Noninvasive, Continuous Hemoglobin Monitoring Helps Clinicians Better Manage Perioperative Bleeding

Referencing studies using technologies such as Masimo SpHb from Masimo (Irvine, CA, USA), the guidelines note that “the use of noninvasive Hb-monitoring methods may be a practical approach to monitor[ing] the Hb concentration continuously and without accumulating additional blood losses.”

The ESAIC which revisits its perioperative blood management guidelines once every five years has published its updated findings based on its systematic review of research published from 2015 to 2021. Noting that managing bleeding during surgery is complex and “involves multiple assessment tools and strategies to ensure optimal patient care,” the guidelines cover various modalities, disciplines, scenarios, and patient populations – including how noninvasive, continuous hemoglobin monitoring can significantly improve blood management.

The ESAIC’s updated guidelines point to a major drawback in using blood gas analyzers and invasive blood sampling to measure hemoglobin during surgery: “single measurements taken at different time points may not depict accurate values.” They also note that excess blood sampling can result in iatrogenic blood loss and hospital-acquired anemia. Noninvasive hemoglobin monitoring cannot replace invasive blood sampling, but provides a “practical approach to monitor[ing] the Hb concentration continuously and without accumulating additional blood losses.” The guidelines also note its importance “for trend analysis and to monitor changes in addition to laboratory-measured Hb concentrations during the intervals between invasive blood sampling and Hb measurements.” The guidelines continue, “Having access to continuous measurements of Hb concentrations offers timely detection of changes in Hb concentrations and adjustment, if necessary, in the clinical setting.” Additionally, the guidelines note that when severe bleeding and volume shifts are expected or occurring, “continuous noninvasive hemoglobin monitoring may be considered for trend analyses and for reducing blood sampling for invasive laboratory measurement of hemoglobin concentration, especially in children.”

The Masimo SpHb uses multiple wavelengths of light to continuously monitor changes in the hemoglobin trend between invasive blood samples in real-time. This advanced technology has proven beneficial in patient blood management programs, enhancing outcomes in both high- and low-blood loss surgeries such as decreasing the number of patients requiring allogeneic transfusions, reducing the total units of red blood cells transfused per patient, and decreasing the time to transfusion, reducing costs, and lowering patient mortality within 30 and 90 days after surgery by 33% and 29%, respectively when combined with a goal-directed fluid therapy algorithm using Masimo PVi.

“Noninvasive hemoglobin measurements now represent standard of care in many clinical scenarios,” said Professor Kai Zacharowski, past President of ESAIC and senior author of the guidelines. “With their inclusion in the latest perioperative bleeding guidelines, we hope that more anesthesiologists around the world incorporate this technology into their daily practice to help improve overall patient blood management.”

“With laboratory measurements, and even with bedside point-of-care hemoglobin testing, results are intermittent, sampling errors can occur, and performing these tests can be distracting during complex cases and while caring for critically ill patients,” added Dr. William C. Wilson, Chief Medical Officer, Masimo. “SpHb monitoring provides real-time visibility to hemoglobin levels throughout the continuum of care and has the advantages of trend analysis as well as reductions in workload and delay, enabling clinicians to adjust blood management and observe results simultaneously.”

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