Document Detail


Precision of noninvasive hemoglobin-level measurement by pulse co-oximetry in patients admitted to intensive care units for severe gastrointestinal bleeds.
MedLine Citation:
PMID:  22732278     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Measurement of total hemoglobin, based on pulse co-oximetry, is a continuous and noninvasive method that has been principally evaluated in healthy volunteers subjected to hemodilution. We tested the hypothesis that its accuracy could adversely affect patients presenting with severe hemorrhage, which is traditionally associated with increased microvascular tone.
DESIGN: Observational study.
SETTING: Twelve-bed mixed medico-surgical intensive care unit.
PATIENTS: Thirty-three patients admitted to our critical care unit for gastrointestinal bleeds were included.
INTERVENTIONS: A spectrophotometric sensor was positioned on the patient's fingertip and connected to a pulse co-oximeter. During the first 24 hrs following admission, venous hemoglobin level was determined at the laboratory every 8 hrs and was compared with hemoglobin levels displayed on the pulse co-oximeter measurements screen and/or measured from capillary blood using a portable photometer.
MEASUREMENTS AND MAIN RESULTS: The primary end point was the percentage of inaccurate measurements, which were defined as >15% difference compared with reference values or their unavailability for any technical reason. Twenty-five (19%) measurements of pulse co-oximeter measurements were unavailable from the screen. Pulse co-oximeter measurements and capillary hemoglobin levels were significantly correlated to venous hemoglobin level. For venous hemoglobin level compared with pulse co-oximeter measurements (n = 105), and for venous hemoglobin level compared with capillary hemoglobin levels (n = 111), the biases were, respectively, 1.0 ± 1.9 g dL and 0.4 ± 1.0 g dL (p < .05). The proportion of inaccurate measurements was significantly higher for pulse co-oximeter measurements (56% vs. 15%, p < .05). Although the use of norepinephrine did not affect concordance parameters, unavailability of measurements was frequently observed (42% vs. 15%, p < .05).
CONCLUSIONS: Determination of pulse co-oximetry-based hemoglobin in patients presenting with severe gastrointestinal bleeds can be inaccurate, which renders its use to guide transfusion decisions potentially hazardous. The unavailability of measurements, especially during vasopressor infusion, represents another serious limitation for hemorrhagic patients.
Authors:
Julien Coquin; Antoine Dewitte; Yannick Le Manach; Marie Caujolle; Olivier Joannes-Boyau; Catherine Fleureau; Gérard Janvier; Alexandre Ouattara
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  40     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-20     Completed Date:  2012-11-28     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2576-82     Citation Subset:  AIM; IM    
Affiliation:
CHU de Bordeaux, Service d'Anesthésie-Réanimation II, Bordeaux, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Blood Transfusion / methods,  statistics & numerical data
Cohort Studies
Critical Care / methods
Critical Illness / mortality,  therapy
Decision Making
Female
Follow-Up Studies
France
Gastrointestinal Hemorrhage / diagnosis*,  mortality,  therapy
Hemoglobinometry / methods
Hemoglobins / analysis*
Humans
Intensive Care Units*
Male
Middle Aged
Monitoring, Physiologic / instrumentation
Needs Assessment
Oximetry / methods*
Patient Admission / statistics & numerical data
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Spectrophotometry / methods
Survival Rate
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Hemoglobins
Comments/Corrections
Comment In:
Crit Care Med. 2013 May;41(5):e52   [PMID:  23591235 ]
Crit Care Med. 2013 May;41(5):e53   [PMID:  23591236 ]
Crit Care Med. 2012 Sep;40(9):2715-6   [PMID:  22903096 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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