Without SpHb, clinicians are often limited to invasive blood samples, which provide intermittent and delayed laboratory hemoglobin results
SpHb can be used in conjunction with traditional laboratory methods to obtain real-time visibility to changes, or lack of changes, in hemoglobin between invasive blood samples
SpHb trend monitoring may provide additional insight between invasive blood samples when:
SpHb was retrospectively obtained for the surgical case shown to the left, in which clinicians could not assess the hemoglobin trend between invasive blood samples during the procedure.1
Studies have shown that SpHb may help clinicians reduce blood transfusions in both low- and high-blood-loss surgeries.2,3
A randomized trial of 327 patients undergoing elective orthopedic surgery, conducted at Massachusetts General Hospital (MGH), found that the use of continuous, noninvasive hemoglobin monitoring reduced the rate of transfusions when compared to standard care without continuous, noninvasive hemoglobin monitoring.2
A prospective cohort study of 106 neurosurgical patients found that adding SpHb monitoring to standard-of-care blood management resulted in decreased blood utilization in high-blood-loss neurosurgery, while also facilitating earlier transfusions.3*
Clinical decisions regarding red blood cell transfusions should be based on the clinician’s judgment considering among other factors: patient condition, continuous SpHb monitoring, and laboratory diagnostic tests using blood samples.
* Study Protocol: The transfusion threshold of 10g/dL was predetermined by the study protocol and may not be appropriate for all patients. The blood sampling technique was the same for patients in both the control and the test group. Arterial blood was drawn from a 20 gauge radial artery cannula into 2mL ethylenediaminetetraacetic acid collection tubes, thoroughly mixed then sent immediately to the central lab for analysis by a hematology analyzer. The reference laboratory device used for hemoglobin measurements in the study was a Coulter GEN-S Hematology Analyzer.
Provided alongside SpHb on rainbow® Pulse CO-Oximetry sensors, Pleth Variability Index (PVi) provides a continuous noninvasive measure of the relative variability in the photoplethysmograph (pleth) during respiratory cycles that may be used as a dynamic indicator of fluid responsiveness in select populations of mechanically ventilated adult patients.4 The following hepatic surgery case depicts the effect of dilution on total hemoglobin upon the infusion of 2.5L of crystalloid.5
A single-center quality initiative involving 18,716 patients in the OR, ICU, and PACU was implemented in Limoges, France. The study used a Goal-directed Therapy (GDT) protocol with PVi in conjunction with a blood transfusion protocol based on SpHb. Results demonstrated that monitoring with SpHb and PVi integrated in a vascular filling algorithm was associated with earlier transfusion and reduced 30- and 90-day mortality by 33% and 29%, respectively, on a whole hospital scale.6
Monitoring hemoglobin continuously and noninvasively through different care areas
Masimo rainbow SET is a noninvasive monitoring platform featuring Masimo SET® Measure-through Motion and Low Perfusion™ pulse oximetry with the option to measure multiple additional parameters.
Peiris P. et al. Proceeding for the Society for the Advancement of Blood Medicine 2010 Annual Meeting. Abs 4091.
Ehrenfeld et al. J Blood Disorders Transf. 2014. 5:9.
Awada WN et al. J Clin Monit Comput. DOI 10.1007/s10877-015-9660-4.
Cannesson et al. J Cardiothorac Vas Anes. 2010.
Perel. Critical Care. 2017;21:291.
Cros et al. J Clin Monit Comput. Aug 2019:1-9. Study utilized a goal-directed fluid therapy protocol with PVi® in conjunction with a blood transfusion protocol based on SpHb.
Clinical decisions regarding red blood cell transfusions should be based on the clinician’s judgment considering among other factors: patient condition, continuous SpHb monitoring, and laboratory diagnostic tests using blood samples. SpHb monitoring is not intended to replace laboratory blood testing.
The accuracy of PVi in predicting fluid responsiveness is variable and influenced by numerous patient, procedure, and device-related factors. PVi measures the variation in the plethysmography amplitude but does not provide measurements of stroke volume or cardiac output. Fluid management decisions should be based on a complete assessment of the patient’s condition and should not be based solely on PVi.
Caution: Federal (USA) law restricts this device to sale by or on the order of a physician. See instructions for use for full prescribing information, including indications, contraindications, warnings, and precautions.
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