Noninvasive Continuous Hemoglobin Monitoring in Combat Casualties: A Pilot Study
Elizabeth Bridges1, Jennifer J Hatzfeld
1*Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle, Washington†Defense Medical Research and Development Program Combat Casualty Care, Research (MRMC-RTC), Fort Detrick, Maryland.
Shock (Augusta, Ga.)
|August 9, 2016
Summary
Noninvasive hemoglobin measurement (SpHb) in combat casualties is not precise enough for sole transfusion decisions. Further research is needed to assess its utility for monitoring hemoglobin trends or early deterioration detection.
Area of Science:
- Trauma and Emergency Medicine
- Medical Device Technology
- Critical Care Monitoring
Background:
- Accurate hemoglobin (Hb) monitoring is crucial for managing seriously injured casualties.
- Noninvasive hemoglobin measurement (SpHb) offers a potential alternative to traditional laboratory methods.
- Assessing SpHb accuracy and its ability to trend Hb levels in combat trauma is vital.
Purpose of the Study:
- To evaluate the accuracy and precision of SpHb against laboratory/point-of-care Hb measurements.
- To determine the capability of SpHb to track hemoglobin trends in severely injured combat casualties.
- To compare SpHb performance with established thresholds for clinical decision-making.
Main Methods:
- An observational study was conducted on combat casualties at two military trauma hospitals.
- SpHb was measured using the Masimo Rainbow SET Pulse CO-Oximeter.
- Simultaneous invasive Hb measurements were analyzed using Coulter or iStat analyzers for comparison.
Main Results:
- A total of 49 SpHb-Hb pairs were analyzed from 23 patients.
- The bias between SpHb and Hb was 0.3 ± 1.6 g/dL, with wide limits of agreement (-2.4, 3.4 g/dL).
- SpHb showed moderate performance for detecting changes >1 g/dL (sensitivity 61%, specificity 85%).
Conclusions:
- Continuous SpHb is currently not precise enough to be the sole transfusion trigger in trauma patients.
- Further investigation is required to ascertain SpHb's utility for trending Hb or as an early warning system in combat casualties.
- The study highlights the need for more research into SpHb's role in critical care settings.
