Preliminary Study On The Application Of Noninvasive Continuous Hemoglobin Monitoring In ICU Patients With Severe Trauma

Objective:To explore the value of continuous monitoring of non-invasive hemoglobin in patients with severe trauma in ICU.Methods:A prospective observational study.From November 2014 to November 2015,patients with severe trauma in an emergency Intensive Care Unit(ICU)of a general hospital needed transfusion of erythrocyte suspension who were selected as the subjects.Hemoglobin(SpHb)levels were monitored by a non-invasive hemoglobin monitor.The non-invasive hemoglobin values were recorded eight times every 15 minutes before and half an hour after the transfusion.Total hemoglobin(tHb)was measured before and half an hour after transfusion.Bland-Altman diagram consistency test was used to compare the correlation between non-invasive hemoglobin continuous monitoring results and traditional test results.Bilirubin,creatinine,blood glucose,body temperature,heart rate,blood pressure,oxygen saturation,peripheral perfusion index(PI)and perfusion variability index(PVI)were included as covariates,and by multivariate linear regression analysisthe factors affecting the consistency of the two methods were compared.Results:(1)Seventy-five subjects were enrolled in the study cycle,including 45 males(60%)with an average age of(54±17)years.In the causes of injury,traffic accident injuries accounted for 48%,height injuries accounted for 44%,and others accounted for 8%.The major sites of trauma were chest,head,pelvic limbs and abdomen in turn.The average injury severity score(ISS)was 23.5±7.1 and the average erythrocyte suspension infusion volume was(1.82±0.38)units.(2)The tHb measured by traditional method before blood transfusion in 75 traumatic patients was(6.36±0.47)g/dL,and was(7.38±0.54)g/dL 30 minutes after blood transfusion.The value of non-invasive hemoglobin SpHb increased gradually during transfusion(F=14.487,p<0.01).The monitoring value of hemoglobin SpHb 30 minutes after transfusion node was equivalent to that of tHb(t=-1.189,p=0.246).After repeated analysis of variance,there was no significant difference between non-invasive monitoring of SpHb and traditional monitoring of tHb(F=0.4965,p=0.485).(3)Bland-Altman diagram showed that the results of non-invasive monitoring of SpHb were in good agreement with those traditional measurement of blood tHb.(4)Multivariate linear regression analysis showed that the beneficial factors affecting the results of non-invasive monitoring and traditional hemoglobin measurement were initial blood glucose(B=-0.038,p=0.03),pre-transfusion temperature(B=-0.152,p=0.023),and the risk factors were pre-transfusion PVI(B=0.012,p=0.019).Conclusion:Non-invasive hemoglobin continuous monitoring technology can accurately reflect the changes of hemoglobin in patients with severe trauma during blood transfusion.It has the advantage of real-time and dynamic monitoring,and may be of better significance in acute traumatic hemorrhage.It is worth further study.