Hemorrhage
Conditions
Brief summary
The purpose of this study is to determine whether Noninvasive and Continuous Hemoglobin Monitoring (NACHO) for Surgical Blood Management affects transfusion decision making algorithm in the operating room.
Detailed description
Blood transfusions are associated with various risks including viral infections, delayed wound healing, transfusion related acute lung injury and cardiovascular complications. Despite limitations, and ongoing efforts to identify and validate other more-physiologically-relevant triggers for blood transfusions, hemoglobin-based transfusion triggers are still commonly used in practice, as well as in all currently available transfusion guidelines, alone, or in combination with other parameters. In the operating room the anesthesiologist has to withdraw blood from the patient and send it to the lab or the blood gas machine to achieve hemoglobin levels. It may be suggested that the ability to continuously monitor hemoglobin levels may help physicians to take more appropriate transfusion decisions; i.e, the physicians will either identify critical decreases in hemoglobin levels earlier and respond appropriately or avoid over-transfusing when hemoglobin levels have not decreased yet. Accordingly, monitors of hemoglobin levels are used in the operating theatre in many centers, although their blood-conserving effect has not been proven yet. We believe that the transfusion decision making algorithm in the operating room relies less heavily on on spot measures of hemoglobin levels but rather on patient's comorbidities, expected additional bleeding according to the surgery and the surgeon, the course of the operation (the operating field is open and thus surgeons can tell if it is oozing or frank bleeding, if they can control bleeding promptly or not etc..), hemodynamic data available from the different invasive and non-invasive monitors, pressure from the surgeon, etc. It is therefore suggested that continuous monitoring of hemoglobin levels may be less relevant in this environment. Specific Aims/Hypothesis: 1. The primary hypothesis is that continuous noninvasive hemoglobin monitoring will not reduce the number of blood transfusions in patients undergoing surgeries associated with a significant risk of bleeding. 2. The secondary hypothesis is that in patients monitored with continuous noninvasive hemoglobin, there will not be earlier warning of critical drops in hemoglobin, resulting in less frequent complications compared with patients who are not being monitored with continuous noninvasive hemoglobin.
Interventions
None listed
Sponsors
Tel-Aviv Sourasky Medical Center
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Anesthesiologists Eligibility Criteria Inclusion Criteria: * Consenting anesthesiologist * Anticipate to manage at least 10 cases per month * At least 3-year post-graduate clinical experience as an anesthesiologist responsible for making transfusion decisions for individual patients
Exclusion criteria
* Not meeting the appropriate licensing requirements * No being board-certified in Anesthesiology * Inability or unwillingness to complete study-related procedures, including undergoing training with regards to using and interpreting the monitor data in the operating room 2. Eligible patients under the case of the consenting eligible Anesthesiologist. Inclusion criteria: 150 Adult patients undergoing major surgeries associated with possibility of significant blood loss (e.g. such that blood is cross-matched and available before the start of the case as per hospital routine practice). * Consenting patients who are primarily managed by the consenting anesthesiologists participating in the study * At least one finger available and accessible for performing non-invasive hemoglobin monitoring.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of allogeneic Red Blood Cells (RBC) units transfused intraoperatively | perioperative period untill the end of surgery |
Secondary
| Measure | Time frame |
|---|---|
| Hospital stay treatment - Occurrence of any allogeneic RBC transfusions intraoperatively | From end of surgery until 30 days after surgery |
| Hospital stay treatment - Total number of allogeneic RBC units transfused perioperatively during hospital stay | From end of surgery until 30 days after surgery |
| Hospital stay treatment - Incidence of new (or worsening of pre-existing) ischemic events | From end of surgery until 30 days after surgery |
| Hospital stay treatment - 30-day mortality | From end of surgery until 30 days after surgery |
| Hospital stay treatment - Length of post-surgery hospital stay | From end of surgery until 30 days after surgery |
Countries
Israel
Contacts
Primary ContactIdit Matot, Professor
Outcome results
None listed