment of blood hemoglobin via CO-oximetry (SpHb) assessed by spot measurements lacks sufficient accuracy for clinical decision making in trauma patients. However the precision and utility of trending of continuous hemoglobin has not been evaluated in hemorrhaging humans. This study measured the trending and concordance of SpHb changes during dynamic variations resulting from controlled hemorrhage with concomitant fluid infusion.

METHODS: With IRB approval and informed consent, 12 healthy volunteers under general anesthesia were subjected to hemorrhage (10 ml/kg over 15 minutes) accompanied by lactated Ringer`s infusion (30 ml/kg over 20 minutes). SpHb was measured continuously by the Masimo Radical-7, while total hemoglobin (tHb) was measured by arterial blood sampling.

RESULTS: Trend analysis, assessed by plots of SpHb over time of 12 subjects, shows consistent falls in SpHb during hemodilution without exception. Four-quadrant concordance analysis was 95.4% with an exclusion zone of 1 g/dl. Spot comparisons of 106 data pairs (SpHb and tHb) showed that 50% exhibited error > 1g/dl with bias of 1.08 ± 0.82 g/dl, 95% LOA -0.5; 2.6.

CONCLUSION: Both trend analysis and concordance analysis suggest high precision of pulse CO-oximetry during hemodilution by hemorrhage and fluid bolus in human volunteers. However, accuracy was similar to other studies and therefore the use of pulse CO-oximetry alone is likely insufficient to make transfusion decisions.

Original languageEnglish (US)
JournalShock
DOIs
StateAccepted/In press - Dec 18 2014

Fingerprint

Oximetry
Hemoglobins
Carbon Monoxide
Hemorrhage
Hemodilution
Research Ethics Committees
Critical Care
Informed Consent
General Anesthesia
Volunteers
Healthy Volunteers
crystalloid solutions
Wounds and Injuries

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine

Cite this

Trending, Accuracy, and Precision of Noninvasive Hemoglobin Monitoring During Human Hemorrhage and Fixed Crystalloid Bolus. / Marques, Nicole Ribeiro; Kramer, George; Voigt, Richard Benjamin; Salter, Michael G.; Kinsky, Michael.

In: Shock, 18.12.2014.

Research output: Contribution to journalArticle

@article{c12d3b5945c24fb79d6c6afb12b4f771,
title = "Trending, Accuracy, and Precision of Noninvasive Hemoglobin Monitoring During Human Hemorrhage and Fixed Crystalloid Bolus",
abstract = "BACKGROUND: Automated critical care systems for enroute care will rely heavily on noninvasive continuous monitoring. It has been reported that noninvasive assessment of blood hemoglobin via CO-oximetry (SpHb) assessed by spot measurements lacks sufficient accuracy for clinical decision making in trauma patients. However the precision and utility of trending of continuous hemoglobin has not been evaluated in hemorrhaging humans. This study measured the trending and concordance of SpHb changes during dynamic variations resulting from controlled hemorrhage with concomitant fluid infusion.METHODS: With IRB approval and informed consent, 12 healthy volunteers under general anesthesia were subjected to hemorrhage (10 ml/kg over 15 minutes) accompanied by lactated Ringer`s infusion (30 ml/kg over 20 minutes). SpHb was measured continuously by the Masimo Radical-7, while total hemoglobin (tHb) was measured by arterial blood sampling.RESULTS: Trend analysis, assessed by plots of SpHb over time of 12 subjects, shows consistent falls in SpHb during hemodilution without exception. Four-quadrant concordance analysis was 95.4{\%} with an exclusion zone of 1 g/dl. Spot comparisons of 106 data pairs (SpHb and tHb) showed that 50{\%} exhibited error > 1g/dl with bias of 1.08 ± 0.82 g/dl, 95{\%} LOA -0.5; 2.6.CONCLUSION: Both trend analysis and concordance analysis suggest high precision of pulse CO-oximetry during hemodilution by hemorrhage and fluid bolus in human volunteers. However, accuracy was similar to other studies and therefore the use of pulse CO-oximetry alone is likely insufficient to make transfusion decisions.",
author = "Marques, {Nicole Ribeiro} and George Kramer and Voigt, {Richard Benjamin} and Salter, {Michael G.} and Michael Kinsky",
year = "2014",
month = "12",
day = "18",
doi = "10.1097/SHK.0000000000000310",
language = "English (US)",
journal = "Shock",
issn = "1073-2322",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Trending, Accuracy, and Precision of Noninvasive Hemoglobin Monitoring During Human Hemorrhage and Fixed Crystalloid Bolus

AU - Marques, Nicole Ribeiro

AU - Kramer, George

AU - Voigt, Richard Benjamin

AU - Salter, Michael G.

AU - Kinsky, Michael

PY - 2014/12/18

Y1 - 2014/12/18

N2 - BACKGROUND: Automated critical care systems for enroute care will rely heavily on noninvasive continuous monitoring. It has been reported that noninvasive assessment of blood hemoglobin via CO-oximetry (SpHb) assessed by spot measurements lacks sufficient accuracy for clinical decision making in trauma patients. However the precision and utility of trending of continuous hemoglobin has not been evaluated in hemorrhaging humans. This study measured the trending and concordance of SpHb changes during dynamic variations resulting from controlled hemorrhage with concomitant fluid infusion.METHODS: With IRB approval and informed consent, 12 healthy volunteers under general anesthesia were subjected to hemorrhage (10 ml/kg over 15 minutes) accompanied by lactated Ringer`s infusion (30 ml/kg over 20 minutes). SpHb was measured continuously by the Masimo Radical-7, while total hemoglobin (tHb) was measured by arterial blood sampling.RESULTS: Trend analysis, assessed by plots of SpHb over time of 12 subjects, shows consistent falls in SpHb during hemodilution without exception. Four-quadrant concordance analysis was 95.4% with an exclusion zone of 1 g/dl. Spot comparisons of 106 data pairs (SpHb and tHb) showed that 50% exhibited error > 1g/dl with bias of 1.08 ± 0.82 g/dl, 95% LOA -0.5; 2.6.CONCLUSION: Both trend analysis and concordance analysis suggest high precision of pulse CO-oximetry during hemodilution by hemorrhage and fluid bolus in human volunteers. However, accuracy was similar to other studies and therefore the use of pulse CO-oximetry alone is likely insufficient to make transfusion decisions.

AB - BACKGROUND: Automated critical care systems for enroute care will rely heavily on noninvasive continuous monitoring. It has been reported that noninvasive assessment of blood hemoglobin via CO-oximetry (SpHb) assessed by spot measurements lacks sufficient accuracy for clinical decision making in trauma patients. However the precision and utility of trending of continuous hemoglobin has not been evaluated in hemorrhaging humans. This study measured the trending and concordance of SpHb changes during dynamic variations resulting from controlled hemorrhage with concomitant fluid infusion.METHODS: With IRB approval and informed consent, 12 healthy volunteers under general anesthesia were subjected to hemorrhage (10 ml/kg over 15 minutes) accompanied by lactated Ringer`s infusion (30 ml/kg over 20 minutes). SpHb was measured continuously by the Masimo Radical-7, while total hemoglobin (tHb) was measured by arterial blood sampling.RESULTS: Trend analysis, assessed by plots of SpHb over time of 12 subjects, shows consistent falls in SpHb during hemodilution without exception. Four-quadrant concordance analysis was 95.4% with an exclusion zone of 1 g/dl. Spot comparisons of 106 data pairs (SpHb and tHb) showed that 50% exhibited error > 1g/dl with bias of 1.08 ± 0.82 g/dl, 95% LOA -0.5; 2.6.CONCLUSION: Both trend analysis and concordance analysis suggest high precision of pulse CO-oximetry during hemodilution by hemorrhage and fluid bolus in human volunteers. However, accuracy was similar to other studies and therefore the use of pulse CO-oximetry alone is likely insufficient to make transfusion decisions.

UR - http://www.scopus.com/inward/record.url?scp=84919623331&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84919623331&partnerID=8YFLogxK

U2 - 10.1097/SHK.0000000000000310

DO - 10.1097/SHK.0000000000000310

M3 - Article

JO - Shock

JF - Shock

SN - 1073-2322

ER -