Helmer Philipp, Steinisch Andreas, Hottenrott Sebastian, Schlesinger Tobias, Sammeth Michael, Meybohm Patrick, Kranke Peter
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany.
Department of Anaesthesiology and Intensive Care, BG Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany.
Diagnostics (Basel). 2025 Jan 8;15(2):128. doi: 10.3390/diagnostics15020128.
: Hemoglobin (Hb) is a crucial parameter in perioperative care due to its essential role for oxygen transport and tissue oxygenation. Accurate Hb monitoring allows for timely interventions to address perioperative anemia and, thus, prevent morbidity and mortality. Traditional Hb measurements rely on invasive blood sampling, which significantly contributes to iatrogenic anemia and poses discomfort and increased infection risks. The advent of non-invasive devices like Masimo's Rad-67™, which measures Hb using pulse CO-oximetry (SpHb), offers a promising alternative. This study evaluates the accuracy of SpHb compared to clinical standard blood gas analysis (BGA) in perioperative patients. : This retrospective study analyzed 335 paired Hb measurements with an interval <15 min between SpHb and BGA in the operating theater and post-anesthesia care unit of a university hospital. Patients experiencing hemodynamic instability, acute bleeding, or critical care were excluded. Statistical analysis included Bland-Altman plots and Pearson correlation coefficients (PCCs) to assess the agreement between SpHb and BGA. Potential confounders, e.g., patient age, skin temperature, sex, perfusion index (PI), and atrial fibrillation, were also analyzed. : The bias of the SpHb compared to BGA according to Bland-Altman was 0.00 g/dL, with limits of agreement ranging from -2.70 to 2.45 g/dL. A strong correlation was observed ( = 0.79). Overall, 57.6% of the paired measurements showed a deviation between the two methods of ≤±1 g/dL; however, this applied to only 33.3% of the anemic patients. Modified Clark's Error Grid analysis showed 85.4% of values fell within clinically acceptable limits. Sex was found to have a statistically significant, but not clinically relevant, effect on accuracy ( = 0.02). : The Rad-67 demonstrates reasonable accuracy for non-invasive SpHb, but exhibits significant discrepancies in anemic patients with overestimating low values. While it offers potential for reducing iatrogenic blood loss, SpHb so far should not replace BGA in critical clinical decision-making.
血红蛋白（Hb）在围手术期护理中是一个关键参数，因为它在氧运输和组织氧合方面起着至关重要的作用。准确的Hb监测有助于及时干预以解决围手术期贫血问题，从而预防发病和死亡。传统的Hb测量依赖于侵入性采血，这会显著导致医源性贫血，并带来不适和增加感染风险。像Masimo的Rad - 67™这样的非侵入性设备的出现，它使用脉搏碳氧血红蛋白测定法（SpHb）来测量Hb，提供了一个有前景的替代方法。本研究评估了围手术期患者中SpHb与临床标准血气分析（BGA）相比的准确性。 这项回顾性研究分析了大学医院手术室和麻醉后护理单元中335对Hb测量值，SpHb和BGA之间的间隔<15分钟。排除血流动力学不稳定、急性出血或重症监护患者。统计分析包括Bland - Altman图和Pearson相关系数（PCCs），以评估SpHb和BGA之间的一致性。还分析了潜在的混杂因素，如患者年龄、皮肤温度、性别、灌注指数（PI）和心房颤动。 根据Bland - Altman分析，SpHb与BGA相比的偏差为0.00 g/dL，一致性界限为-2.70至2.45 g/dL。观察到强相关性（= 0.79）。总体而言，57.6%的配对测量显示两种方法之间的偏差≤±1 g/dL；然而，这仅适用于33.3%的贫血患者。改良的Clark误差网格分析显示85.4%的值落在临床可接受范围内。发现性别对准确性有统计学上显著但临床无关的影响（= 0.02）。 Rad - 67在非侵入性SpHb方面显示出合理的准确性，但在贫血患者中对低值有显著高估的差异。虽然它有减少医源性失血的潜力，但到目前为止，在关键的临床决策中SpHb不应取代BGA。
