Division of Maternal Fetal Medicine, Women & Infants Hospital of Rhode Island, Providence, RI, USA.
Alpert Medical School of Brown University, Providence, RI, USA.
J Perinat Med. 2023 May 9;51(8):997-1005. doi: 10.1515/jpm-2023-0101. Print 2023 Oct 26.
During obstetric hemorrhage, peripheral vasoconstriction maintains heart rate and blood pressure until compensatory mechanisms are overwhelmed and patients deteriorate rapidly. Real-time perfusion measurements could quantify vasoconstriction, improving early recognition of hemorrhage and facilitating early intervention to reduce morbidity and mortality. The AccuFlow device makes rapid, non-invasive, quantitative measurements of perfusion, but has not been studied for hemorrhage detection or used in surgical settings. This study evaluated feasibility, tolerability, and preliminary efficacy of the AccuFlow for assessment of blood loss at cesarean delivery (CD).
In this pilot study, sensors were applied to the wrist, forearm, bicep, and chest wall of 25 patients undergoing scheduled CD. Postoperatively, sensors were removed and patients rated the AccuFlow and the standard anesthesia monitoring equipment on a validated comfort rating scale for wearable computers (CRS). Blood loss was estimated by the surgical team (EBL) and calculated from change in hematocrit, weight, and height (CBL). CRS scores were compared via Wilcoxon signed ranks tests. Coefficients of correlation between sensor readings and CBL, and between EBL and CBL, were compared using Fisher's R-to-z transformation.
There were no safety events; no participants requested device removal. CRS ratings of the AccuFlow and the standard monitoring equipment were similar (7.2 vs. 8.8, p=0.25). Change in wrist perfusion from delivery to dressing placement was more strongly correlated with CBL than was EBL (R=-0.48 vs. R=0.087, p=0.03).
The AccuFlow sensor is well-tolerated and shows promise in detecting intrapartum hemorrhage, though larger studies are needed.
在产科出血期间，外周血管收缩维持心率和血压，直到代偿机制被克服，患者迅速恶化。实时灌注测量可以量化血管收缩，提高对出血的早期认识，并促进早期干预，以降低发病率和死亡率。AccuFlow 设备可快速、无创、定量地测量灌注，但尚未用于出血检测或手术环境中。本研究评估了 AccuFlow 在剖宫产术中评估失血量的可行性、耐受性和初步疗效。
在这项初步研究中，传感器被应用于 25 名接受择期剖宫产的患者的手腕、前臂、二头肌和胸壁。术后，传感器被移除，患者使用可穿戴计算机的验证舒适度评分量表（CRS）对 AccuFlow 和标准麻醉监测设备进行评分。手术团队（EBL）估计失血量，并通过血细胞比容、体重和身高的变化（CBL）计算失血量。通过 Wilcoxon 符号秩检验比较 CRS 评分。使用 Fisher's R-to-z 变换比较传感器读数与 CBL 之间，以及 EBL 与 CBL 之间的相关系数。
没有发生安全事件；没有参与者要求移除设备。AccuFlow 和标准监测设备的 CRS 评分相似（7.2 与 8.8，p=0.25）。从分娩到敷裹过程中腕部灌注的变化与 CBL 的相关性强于与 EBL 的相关性（R=-0.48 与 R=0.087，p=0.03）。
AccuFlow 传感器耐受性良好，在检测产时出血方面具有潜力，但需要更大的研究。
