Accuracy of Determining Hemoglobin Level Using Occlusion Spectroscopy in Patients with Severe Gastrointestinal Bleeding
Accuracy of Determining Hemoglobin Level Using Occlusion Spectroscopy in Patients with Severe Gastrointestinal Bleeding
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DOI：
10.1097/aln.0b013e3182833fcc
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发表时间：
2013-03-01
期刊：
影响因子：
8.8
通讯作者：
Ouattara, Alexandre
中科院分区：
文献类型：
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作者：
Coquin, Julien;Bertarrex, Amandine;Ouattara, Alexandre
背景：在出现严重出血的患者中，作者进行了一项等效试验，比较了无创闭塞光谱法和毛细血管血法来确定血红蛋白水平。方法：这项前瞻性观察性研究包括因胃肠道出血而入住重症监护室的患者。连接到 NBM-200MP（OrSense r，Nes Ziona，以色列）的环形传感器安装在患者的拇指上，以间歇性测量血红蛋白 (So t Hb)。入院后 24 小时内，每 8 小时在实验室测定一次静脉血红蛋白水平（被视为参考方法），并与 So t Hb 和毛细血管血法进行比较。主要终点是不准确测量的比例，定义为与参考值相比差异大于 15% 或由于任何技术原因无法获得。结果：该研究原定包括 68 名患者，但在对 34 名患者进行中期分析后提前停止。不准确的比例表明，So t Hb 不能被视为等同于毛细血管血法（47% [95% CI, 43-51] 和 24% [95% CI, 2028]）。考虑静脉血红蛋白水平作为参考方法，So t Hb (n = 133) 和毛细血管血方法 (n = 135) 的平均偏差分别为 -0.4 +/- 2.0 和 0.8 +/- 1.2 g/dl (P < 0.05)。因此，t Hb 与输血失败发生率增加相关。在接受血管加压药物的患者中，So t Hb 的不准确性往往会增加。结论：基于闭塞光谱的无创测定血红蛋白水平对于严重消化道出血的患者缺乏准确性，不能被认为与基于毛细血管的方法等效。这种不准确性似乎受到血管加压剂输注的适度影响。
Background: In patients presenting with severe hemorrhage, the authors conducted an equivalence trial that compared noninvasive occlusion spectroscopy and the capillary blood method to determine hemoglobin level.Methods: This prospective observational study included patients admitted to their intensive care unit for gastrointestinal bleeding. A ring-shaped sensor, connected to a NBM-200MP (OrSense r, Nes Ziona, Israel), was fitted onto the patient's thumb to intermittently measure hemoglobin (So t Hb). During the first 24 h after admission, venous hemoglobin level, considered as the reference method, was determined at the laboratory every 8 h and was compared to So t Hb and the capillary blood method. The primary endpoint was the proportion of inaccurate measurements, defined as greater than 15% difference compared with reference values or their unavailability for any technical reason.Results: The study was scheduled to include 68 patients but was stopped prematurely after an interim analysis of 34 patients. The proportion of inaccuracies revealed that So t Hb could not be considered equivalent to the capillary blood method (47% [95% CI, 43-51] and 24% [95% CI, 2028]). Considering venous hemoglobin level as a reference method, the mean biases for So t Hb (n = 133) and the capillary blood method (n = 135) were, respectively, -0.4 +/- 2.0 and 0.8 +/- 1.2 g/dl (P < 0.05). So t Hb was associated with an increased incidence of failed transfusion. The inaccuracy of So t Hb tended to be increased in patients receiving vasopressor agents.Conclusions: Noninvasive determination of hemoglobin level based on occlusion spectroscopy lacks accuracy in patients presenting with severe gastrointestinal bleeding and cannot be considered equivalent to the capillary-based method. This inaccuracy seems to be moderately influenced by the infusion of vasopressor agents.