Central European Annals of Clinical Research

(ISSN: 2668-7305) Open Access Journal
CEACR 2019, 1(1), 2; doi: 10.35995/xx.xx.ceacr.ceacr1010002

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

1 AORN dei Colli, Anaesthesia and Intensive Care Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy; (A.R.); (M.C.); (R.A.); (A.C.)
2 AORN Cardarelli, Anaesthesia and Intensive Care, Via Antonio Cardarelli, 80131 Naples, Italy;
* Corresponding author:
* Author to whom correspondence should be addressed.
Received: 25 Nov 2019 / Revised: 26 Nov 2019 / Accepted: 2019-11-26 / Published: 2019-12-02
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ABSTRACT

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.
Keywords: haemoglobin; noninvasive monitoring; trend analysis; aortic surgery; goal-directed therapy
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
CITE
De Rosa, R.C.; Romanelli, A.; Calabria, M.; Abbate, R.; Montesano, R.; Corcione, A. Continuous Noninvasive Haemoglobin Monitoring in Vascular Surgery within the Goal-Directed Therapy Protocol. CEACR 2019, 1, 2.
De Rosa RC, Romanelli A, Calabria M, Abbate R, Montesano R, Corcione A. Continuous Noninvasive Haemoglobin Monitoring in Vascular Surgery within the Goal-Directed Therapy Protocol. Central European Annals of Clinical Research. 2019; 1(1):2.
De Rosa, Rosanna Carmela; Romanelli, Antonio; Calabria, Mariangela; Abbate, Roberta; Montesano, Raffaele; Corcione, Antonio. 2019. "Continuous Noninvasive Haemoglobin Monitoring in Vascular Surgery within the Goal-Directed Therapy Protocol." CEACR 1, no. 1: 2.
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