Trending, accuracy, and precision of noninvasive hemoglobin monitoring during human hemorrhage and fixed crystalloid bolus

Automated critical care systems for en route 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 have 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. With institutional review board approval and informed consent, 12 healthy volunteers under general anesthesia were subjected to hemorrhage (10 mL/kg for 15 min) accompanied by Ringer's lactate solution infusion (30 mL/kg for 20 min). The SpHb was measured continuously by the Masimo Radical-7, whereas total blood hemoglobin was measured by arterial blood sampling. Trend analysis, assessed by plots of SpHb against 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 total blood hemoglobin) showed that 50% exhibited an error of more than 1 g/dL with bias of 1.08 T 0.82 g/dL and 95% limits of agreement of -0.5 to 2.6. 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.